Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare

Yamini Kalidindi, Joel Segel, Jeah Jung

Research output: Contribution to journalArticle

Abstract

Objectives: To compare patterns and understand drivers of spending and utilization by month in the last 6 months of life between patients with lung cancer who used hospice versus those who did not. Study Design: Retrospective cohort analysis using 2009 to 2013 Medicare claims. Methods: We used a 10% random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013 (43 789 beneficiaries). Patients were assigned to 2 groups depending on whether they used hospice care in the last 6 months of life. The following outcomes were constructed by month: (1) all-cause Medicare spending, (2) indicator of hospitalization, (3) indicator of emergency department (ED) visit, (4) number of part B chemotherapy claims, and (5) number of radiation therapy sessions. We used a combination of propensity score matching and regression analysis to compare outcomes between the 2 groups. Results: Patients who used hospice had significantly lower spending in the last month of life compared to nonusers (US$16 907 vs US$26 906, P <.00). The spending differences in the last month of life between the 2 groups were largely driven by lower likelihood of hospitalization (54% vs 80%, P <.01) and ED visits (15% vs 22%, P <.01) and fewer chemotherapy (0.12 vs 0.32, P <.01) and radiation therapy sessions (0.80 vs 1.26, P <.01). During the other months in the 6-month period, spending was similar between the 2 groups. Conclusions: Timely hospice enrollment of patients with lung cancer—the group suffering from high morbidity and mortality among patients with cancer—may lead to significant cost savings.

Original languageEnglish (US)
JournalAmerican Journal of Hospice and Palliative Medicine
DOIs
StateAccepted/In press - Jan 1 2019

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Hospices
Medicare
Lung Neoplasms
Hospital Emergency Service
Hospitalization
Radiotherapy
Hospice Care
Drug Therapy
Fee-for-Service Plans
Propensity Score
Cost Savings
Cohort Studies
Retrospective Studies
Regression Analysis
Morbidity
Lung
Mortality

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

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title = "Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare",
abstract = "Objectives: To compare patterns and understand drivers of spending and utilization by month in the last 6 months of life between patients with lung cancer who used hospice versus those who did not. Study Design: Retrospective cohort analysis using 2009 to 2013 Medicare claims. Methods: We used a 10{\%} random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013 (43 789 beneficiaries). Patients were assigned to 2 groups depending on whether they used hospice care in the last 6 months of life. The following outcomes were constructed by month: (1) all-cause Medicare spending, (2) indicator of hospitalization, (3) indicator of emergency department (ED) visit, (4) number of part B chemotherapy claims, and (5) number of radiation therapy sessions. We used a combination of propensity score matching and regression analysis to compare outcomes between the 2 groups. Results: Patients who used hospice had significantly lower spending in the last month of life compared to nonusers (US$16 907 vs US$26 906, P <.00). The spending differences in the last month of life between the 2 groups were largely driven by lower likelihood of hospitalization (54{\%} vs 80{\%}, P <.01) and ED visits (15{\%} vs 22{\%}, P <.01) and fewer chemotherapy (0.12 vs 0.32, P <.01) and radiation therapy sessions (0.80 vs 1.26, P <.01). During the other months in the 6-month period, spending was similar between the 2 groups. Conclusions: Timely hospice enrollment of patients with lung cancer—the group suffering from high morbidity and mortality among patients with cancer—may lead to significant cost savings.",
author = "Yamini Kalidindi and Joel Segel and Jeah Jung",
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AU - Segel, Joel

AU - Jung, Jeah

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N2 - Objectives: To compare patterns and understand drivers of spending and utilization by month in the last 6 months of life between patients with lung cancer who used hospice versus those who did not. Study Design: Retrospective cohort analysis using 2009 to 2013 Medicare claims. Methods: We used a 10% random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013 (43 789 beneficiaries). Patients were assigned to 2 groups depending on whether they used hospice care in the last 6 months of life. The following outcomes were constructed by month: (1) all-cause Medicare spending, (2) indicator of hospitalization, (3) indicator of emergency department (ED) visit, (4) number of part B chemotherapy claims, and (5) number of radiation therapy sessions. We used a combination of propensity score matching and regression analysis to compare outcomes between the 2 groups. Results: Patients who used hospice had significantly lower spending in the last month of life compared to nonusers (US$16 907 vs US$26 906, P <.00). The spending differences in the last month of life between the 2 groups were largely driven by lower likelihood of hospitalization (54% vs 80%, P <.01) and ED visits (15% vs 22%, P <.01) and fewer chemotherapy (0.12 vs 0.32, P <.01) and radiation therapy sessions (0.80 vs 1.26, P <.01). During the other months in the 6-month period, spending was similar between the 2 groups. Conclusions: Timely hospice enrollment of patients with lung cancer—the group suffering from high morbidity and mortality among patients with cancer—may lead to significant cost savings.

AB - Objectives: To compare patterns and understand drivers of spending and utilization by month in the last 6 months of life between patients with lung cancer who used hospice versus those who did not. Study Design: Retrospective cohort analysis using 2009 to 2013 Medicare claims. Methods: We used a 10% random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013 (43 789 beneficiaries). Patients were assigned to 2 groups depending on whether they used hospice care in the last 6 months of life. The following outcomes were constructed by month: (1) all-cause Medicare spending, (2) indicator of hospitalization, (3) indicator of emergency department (ED) visit, (4) number of part B chemotherapy claims, and (5) number of radiation therapy sessions. We used a combination of propensity score matching and regression analysis to compare outcomes between the 2 groups. Results: Patients who used hospice had significantly lower spending in the last month of life compared to nonusers (US$16 907 vs US$26 906, P <.00). The spending differences in the last month of life between the 2 groups were largely driven by lower likelihood of hospitalization (54% vs 80%, P <.01) and ED visits (15% vs 22%, P <.01) and fewer chemotherapy (0.12 vs 0.32, P <.01) and radiation therapy sessions (0.80 vs 1.26, P <.01). During the other months in the 6-month period, spending was similar between the 2 groups. Conclusions: Timely hospice enrollment of patients with lung cancer—the group suffering from high morbidity and mortality among patients with cancer—may lead to significant cost savings.

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