Changes in Medicare Costs with the Growth of Hospice Care in Nursing Homes
Open accessAbstract
BACKGROUND: Nursing home residents' use of hospice has substantially increased. Whether this increase in hospice use reduces end-of-life expenditures is unknown. METHODS: The expansion of hospice between 2004 and 2009 created a natural experiment, allowing us to conduct a difference-in-differences matched analysis to examine changes in Medicare expenditures in the last year of life that were associated with this expansion. We also assessed intensive care unit (ICU) use in the last 30 days of life and, for patients with advanced dementia, feeding-tube use and hospital transfers within the last 90 days of life. We compared a subset of hospice users from 2009, whose use of hospice was attributed to hospice expansion, with a matched subset of non-hospice users from 2004, who were considered likely to have used hospice had they died in 2009. RESULTS: Of 786,328 nursing home decedents, 27.6% in 2004 and 39.8% in 2009 elected to use hospice. The 2004 and 2009 matched hospice and nonhospice cohorts were similar (mean age, 85 years; 35% male; 25% with cancer). The increase in hospice use was associated with significant decreases in the rates of hospital transfers (2.4 percentage-point reduction), feeding-tube use (1.2 percentage-point reduction), and ICU use (7.1 percentage-point reduction). The mean length of stay in hospice increased from 72.1 days in 2004 to 92.6 days in 2009. Between 2004 and 2009, the expansion of hospice was associated with a mean net increase in Medicare expenditures of $6,761 (95% confidence interval, 6,335 to 7,186), reflecting greater additional spending on hospice care ($10,191) than reduced spending on hospital and other care ($3,430). CONCLUSIONS: The growth in hospice care for nursing home residents was associated with less aggressive care near death but at an overall increase in Medicare expenditures. (Funded by the Centers for Medicare and Medicaid Services and the National Institute on Aging.).
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Expansion of hospice care is associated with fewer individuals with dementia having more than two hospitalizations for any reason or more than one hospitalization for pneumonia, urinary tract infection, dehydration or sepsis in the last 90 days of life.
“Expansion of hospice care is associated with fewer individuals with dementia having more than two hospitalizations for any reason or more than one hospitalization for pneumonia, urinary tract infection, dehydration or sepsis in the last 90 days of life.775”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [775]
The Methods (Outcomes) define “burdensome transitions” using the hospitalization thresholds in the claim, and the Results (Changes in the Aggressiveness of End-of-Life Care) report a reduction in that outcome among hospice users. The finding applies specifically to nursing home decedents with advanced dementia, not to all individuals with dementia. (LLM, conf=0.88)
Experimental — accuracy not yet measuredExpansion of hospice care is associated with fewer individuals with dementia having more than two hospitalizations for any reason or more than one hospitalization for pneumonia, urinary tract infection, dehydration or sepsis in the last 90 days of life.
“Expansion of hospice care is associated with fewer individuals with dementia having more than two hospitalizations for any reason or more than one hospitalization for pneumonia, urinary tract infection, dehydration or sepsis in the last 90 days of life. 933”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [933]
The Results section reports fewer burdensome transitions in the last 90 days of life among hospice users with advanced dementia. The Methods section defines those transitions using the hospitalization thresholds in the claim. The finding concerns nursing home decedents with advanced dementia, not individuals with dementia generally. (LLM, conf=0.88)
Experimental — accuracy not yet measuredWith the expansion of Medicare-supported hospice care, the use of feeding tubes in the last three to six months of life has decreased for individuals with Alzheimer's or other dementias.
“With the expansion of Medicare‐supported hospice care, the use of feeding tubes in the last three to six months of life has decreased for individuals with Alzheimer's or other dementias. 928 , 933”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [933]
The Results section reports a 1.2-percentage-point decrease in feeding-tube insertions associated with hospice use among nursing home residents with advanced dementia in the last 90 days of life. The claim extends this finding to people with Alzheimer's or other dementias generally and to a three-to-six-month period; the paper's reported measure covers only the last three months. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Austin, P. C. (2009) · Statistics in Medicine · doi:10.1002/sim.3697 · Cited by 6,758 · see citing works
Inference with Difference-in-Differences and Other Panel Data
Donald, S. G., & Lang, K. (2007) · Review of Economics and Statistics · doi:10.1162/rest.89.2.221 · Cited by 1,324 · see citing works
Normand, S., Landrum, M., Guadagnoli, E., Ayanian, J. Z., Ryan, T. J., Cleary, P., & McNeil, B. J. (2001) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00321-8 · Cited by 1,256 · see citing works
End-of-Life Transitions among Nursing Home Residents with Cognitive Issues
Gozalo, P., Teno, J. M., Mitchell, S. L., Skinner, J., Bynum, J., Tyler, D., & Mor, V. (2011) · New England Journal of Medicine · doi:10.1056/nejmsa1100347 · Cited by 484 · see citing works
Self-citationLong‐Term Trends in Medicare Payments in the Last Year of Life
Riley, G. F., & Lubitz, J. D. (2010) · Health Services Research · doi:10.1111/j.1475-6773.2010.01082.x · Cited by 443 · see citing works
Reducing Health Care Costs by Reducing the Need and Demand for Medical Services
Fries, J. F., Koop, C. E., Beadle, C. E., Cooper, P. P., England, M. J., Greaves, R. F., Sokolov, J. J., & Wright, D. (1993) · New England Journal of Medicine · doi:10.1056/nejm199307293290506 · Cited by 404 · see citing works
Cost Savings at the End of Life
Emanuel, E. (1996) · JAMA · doi:10.1001/jama.1996.03530480049040 · Cited by 279 · see citing works
Mitchell, S. L., Miller, S. C., Teno, J. M., Kiely, D. K., Davis, R. B., & Shaffer, M. L. (2010) · JAMA · doi:10.1001/jama.2010.1572 · Cited by 249 · see citing works
Self-citationAdjusting capitation rates using objective health measures and prior utilization.
Newhouse, J. P., Manning, W. G., Keeler, E. B., & Sloss, E. M. (1989) · PubMed Central · Cited by 243 · see citing works
Does Receipt of Hospice Care in Nursing Homes Improve the Management of Pain at the End of Life?
Miller, S. C., Mor, V., Wu, N., Gozalo, P. L., & Lapane, K. L. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50118.x · Cited by 240 · see citing works
Self-citationKelley, A. S., Deb, P., Du, Q., Carlson, M. D. A., & Morrison, R. S. (2013) · Health Affairs · doi:10.1377/hlthaff.2012.0851 · Cited by 231 · see citing works
Taylor, D. H., Ostermann, J., Houtven, C. H. V., Tulsky, J. A., & Steinhauser, K. E. (2007) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.05.028 · Cited by 208 · see citing works
Families' Perception of the Added Value of Hospice in the Nursing Home
Baer, W. M., & Hanson, L. C. (2000) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2000.tb06883.x · Cited by 166 · see citing works
Medicare Program Expenditures Associated with Hospice Use
Campbell, D. E., Lynn, J., Louis, T. A., & Shugarman, L. R. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-4-200402170-00009 · Cited by 132 · see citing works
Does Hospice Improve Quality of Care for Persons Dying from Dementia?
Teno, J. M., Gozalo, P. L., Lee, I. C., Kuo, S., Spence, C., Connor, S. R., & Casarett, D. (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03505.x · Cited by 113 · see citing works
Self-citationThe Growth of Hospice Care in U.S. Nursing Homes
Miller, S. C., Lima, J. C., Gozalo, P. L., & Mor, V. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02968.x · Cited by 101 · see citing works
Self-citationRationing, Patient Preferences, and Cost of Care at the End of Life
SINGER, P. A. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.1992.00400150012003 · Cited by 74 · see citing works
Cost savings at the end of life. What do the data show?
Emanuel, E. J. (1996) · JAMA · doi:10.1001/jama.275.24.1907 · Cited by 69 · see citing works
Hospice Effect on Government Expenditures among Nursing Home Residents
Gozalo, P. L., Miller, S. C., Intrator, O. K., Barber, J. P., & Mor, V. (2007) · Health Services Research · doi:10.1111/j.1475-6773.2007.00746.x · Cited by 58 · see citing works
Self-citationRationing, patient preferences, and cost of care at the end of life
Singer, P. A. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.152.3.478 · Cited by 13 · see citing works
Differences in Patient Demographics and Expenditures Among Medicare Hospice Providers
Banaszak‐Holl, J., & Mor, V. (1996) · The Hospice Journal · doi:10.1080/0742-969x.1996.11882824 · Cited by 13 · see citing works
Self-citationDifferences in Patient Demographics and Expenditures Among Medicare Hospice Providers
Banaszak‐Holl, J. (1996) · The Hospice Journal · doi:10.1300/j011v11n03_01 · Cited by 7 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
2016 Alzheimer's disease facts and figures
Alzheimer's Association (2016) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2016.03.001 · Cited by 5,069 · see citing works
2023 Alzheimer's disease facts and figures
(2023) · Alzheimer's & Dementia · doi:10.1002/alz.13016 · Cited by 3,212 · see citing works
2024 Alzheimer's disease facts and figures
(2024) · Alzheimer's & Dementia · doi:10.1002/alz.13809 · Cited by 2,536 · see citing works
2019 Alzheimer’s disease facts and figures.
Alzheimer's Association (2019) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2019.01.010 · Cited by 2,461 · see citing works
2022 Alzheimer's disease facts and figures
Anonymous (2022) · Alzheimer s & Dementia · doi:10.1002/alz.12638 · Cited by 2,384 · see citing works
2020 Alzheimer's disease facts and figures
(2020) · Alzheimer's & Dementia · doi:10.1002/alz.12068 · Cited by 2,353 · see citing works
2021 Alzheimer's disease facts and figures
Anonymous (2021) · Alzheimer s & Dementia · doi:10.1002/alz.12328 · Cited by 2,236 · see citing works
2018 Alzheimer's disease facts and figures
Alzheimer's Association (2018) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2018.02.001 · Cited by 1,912 · see citing works
2017 Alzheimer's disease facts and figures
(, T. D. B. T. A.-R. C. C. A. S. O. A. C. B. S., different, ). J. A. I. A., destroyed, S. A. T. A. S. T. M. E. T. M. C. I. S. I. A. G. W. A. T. R. N. I. T. O. B. T. F. N. T. B. D. A. D. A. U. I. B. R. I. I. F. N. M. A. N. I. O. P. O. T. B. A. D. A., difficulties, I. E. O., agitation, I. N. S. S. A., & delusions., S. A. (2017) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2017.02.001 · Cited by 1,322 · see citing works
2025 Alzheimer's disease facts and figures
(2025) · Alzheimer s & Dementia · doi:10.1002/alz.70235 · Cited by 569 · see citing works
Matching and Regression to the Mean in Difference‐in‐Differences Analysis
Daw, J. R., & Hatfield, L. A. (2018) · Health Services Research · doi:10.1111/1475-6773.12993 · Cited by 270 · see citing works
The Effects of Advance Care Planning Interventions on Nursing Home Residents: A Systematic Review
Martin, R. S., Hayes, B. J., Gregorevic, K. J., & Lim, W. K. (2016) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2015.12.017 · Cited by 268 · see citing works
Mues, K. E., Liede, A., Liu, J., Wetmore, J. B., Zaha, R. L., Bradbury, B. D., Collins, A. B., & Gilbertson, D. T. (2017) · Clinical Epidemiology · doi:10.2147/clep.s105613 · Cited by 248 · see citing works
Palliative care in patients with heart failure
McIlvennan, C. K., & Allen, L. A. (2016) · BMJ · doi:10.1136/bmj.i1010 · Cited by 189 · see citing works
Jordan, R. I., Allsop, M. J., ElMokhallalati, Y., Jackson, C., Edwards, H. L., Chapman, E., Deliëns, L., & Bennett, M. (2020) · BMC Medicine · doi:10.1186/s12916-020-01829-x · Cited by 188 · see citing works
End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported
French, E., McCauley, J., Aragón, M. J., Bakx, P., Chalkley, M., Chen, S. H., Christensen, B. J., Chuang, H., Côté‐Sergent, A., Nardi, M. D., et al. (2017) · Health Affairs · doi:10.1377/hlthaff.2017.0174 · Cited by 154 · see citing works
Miller, S. C., Lima, J. C., Intrator, O. K., Martin, E. W., Bull, J., & Hanson, L. C. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14469 · Cited by 125 · see citing works
Self-citationWachterman, M. W., Hailpern, S. M., Keating, N. L., Tamura, M. K., & O’Hare, A. M. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.0256 · Cited by 88 · see citing works
Bond, W. F., Kim, M., Franciskovich, C. M., Weinberg, J. E., Svendsen, J. D., Fehr, L. S., Funk, A., Sawicki, R., & Asche, C. V. (2017) · Journal of Palliative Medicine · doi:10.1089/jpm.2017.0566 · Cited by 81 · see citing works
Davis, M. A., Nallamothu, B. K., Banerjee, M., & Bynum, J. (2016) · Health Affairs · doi:10.1377/hlthaff.2015.1419 · Cited by 73 · see citing works
The rise of concurrent care for veterans with advanced cancer at the end of life
Mor, V., Joyce, N. R., Coté, D. L., Gidwani, R. A., Ersek, M. T., Levy, C. R., Faricy‐Anderson, K., Miller, S. C., Wagner, T. H., Kinosian, B. P., et al. (2015) · Cancer · doi:10.1002/cncr.29827 · Cited by 61 · see citing works
Self-citation2026 Alzheimer's disease facts and figures
(2026) · Alzheimer s & Dementia · doi:10.1002/alz.71345 · Cited by 61 · see citing works
Hospice Use, Hospitalization, and Medicare Spending at the End of Life
Zuckerman, R. B., Stearns, S. C., & Sheingold, S. H. (2015) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbv109 · Cited by 57 · see citing works
Regulating and Paying for Hospice and Palliative Care: Reflections on the Medicare Hospice Benefit
Mor, V., & Teno, J. M. (2016) · Journal of Health Politics Policy and Law · doi:10.1215/03616878-3620893 · Cited by 56 · see citing works
Self-citationPredicting Readmission at Early Hospitalization Using Electronic Clinical Data
Tabak, Y. P., Sun, X., Nuñez, C. M., Gupta, V., & Johannes, R. S. (2016) · Medical Care · doi:10.1097/mlr.0000000000000654 · Cited by 42 · see citing works
Matching the production of doctors with national needs
Gorman, D. F. (2017) · Medical Education · doi:10.1111/medu.13369 · Cited by 42 · see citing works
Amblàs-Novellas, J., Santaeugènia, S., Vela, E., Clèries, M., & Contel, J. C. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01587-8 · Cited by 36 · see citing works
End-of-Life Care Intensity and Hospice Use
Wang, S., Aldridge, M. D., Gross, C. P., Canavan, M., Cherlin, E. J., Johnson‐Hürzeler, R., & Bradley, E. H. (2016) · Medical Care · doi:10.1097/mlr.0000000000000547 · Cited by 34 · see citing works
Stewart, J. T., & Schultz, S. K. (2017) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2017.10.011 · Cited by 34 · see citing works
Miranda, R., Smets, T., Schreye, R. D., Faes, K., Noortgate, N. V. D., Cohen, J., & den Block, L. V. (2021) · Palliative Medicine · doi:10.1177/02692163211019321 · Cited by 30 · see citing works
Iyer, A. S., Goodrich, C. A., Dransfield, M. T., Alam, S. S., Brown, C. J., Landefeld, C. S., Bakitas, M. A., & Brown, J. R. (2019) · The American Journal of Medicine · doi:10.1016/j.amjmed.2019.11.024 · Cited by 29 · see citing works
Unroe, K. T., Bernard, B. L., Stump, T. E., Tu, W., & Callahan, C. M. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14826 · Cited by 28 · see citing works
Cultural Differences in Advance Care Planning and Implications for Practice
Ha, J., Lee, C., & Yoo, J. (2021) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228211029502 · Cited by 28 · see citing works
What Can Economics Say about Alzheimer’s Disease?
Chandra, A., Coile, C., & Mommaerts, C. (2023) · Journal of Economic Literature · doi:10.1257/jel.20211660 · Cited by 27 · see citing works
Leniz, J., Yi, D., Yorganci, E., Williamson, L. E., Suji, T., Cripps, R., Higginson, I. J., & Sleeman, K. E. (2021) · Alzheimer's & Dementia: Translational Research & Clinical Interventions · doi:10.1002/trc2.12198 · Cited by 24 · see citing works
von Gunten, C. F., Mullan, P. B., Nelesen, R. A., Garman, K., McNeal, H., Savoia, M. C., Muchmore, E. A., Ikeda, T., Amundson, S. A., McKennett, M., et al. (2016) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909116655767 · Cited by 21 · see citing works
Wang, J., Zhou, A., Peng, H., Zhu, N., Liu, Y., Zheng, X., Li, M., Xie, N., & Deng, R. (2023) · Annals of Palliative Medicine · doi:10.21037/apm-23-367 · Cited by 19 · see citing works
Palliative Care Consults in U.S. Nursing Homes: Not Just for the Dying
Lima, J. C., & Miller, S. C. (2017) · Journal of Palliative Medicine · doi:10.1089/jpm.2017.0099 · Cited by 19 · see citing works
Self-citationParackal, A., Ramamoorthi, K., & Tarride, J. (2021) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091211011138 · Cited by 18 · see citing works
Changes In End-Of-Life Care In The Medicare Shared Savings Program
Gilstrap, L. G., Huskamp, H. A., Stevenson, D. G., Chernew, M. E., Grabowski, D. C., & McWilliams, J. M. (2018) · Health Affairs · doi:10.1377/hlthaff.2018.0491 · Cited by 18 · see citing works
Cai, S., Miller, S. C., & Gozalo, P. L. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.10.020 · Cited by 17 · see citing works
Self-citationHashimie, J., Schultz, S. K., & Stewart, J. T. (2019) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2019.11.011 · Cited by 17 · see citing works
Factors associated with end‐of‐life by home‐visit nursing‐care providers in Japan
Nakanishi, M., Niimura, J., & Nishida, A. (2016) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.12822 · Cited by 17 · see citing works
Chu, C.-P., Huang, C.-Y., Kuo, C.-J., Chen, Y.-Y., Chen, C.-T., Yang, T.-W., & Liu, H.-C. (2020) · BMC Palliative Care · doi:10.1186/s12904-020-00627-9 · Cited by 16 · see citing works
Effect of Hospice Use on Costs of Care for Long‐Stay Nursing Home Decedents
Unroe, K. T., Sachs, G. A., Dennis, M. E., Hickman, S. E., Stump, T. E., Tu, W., & Callahan, C. M. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14070 · Cited by 16 · see citing works
End of life care in nursing homes: Translating focus group findings into action
Bükki, J., Neuhaus, P. M., & Paal, P. (2016) · Geriatric Nursing · doi:10.1016/j.gerinurse.2016.06.011 · Cited by 14 · see citing works
Wang, S., Hsu, S. H., Huang, S., Soulos, P. R., & Gross, C. P. (2017) · Health Affairs · doi:10.1377/hlthaff.2016.0683 · Cited by 13 · see citing works
Drageset, J., Eide, G. E., & Corbett, A. (2017) · Patient Related Outcome Measures · doi:10.2147/prom.s125500 · Cited by 13 · see citing works
Tracking hospital costs in the last year of life ― The Shanghai experience
Zhu, B., Li, F., Wang, C., Wang, L., He, Z., Zhang, X., Song, P., Ding, L., & Jin, C. (2018) · BioScience Trends · doi:10.5582/bst.2017.01245 · Cited by 13 · see citing works
Epidemiologic Study of Myasthenia Gravis in the Elderly US Population
Bruckman, D., Lee, I., Schold, J. D., Claytor, B., Silvestri, N. J., Hehir, M. K., & Li, Y. (2024) · Neurology · doi:10.1212/wnl.0000000000210005 · Cited by 12 · see citing works
Purchasing better, innovative and integrated health services
Gorman, D. F., & Horn, M. J. (2015) · Internal Medicine Journal · doi:10.1111/imj.12929 · Cited by 12 · see citing works
Intervenção em cuidados paliativos: conhecimento e percepção dos enfermeiros
da Silva, H. A., Viana, G. K. B., Lima, A. K. G., Mourão, C. M. L., & de Lima, A. L. A. (2018) · Revista de Enfermagem UFPE on line · doi:10.5205/1981-8963.2018.22653 · Cited by 12 · see citing works
Burke, R. E., Canamucio, A., Medvedeva, E. L., Hume, E. L., & Navathe, A. S. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.22382 · Cited by 12 · see citing works
End-of-life expenditure on health care for the older population: a scoping review
Kocot, E., Ferrero, A., Shrestha, S., & Dubas‐Jakóbczyk, K. (2024) · Health Economics Review · doi:10.1186/s13561-024-00493-8 · Cited by 11 · see citing works
Zhang, Y., Shao, H., Zhang, M., & Li, J. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08031-8 · Cited by 11 · see citing works
Effectiveness and cost-effectiveness of palliative care in natural experiments: a systematic review
Jiang, J., Kim, N., Garrido, M. M., Jacobson, M., Mockler, D., & May, P. (2023) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2022-003993 · Cited by 11 · see citing works
Gellert, P. R., Eggert, S., Zwillich, C., Hörter, S., Kuhlmey, A., & Dräger, D. (2018) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2018.02.010 · Cited by 11 · see citing works
Postacute Care Use and Outcomes Among Medicare Advantage vs Traditional Medicare Beneficiaries
Roy, I., Hutchins, F., Rose, L., Zhong, S., Patel, S. R., Kumar, A., Werner, R. M., & Burke, R. E. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.40347 · Cited by 10 · see citing works
Hung, P., Hsu, S. H., & Wang, S. (2020) · Value in Health · doi:10.1016/j.jval.2020.01.021 · Cited by 10 · see citing works
A Nurse Practitioner–Driven Palliative and Supportive Care Service in Nursing Homes
Carpenter, J. G., Murthi, J., Langford, M., & Lopez, R. P. (2024) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0000000000001028 · Cited by 10 · see citing works
Trends in Contracting and Common Ownership Between Hospice Agencies and Nursing Homes
Stevenson, D. G., Sinclair, N., Zhang, S., Meneades, L. M., & Huskamp, H. A. (2020) · Medical Care · doi:10.1097/mlr.0000000000001289 · Cited by 9 · see citing works
Predictors of Death in the Hospital for Patients with Chronic Serious Illness
Hicks, K. M., Downey, L., Engelberg, R. A., Fausto, J. A., Starks, H. E., Dunlap, B., Sibley, J., Lober, W. B., Khandelwal, N., Loggers, E. T., et al. (2018) · Journal of Palliative Medicine · doi:10.1089/jpm.2017.0127 · Cited by 9 · see citing works
Nursing Leadership and Palliative Care in Long-Term Care for Residents with Advanced Dementia
Lopez, R. P., Kris, A. E., & Rossmassler, S. C. (2022) · Nursing Clinics of North America · doi:10.1016/j.cnur.2022.02.006 · Cited by 9 · see citing works
Dying or Lying? For-Profit Hospices and End of Life Care
B, J. G. A., Howard, D., Leder-Luis, J., & Caputi, T. L. (2023) · National Bureau of Economic Research · doi:10.3386/w31035 · Cited by 9 · see citing works
Classifying End-of-Life Patterns: Evidence From the National Health and Aging Trends Study
Bhagianadh, D., & Arora, K. (2022) · The Gerontologist · doi:10.1093/geront/gnac160 · Cited by 8 · see citing works
Institutional Special Needs Plans and Hospice Enrollment in Nursing Homes: A National Analysis
Dhingra, L. K., Lipson, K., Dieckmann, N. F., Chen, J., Bookbinder, M., & Portenoy, R. K. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16103 · Cited by 7 · see citing works
Health Care Costs Associated With Hospice Use For People With Dementia In The US
Aldridge, M. D., Hunt, L. J., Harrison, K. L., McKendrick, K., Li, L., & Morrison, R. S. (2023) · Health Affairs · doi:10.1377/hlthaff.2023.00036 · Cited by 7 · see citing works
Linking Quality and Spending to Measure Value for People with Serious Illness
Ryan, A. M., & Rodgers, P. E. (2017) · Journal of Palliative Medicine · doi:10.1089/jpm.2017.0496 · Cited by 7 · see citing works
Targeting Enhanced Services Toward High-Cost, High-Need Medicare Patients
Dattalo, M., Nothelle, S. K., & Chapman, E. N. (2016) · Springer eBooks · doi:10.1007/978-3-319-28137-7_2 · Cited by 7 · see citing works
Investing in Better Care for Patients Dying in Nursing Homes
Hamel, M. B. (2015) · New England Journal of Medicine · doi:10.1056/nejme1502735 · Cited by 7 · see citing works
What Predicts Hospice Use in the Nursing Home?
Reinhardt, J. P. (2020) · Journal of Social Work in End-of-Life & Palliative Care · doi:10.1080/15524256.2020.1800553 · Cited by 6 · see citing works
Administrative Data for Research: An Increasingly Powerful Tool, but Still With Caveats
Sloane, P. D., Mor, V., & Preisser, J. S. (2018) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.11.015 · Cited by 6 · see citing works
Self-citationThe application of palliative care in dementia
Tajari, M., & Pandpazir, M. (2019) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_105_18 · Cited by 6 · see citing works
Drageset, J., & Eide, G. E. (2020) · SAGE Open Nursing · doi:10.1177/2377960820907778 · Cited by 5 · see citing works
What Can Economics Say About Alzheimer's Disease?
Chandra, A., Coile, C., & Mommaerts, C. (2020) · National Bureau of Economic Research · doi:10.3386/w27760 · Cited by 5 · see citing works
Lake, D. T., Kumar, S., Geng, F., & Gozalo, P. L. (2025) · Journal of the American Geriatrics Society · doi:10.1111/jgs.70164 · Cited by 4 · see citing works
Self-citationProportion of Decedents’ Expenditures Among Recent Reductions in Medicare Expenditures
Weeks, W. B., Kirkland, K. B., Freeh, C., & Weinstein, J. N. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.8213 · Cited by 4 · see citing works
A finest balancing score algorithm to avoid common pitfalls of propensity score matchingPreprint
Bestehorn, F., Bestehorn, M., Bestehorn, M., & Kirches, C. (2018) · arXiv (Cornell University) · Cited by 4 · see citing works
Dying or Lying? For-Profit Hospices and End-of-Life Care
B, J. G. A., Howard, D. H., Leder-Luis, J., & Caputi, T. L. (2024) · American Economic Review · doi:10.1257/aer.20230328 · Cited by 3 · see citing works
DeForge, C. E., Ma, H. S., Dick, A. W., Stone, P. W., Orewa, G. N., Dhingra, L. K., Portenoy, R. K., & Quigley, D. D. (2025) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091251313761 · Cited by 3 · see citing works
Causal inference with cross-temporal design
Cao, Y., Gozalo, P. L., & Gutman, R. (2025) · Biometrics · doi:10.1093/biomtc/ujae163 · Cited by 3 · see citing works
Self-citationTang, P.-U., Wu, I.-H., Lao, I.-H., Leong, W., & Hu, C. (2020) · Innovations in Digital Health Diagnostics and Biomarkers · doi:10.36401/iddb-20-04 · Cited by 3 · see citing works
The Medicare Hospice Benefit in Nursing Homes: Issues, Incentives, and Utilization
Stearns, S. C., Aykan, H., & Meier, D. E. (2018) · Public Policy & Aging Report · doi:10.1093/ppar/pry024 · Cited by 3 · see citing works
Taylor, R. A., Dionne-Odom, J. N., Currie, E. R., Stockdill, M., & Bakitas, M. A. (2019) · Oxford University Press eBooks · doi:10.1093/med/9780190862374.003.0055 · Cited by 3 · see citing works
How much end‐of‐life care is of low value
Scott, I. A. (2018) · Internal Medicine Journal · doi:10.1111/imj.14054 · Cited by 3 · see citing works
Survival Outcomes of Medicare‐Covered Elderly US Population With Myasthenia Gravis
Li, Y., Bruckman, D., Schold, J. D., Claytor, B., Silvestri, N. J., Hehir, M. K., & Lee, I. (2025) · Muscle & Nerve · doi:10.1002/mus.70045 · Cited by 2 · see citing works
Neuropalliative Care in Severe Acute Brain Injury and Stroke
Creutzfeldt, C. J. (2025) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/cont.0000000000001636 · Cited by 2 · see citing works
Patterns of Expenditure in Healthcare for Elderly in Shanghai
Zhu, B., Li, F., Wang, L., Chang-ying, W., & Chunlin, J. (2020) · China Report · doi:10.1177/0009445520930402 · Cited by 2 · see citing works
McGrath, L. B., & Goodlin, S. J. (2017) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-017-0530-0 · Cited by 2 · see citing works
Why Do Vote-by-Mail Elections Boost Voter Turnout?Preprint
Atsusaka, Y., Menger, A., & Stein, R. M. (2020) · SSRN Electronic Journal · doi:10.2139/ssrn.3722705 · Cited by 2 · see citing works
Reddy, A., Gunnink, E. J., Rojas, J., Nelson, K. N., & Wong, E. S. (2024) · Journal of General Internal Medicine · doi:10.1007/s11606-024-09169-9 · Cited by 1 · see citing works
Institutional Special Needs Plans and End-of-Life Outcomes for Nursing Home Residents With Dementia
White, E. M., Gozalo, P. L., Santostefano, C. M., Kosar, C. M., McGarry, B. E., Geng, F., Zorowitz, R. A., Grabowski, D. C., Mor, V., & Rahman, M. (2026) · JAMA Health Forum · doi:10.1001/jamahealthforum.2026.1649 · Cited by 1 · see citing works
Self-citationFactors of Hospitals Associated With an Independent Hospice Care Unit
Park, Y., Chang, H., & Shin, H. (2021) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0000000000000806 · Cited by 1 · see citing works
Palliative Care, Hospice Care, Advance Care Planning, and Advance Directives
Taylor, A. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803523-8.00004-6 · Cited by 1 · see citing works
Wang, L., & Nelson, J. W. (2019) · International Journal for Human Caring · doi:10.20467/1091-5710.23.4.275
Weeks, W. B., Cao, S. Y., Lester, C. M., & Weinstein, J. N. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.0861
Bestehorn, F., Bestehorn, M., & Kirches, C. (2021) · arXiv (Cornell University) · doi:10.48550/arxiv.2101.07029
Insurance Coverage for Pregnant Women: Assessing Patterns, Policy Impacts and Methods for Evaluation
Daw, J. R. (2018) · Digital Access to Scholarship at Harvard (DASH) (Harvard University)
Brownlee, S., & Lazris, A. (2016) · Cornell University Press eBooks · doi:10.1353/book.57722
- Authors
- Gozalo, P., Plotzke, M., Mor, V., Miller, S. C., & Teno, J. M.
- Affiliations
- Brown University (US)
- Schulman, Ronca & Bucuvalas (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2015-05-07
- Volume
- 372
- Issue
- 19
- Pages
- 1823-1831
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4465278
- OpenAlex
- W2139099731
- Cited by
- 117
- References
- 21
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 10 · 2023: 8 · 2022: 3 · 2021: 7 · 2020: 18 · 2019: 8 · 2018: 14 · 2017: 14 · 2016: 15 · 2015: 5
- FWCI
- 17.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (2p01ag027296-16)
- National Institute on Aging (AG027296, P01AG-027296)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- hospice care, nursing home residents, Medicare spending, end-of-life care, intensive care utilization, tube feeding, hospital transfer, advanced dementia, last year of life, natural experiment
- MeSH terms
- Aged, Aged, 80 and over, Health Expenditures, Female, Medicare, Humans, Male, Nursing Homes, Terminal Care, United States, Least-Squares Analysis, Health Care Costs, Hospice Care, Propensity Score
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
