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Study looks at cost of death for Medicare enrollees

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Everyone dies, but the way Medicare enrollees use health care services in their last year of life varies widely.

Matthew Allen Davis, a researcher at the University of Michigan nursing school in Ann Arbor, Michigan, and three colleagues look at the health care claim patterns of Medicare enrollees who are near death in a paper published in Health Affairs.

Related: Talking about death and humanity

Health Affairs is an academic journal that covers health care finance and health care delivery systems.

Davis and his colleagues studied end-of-life spending patterns by analyzing the claims of older Medicare enrollees who died in 2012.

The researchers found that 49 percent spent a high amount throughout their last year of life, and 29 percent spent a moderate amount. Twelve percent spent a moderate amount but had a big increase in spending at the end.

About 10 percent had claims that rose steadily throughout the last year of life.

The patients with high persistent spending were more likely to use hospice care in their last year of life and more likely to end up using a ventilator.

The researchers say high persistent costs seem to have more to do with having multiple chronic illnesses than with any specific illness.

When the researchers applied their four end-of-life spending pattern categories to Medicare enrollees in different regions of the United States, they discovered that the percentage of enrollees in each category differed significantly from region to region.

The region-to-region variation “suggests that end-of-life care patterns might be an indicator of variation in treatment intensity,” the analysts say. 

Another implication is that trying to help older patients with multiple chronic conditions might do more to hold down Medicare spending than focusing on the sickest patients, the researchers say.

“Strategies focused on improving quality and reducing costs for people immediately approaching death might have less of an impact than originally anticipated,” the researchers say.


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