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  • Title: Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare.
    Author: Kalidindi Y, Segel J, Jung J.
    Journal: Am J Hosp Palliat Care; 2020 Apr; 37(4):286-293. PubMed ID: 31564110.
    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.
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