More Hospice in Nursing Homes, Associated Costs Are Up
(HealthDay News) — More nursing home residents are opting for hospice care, but at an overall increase in Medicare expenditures, according to a new study published in the May 7 issue of the New England Journal of Medicine.
Medicare costs for nursing home residents receiving hospice care increased an average of almost $6,800 per patient between 2004–2009, lead author Pedro Gozalo, PhD, a research associate professor of health services, policy, and practice at the Brown University School of Public Health in Providence, RI, told HealthDay. The increased cost is likely due to hospice care being provided to nursing home residents who are not as near death as initially suspected, Gozalo said.
Medicare initially created its hospice benefit in 1983, and expanded it in 2004 to reflect the growing acceptance of hospice care, Gozalo said. The benefit is paid as a flat per-day fee. Following the expansion, many more nursing home residents opted for hospice. Researchers found that by 2009, nearly 40% of nursing home residents who died had been receiving hospice care, as opposed to about 28% five years earlier.
A review of Medicare data for almost 800,000 nursing home residents who died in either 2004 or 2009 found that hospice care did significantly reduce a number of signs of aggressive-but-futile attempts to prolong life. Use of intensive care dropped by 7%, hospital transfers fell 2%, and feeding tube use declined by 1%. But the average length of stay in hospice increased by 28% during the same period of time, rising from 72 days in 2004 to nearly 93 days in 2009. Medicare ended up spending an additional $10,000 for each patient's hospice care. But Medicare only saved about $3,500 per patient. Those savings came from fewer hospitalizations, less need for skilled nursing facility care, and other areas of cost savings associated with hospice.