Hospice Rates Rise, But Hospitalizations Remain High

Cheryl Clark, for HealthLeaders Media , February 16, 2011

Total costs to Medicare, not including costs patients paid out of pocket, went from $28,766 to $36,216. Risk-adjusted costs in this eight-year period increased 11%

Also, the researchers noted, that even though hospice services appear to be used much more, the use of other expensive services at the end of life remained high, "suggesting that the potential for hospice to prevent costly hospitalizations has yet to be fully realized. It remains unclear whether hospice services [are being used] as a complement to or a substitution for usual acute care."

The percentage of patients hospitalized in intensive care units went from 3.5 days to 4.6 days, which the authors described as significant.

The report shows that these patients continued to receive echocardiograms, stress tests, cardiac catheterizations, coronary artery bypass grafts, cardioverter-defibrillator implantations, pacemakers, and dialysis, although the percentages did not significantly increase except for echocardiograms, and fewer patients received bypass procedures.

In these eight years, the mean number of physician visits went from 7 per patient to 8.3, the number of days home health was used went from 53.2 to 58.6 and the cost for home health care went from $3,484 to $4,232.

In an editorial accompanying the Duke researchers' article, Rosemary Gibson, formerly the leader of the Robert Wood Johnson Foundation's strategy to improve end-of-life care, wrote that the number of palliative care programs in the U.S. in hospitals with 50 more beds increased from 658 in 2000 to 1,487 in 2008.

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