By: Amanda Peterson
Did you know that hospice utilization saves Medicare approximately $2,300 per patient who uses the service? (Taylor et al. 1474). You might think that savings is from the lack of care patients receive, but you would be wrong. Hospice patients receive regular, personalized care once they start receiving services; however, the nature of that care is drastically different from what patients receive who choose other treatments. Instead of chemotherapy, hospice patients receive medications and interventions that make them comfortable. Instead of dialysis, hospice patients are made comfortable in their home. Instead of painful surgeries with mixed results, hospice patients live out their lives with family and friends with their symptoms managed and their physical, spiritual, and emotional needs met.
How is it that such personal, individualized care that requires a whole team of experts to accomplish actually saves Medicare money? And why does that matter? The answer affects everyone, whether they currently receive Medicare benefits or not. End-of-life care and care for terminal diseases is expensive, especially when patients require stays in the Intensive Care Unit (ICU) or make repeated visits to the Emergency Room (ER). Too often, when a patient has a terminal illness, those visits often turn into hospital admissions, especially as diseases progress and patients are unable to care for themselves. As they continue to decline, it becomes impossible for them to return home because the life extending care they need can only be provided in the hospital. Soon one procedure becomes another, which leads to yet another. Lines and tubes may become infected, patients can develop skin infections from remaining in bed all the time, and bacteria like Clostridium difficile (known as C. diff) run rampant and make patients miserable.
In Taylor et al., the researchers found that the amount spent per patient over the last year of life is roughly the same for both patients who use hospice services and those who don’t. However, in looking at that year in detail, they found that most hospice patients had a spike in expenditures in the week before hospice admission, often due to a costly hospitalization that prompts the discussion about a terminal diagnosis. Those costs drop after hospice admission and remain lower until the final week of life (1475-76). Cancer patients who receive hospice care for 58-103 days actually save Medicare closer to $7,000, which is a significant savings that should be capitalized on more frequently (Taylor et al. 1474).
As the researchers state, “Given that hospice has been widely demonstrated to improve quality of life of patients and family members (Christakis & Iwashyna, 2003; Higginson, Finlay, & Goodwin et al.,2003; Wallston, Burger, & Smith et al., 1988 qtd. in Taylor et al.), the Medicare program appears to have a rare situation whereby something that improves quality of life also appears to reduce costs” (Taylor et al. 1474-75). Hospice patients receive the care they need in their homes with friends and family there to support them. Medicare pays for the medicine and supplies they need to deal with their terminal illness, which can include medications like Morphine or Lorazepam, a hospital bed, oxygen, shower chairs, and more. Because hospice is a Medicare benefit, these are available without any copays or deductibles, which saves patients and family members a lot of money. It provides just one more reason why choosing hospice early in a diagnosis benefits both patients and the government agency that regulates its use.
After a patient’s death, hospice bereavement services step in to offer comfort and support to their families. Family members are given the support they need to care for patients throughout the end of their lives, and they continue to receive support afterwards, which is unheard of in the medical community. Add the cost saving benefits to Medicare, and it becomes a mystery why more people don’t choose hospice care after receiving a terminal diagnosis.
Not only are hospice patients costing Medicare less money and spending less on their medical care, they are living full lives up to the very end, surrounded by friends and family, enjoying the things that make them happy, and making lasting memories with the people they love. Medicare truly does have something unique in its hospice benefit if people will only utilize it to its fullest potential.
Taylor, Donald, J. Ostermann, C. Van Houtven, J. Tulsky, K. Steinhauser. “What Length of Hospice Use Maximizes Reduction in Medical Expenditures Near Death in the US Medicare Program?” Social Science and Medicine 65.7 (2007): 1466-1478. Web. 7 Jan. 2017.