Hospice Use And End-Of-Life Spending Trajectories In Medicare Beneficiaries On Hemodialysis.
Publication Title
Health affairs (Project Hope)
Document Type
Article
Publication Date
6-1-2018
Keywords
Cost of Health Care; dialysis; end-of-life; hospice; trajectory
Abstract
Infrequent and late referral to hospice among patients on dialysis likely reflects the impact of a Medicare payment policy that discourages the concurrent receipt of these services, but it may also reflect these patients' less predictable illness trajectories. Among a national cohort of patients on hemodialysis, we identified four distinct spending trajectories during the last year of life that represented markedly different intensities of care. Within the cohort, 9 percent had escalating spending and 13 percent had persistently high spending throughout the last year of life, while 41 percent had relatively low spending with late escalation, and 37 percent had moderate spending with late escalation. Across the four groups, the percentages of patients enrolled in hospice at the time of death were uniformly low ranging from only 19 percent of those with persistently high costs to 21 percent of those with moderate costs and the median number of days spent in hospice during the last year of life was virtually the same (either five or six days). These findings signal the need for greater flexibility in the provision of end-of-life care in this population.
Area of Special Interest
Kidney & Diabetes
Specialty/Research Institute
Nursing
Specialty/Research Institute
Nephrology
Specialty/Research Institute
Palliative Care
