• Medical care · Nov 2011

    Hospice care and resource utilization in Medicare beneficiaries with heart failure.

    • Saul Blecker, Gerard F Anderson, Robert Herbert, Nae-Yuh Wang, and Frederick L Brancati.
    • Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. saul.blecker@nyumc.org
    • Med Care. 2011 Nov 1; 49 (11): 985-91.

    BackgroundAlthough hospice use may be increasing among heart failure patients, its association with both cost and intensity of care in this population has not been well examined.ObjectiveTo assess the association of hospice care with resource utilization among a national sample of Medicare beneficiaries with heart failure during the last 6 months of life.MethodsWe performed a cross-sectional analysis of the 5% sample of Medicare claims data. Negative binomial regression models were used to compare expenditures, hospitalization rates, and intensive care unit (ICU) days between hospice and nonhospice beneficiaries. We used Poisson regression models to compare utilization of certain procedures between hospice and nonhospice beneficiaries.ResultsAmong 16613 Medicare beneficiaries who died with heart failure in 2007, 6436 (38.7%) received hospice care during the last 6 months of life. The mean total medical expenditures were $31,793 (SD 25,691) among decedents with hospice care, in comparison to $34,067 (SD 40,561) among decedents without hospice care. However, after adjustments for covariates, hospice care was associated with 4% higher expenditures (cost ratio, 1.04; 95% confidence interval, CI: 1.01-1.07). Hospice use was associated with reduced hospitalizations (adjusted incidence rate ratio, 0.87, 95% CI: 0.84-0.89), ICU days (adjusted incidence rate ratio, 0.68, 95% CI: 0.63-0.73), and procedures, including cardiac catheterization, noninvasive ventilation, and mechanical ventilation.ConclusionsDespite lower rates of hospitalization, ICU days, and invasive procedures, hospice care was not associated with reduced expenditures in heart failure. Financial savings related to reduced intensive medical care seems to be offset by the expenditures related to hospice care itself.

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