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Medicare Program Expenditures Associated with Hospice Use

Diane E. Campbell, PhD; Joanne Lynn, MD; Tom A. Louis, PhD; and Lisa R. Shugarman, PhD
[+] Article and Author Information

From Medical Outcomes Research and Evaluation Services, Thetford, Vermont; RAND, Santa Monica, California; The Washington Home Center for Palliative Care Studies, Washington, DC; and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.


For author affiliations, see end of text.

Disclaimer: The findings, statements, and views expressed are those of the authors and do not necessarily reflect the opinions and policies of the sponsors.

Grant Support: By the Agency for Healthcare Research and Quality, The National Institute on Aging, The Fan Fox-Leslie Samuels Foundation, and The Washington Home Center for Palliative Care Studies. The work was performed under a cooperative agreement with MedPAC, the Medicare Payment Advisory Commission.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Joanne Lynn, MD, Washington Home Center for Palliative Care Studies and RAND, 4200 Wisconsin Avenue, 4th Floor, Washington, DC 20016; e-mail, jlynn@rand.org.

Current Author Addresses: Dr. Campbell: Medical Outcomes Research and Evaluation Services, PO Box 303, Thetford, VT 05074.

Dr. Lynn: The Washington Home Center for Palliative Care Studies, 4200 Wisconsin Avenue, NW, 4th Floor, Washington, DC 20016.

Dr. Louis: Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205.

Dr. Shugarman: RAND Corporation, 1700 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138.


Ann Intern Med. 2004;140(4):269-277. doi:10.7326/0003-4819-140-4-200402170-00009
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The hospice benefit in Medicare aimed to enhance beneficiaries' options for less aggressive end-of-life medical care and for death at home by providing comprehensive services that were not otherwise covered (for example, outpatient drugs, homemaker services, and bereavement counseling) to patients who agree to forgo “curative treatment for their terminal illness” and who have a physician-certified life expectancy of 6 months or less (1). Previous research on patients with cancer who died between 1981 and 1992 (28) indicated, and opinion leaders have often claimed, that hospice enrollment reduces Medicare program costs compared with conventional care during the last month but not the last year of life (24, 910). Earlier evaluations cautioned that changes in pricing, benefit design, and case mix could affect their findings (3).

Topics

hospice ; medicare ; cancer

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Estimated effect of hospice on adjusted mean Medicare program expenditures in the last year of life by type of Medicare expenditure within condition cohort and age stratum.
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