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 language | English (US) |
|---|---|
| Journal | American Journal of Hospice and Palliative Medicine |
| DOIs | |
| State | Accepted/In press - Jan 1 2019 |
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All Science Journal Classification (ASJC) codes
- Medicine(all)
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Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare. / Kalidindi, Yamini; Segel, Joel; Jung, Jeah.
In: American Journal of Hospice and Palliative Medicine, 01.01.2019.Research output: Contribution to journal › Article
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
PY - 2019/1/1
Y1 - 2019/1/1
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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UR - http://www.scopus.com/inward/citedby.url?scp=85074028009&partnerID=8YFLogxK
U2 - 10.1177/1049909119878446
DO - 10.1177/1049909119878446
M3 - Article
C2 - 31564110
AN - SCOPUS:85074028009
JO - American Journal of Hospice and Palliative Medicine
JF - American Journal of Hospice and Palliative Medicine
SN - 1049-9091
ER -