Rising Medicare Spending for End-of-Life Care Brings Patients’ Wishes into Focus


A new report that shows ever-growing Medicare spending for chronically ill patients in the last two years of life can serve as a reminder for hospitalists to properly gauge patients’ wishes for end-of-life care, one of the authors says.

The brief from the Dartmouth Atlas Project [PDF] shows that from 2007 to 2010, average spending per patient in the last two years of life increased 15.2% to $69,947, and average spending in the last six months of life rose 13.4% to $36,392.

During the same three-year period, patients in their last six months of life were less likely to be hospitalized and logged more time in hospice care—21 days versus 18.3 days—reflecting the wishes of most patients to spend their last days in a homelike environment, the report notes. Accordingly, chronically ill Medicare patients were less likely to die in the hospital by the end of the study period.

David Goodman, MD, MS, co-principal investigator for Dartmouth Atlas of Health Care, says the growing use of hospice care and decreased hospitalization stays “aligns more closely with patients’ preferences.”

“The focus really needs to be on better diagnosis of patients’ preferences to reduce what has been well-documented as overutilization from the patient’s perspective,” Dr. Goodman says.

While costs and trends vary widely among regions and health-care systems, Dr. Goodman attributes the differences to local supplies of hospital beds and practice styles. For example, in regions with more beds, patients are more likely to spend time in the hospital near the end of life, he says. “There is definitely a national trend away from hospital care near the end of life,” he adds. “But that rate of change varies a lot from place to place. It’s helpful for hospitalists to understand where they fit on the spectrum.”

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