TY - JOUR
T1 - Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare
AU - Kalidindi, Yamini
AU - Segel, Joel
AU - Jung, Jeah
N1 - Funding Information:
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. lung cancer Medicare cost impact of hospice end-of-life utilization trends length of hospice use monthly end-of-life costs National Institutes of Health http://dx.doi.org/10.13039/100000002 R24 HD041025 edited-state corrected-proof Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: NIH/NIA grant number 1R01AG047934-01, and NIH grant number R24 HD041025. ORCID iD Yamini Kalidindi https://orcid.org/0000-0002-2972-4569 Joel Segel https://orcid.org/0000-0001-8937-0531 Jeah Jung https://orcid.org/0000-0001-7574-0677
Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: NIH/NIA grant number 1R01AG047934-01, and NIH grant number R24 HD041025.
Publisher Copyright:
© The Author(s) 2019.
PY - 2020/4/1
Y1 - 2020/4/1
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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U2 - 10.1177/1049909119878446
DO - 10.1177/1049909119878446
M3 - Article
C2 - 31564110
AN - SCOPUS:85074028009
VL - 37
SP - 286
EP - 293
JO - American Journal of Hospice and Palliative Medicine
JF - American Journal of Hospice and Palliative Medicine
SN - 1049-9091
IS - 4
ER -