title: Hospice Use, Hospitalization, and Medicare Spending at the End of Life.
abstract: OBJECTIVE
  Prior studies associate hospice use with reduced hospitalization and spending at the end of life based on all Medicare hospice beneficiaries. In this study, we examine the impact of different lengths of hospice care and nursing home residency on hospital use and spending prior to death across 5 disease groups.
  
  
  METHODS
  We compared inpatient hospital days and Medicare spending during the last 6 months of life using hospice versus propensity matched non-hospice beneficiaries who died in 2010, were enrolled in fee for service Medicare throughout the last 2 years of life, and were in at least 1 of 5 disease groups. Comparisons were based on length of hospice use and whether the decedent was in a nursing home during the seventh month prior to death. We regressed a categorical measure of hospice days on outcomes, controlling for observed patient characteristics.
  
  
  RESULTS
  Hospice use over 2 weeks was associated with decreased hospital days (1-5 days overall, with greater decreases for longer hospice use) for all beneficiaries; spending was $900-$5,000 less for hospice use of 31-90 days for most beneficiaries not in nursing homes, except beneficiaries with Alzheimer's. Overall spending decreased with hospice use for beneficiaries in nursing homes with lung cancer only, with a $3,500 reduction.
  
  
  CONCLUSIONS
  The Medicare hospice benefit is associated with reduced hospital care at the end of life and reduced Medicare expenditures for most enrollees. Policies that encourage timely initiation of hospice and discourage extremely short stays could increase these successes while maintaining program goals.
authors.affiliation: Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, District of Columbia. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. rachael.zuckerman@hhs.gov.
authors.forename: Rachael B
authors.initials: RB
authors.lastname: Zuckerman
authors.affiliation: Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.affiliation: Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, District of Columbia.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Sheingold
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002908:Chronic Disease / Q000191:economics* / Q000401:mortality*; D017046:Cost Savings / Q000191:economics / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000191:economics / Q000706:statistics & numerical data; D006738:Hospices / Q000191:economics* / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000191:economics*; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data; D057216:Propensity Score; D013727:Terminal Care / Q000191:economics* / Q000706:statistics & numerical data*; D014481:United States
keywords: End of life care; Hospice; Hospital use; Medicare