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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.).
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“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]
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“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]
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“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]
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Metadata
- 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 › Medicine › Geriatrics and Gerontology › 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
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