Identification of four unique spending patterns among older adults in the last year of life challenges standard assumptions

Health Affairs

Volumn 35, Issue 7, 2016, Pages 1316-1323

  Davis, Matthew Allen ^a,b   Nallamothu, Brahmajee K ^a,c,d   Banerjee, Mousumi ^e   Bynum, Julie P W ^b  

^a UNIVERSITY OF MICHIGAN   (United States)

^b DARTMOUTH INSTITUTE FOR HEALTH POLICY AND CLINICAL PRACTICE   (United States)

^c UNIVERSITY OF MICHIGAN MEDICAL SCHOOL   (United States)

^d VETERANS AFFAIRS MEDICAL CENTER   (United States)

^e UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CAUSE OF DEATH; DEATH; FUNCTIONAL STATUS; HEALTH CARE COST; HEALTH CARE UTILIZATION; HEALTH SERVICE; HOSPICE; HUMAN; LIVING WILL; MEDICARE; OUTPATIENT; TERMINAL CARE; AGED; COHORT ANALYSIS; ECONOMICS; FACTUAL DATABASE; FEMALE; GERIATRIC ASSESSMENT; MALE; PREDICTIVE VALUE; SURVIVAL ANALYSIS; TIME FACTOR; TRENDS; UNITED STATES; UTILIZATION; VERY ELDERLY;

AGED; AGED, 80 AND OVER; CAUSE OF DEATH; COHORT STUDIES; DATABASES, FACTUAL; FEMALE; GERIATRIC ASSESSMENT; HEALTH EXPENDITURES; HUMANS; MALE; MEDICARE; PREDICTIVE VALUE OF TESTS; SURVIVAL ANALYSIS; TERMINAL CARE; TIME FACTORS; UNITED STATES;

EID: 84980351629     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2015.1419     Document Type: Article

References (44)

1. Hogan C. Spending in the last year of life and the impact of hospice on Medicare outlays [Internet]. Washington (DC): Medicare Payment Advisory Commission; 2015 Jun 22 [cited 2016 May 12]. Available from: http://www.medpac.gov/documents/contractor-reports/spending-in-the-last-year-of-life-andthe-impact-of-hospice-on-medicareoutlays-rev.pdf?sfvrsn=4
2. Institute of Medicine. Dying in America: improving quality and honoring individual preferences near the end of life. Washington (DC): National Academies Press; 2015.
3. Gozalo P, Plotzke M, Mor V, Miller SC, Teno JM. Changes in Medicare costs with the growth of hospice care in nursing homes. N Engl J Med. 2015;372(19):1823-31.
4. Riley GF. Long-term trends in the concentration of Medicare spending. Health Aff (Millwood). 2007;26(3): 808-16.
5. Barnato AE, Farrell MH, Chang CC, Lave JR, Roberts MS, Angus DC. Development and validation of hospital "end-of-life" treatment intensity measures. Med Care. 2009;47(10): 1098-105.
6. Goodman DC, Fisher ES, Wennberg JE, Skinner JS, Chasan-Taber S, Bronner KK. Tracking improvement in the care of chronically ill patients: a Dartmouth Atlas brief on Medicare beneficiaries near the end of life [Internet]. Lebanon (NH): Dartmouth Atlas Project; 2013 Jun 12 [cited 2016 May 12]. Available from: http://www.dartmouthatlas.org/downloads/reports/EOL_brief_061213.pdf
7. Nicholas LH, Langa KM, Iwashyna TJ, Weir DR. Regional variation in the association between advance directives and end-of-life Medicare expenditures. JAMA. 2011;306(13): 1447-53.
8. Bischoff KE, Sudore R, Miao Y, Boscardin WJ, Smith AK. Advance care planning and the quality of endof-life care in older adults. J Am Geriatr Soc. 2013;61(2):209-14.
9. Bell M. Why 5% of patients create 50% of health care costs. Forbes [serial on the Internet]. 2013 Jan 10 [cited 2016 May 12]. Available from: http://www.forbes.com/sites/michaelbell/2013/01/10/why-5-ofpatients-create-50-of-health-carecosts/#77188fb47818
10. Neuman T, Cubanski J, Huang J, Damico A. The rising cost of living longer: analysis of Medicare spending by age for beneficiaries in traditional Medicare [Internet]. Menlo Park (CA): Henry J. Kaiser Family Foundation; 2015 Jan 14 [cited 2016 May 12]. Available from: http://kff.org/medicare/report/the-risingcost-of-living-longer-analysis-ofmedicare-spending-by-age-forbeneficiaries-in-traditionalmedicare/
11. Harris P, Wong E, Farrington S, Craig TR, Harrold JK, Oldanie B, et al. Patterns of functional decline in hospice: what can individuals and their families expect? J Am Geriatr Soc. 2013;61(3):413-7.
12. Kelley AS, Ettner SL, Morrison RS, Du Q, Sarkisian CA. Disability and decline in physical function associated with hospital use at end of life. J Gen Intern Med. 2012;27(7):794-800.
13. Teno JM, Weitzen S, Fennell ML, Mor V. Dying trajectory in the last year of life: does cancer trajectory fit other diseases? J Palliat Med. 2001; 4(4):457-64.
14. Harris I, Murray SA. Can palliative care reduce futile treatment? A systematic review. BMJ Support Palliat Care. 2013;3(4):389-98.
15. Gottlieb DJ, Zhou W, Song Y, Andrews KG, Skinner JS, Sutherland JM. Prices don't drive regional Medicare spending variations. Health Aff (Millwood). 2010;29(3): 537-43.
16. Healthcare Cost and Utilization Project. Clinical Classifications Software (CCS) for ICD-9-CM [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; [cited 2016 May 12]. Available from: https://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp
17. Heron M. Deaths: leading causes for 2010. Natl Vital Stat Rep. 2013; 62(6):1-96.
18. Centers for Medicare and Medicaid Services. Crosswalk Medicare provider/supplier to healthcare provider taxonomy [Internet]. Baltimore (MD): CMS; 2015 Nov 12 [cited 2016 May 12]. Available from: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/TaxonomyCrosswalk.pdf
19. Dartmouth Atlas of Health Care. Selected hospital and physician capacity measures [Internet]. Lebanon (NH): Dartmouth Institute; 2015 [cited 2016 May 12]. Available from: http://www.dartmouthatlas.org/tools/downloads.aspx#resources
20. Wallace CL. Hospice eligibility and election: does policy prepare us to meet the need? J Aging Soc Policy. 2015;27(4):364-80.
21. Nagin DS. Group-based modeling of development. Cambridge (MA): Harvard University Press; 2005 Apr.
22. Barnato AE, Anthony DL, Skinner J, Gallagher PM, Fisher ES. Racial and ethnic differences in preferences for end-of-life treatment. J Gen Intern Med. 2009;24(6):695-701.
23. Hanchate A, Kronman AC, Young-Xu Y, Ash AS, Emanuel E. Racial and ethnic differences in end-of-life costs: why do minorities cost more than whites? Arch Intern Med. 2009;169(5):493-501.
24. Levinsky NG, Yu W, Ash A, Moskowitz M, Gazelle G, Saynina O, et al. Influence of age on Medicare expenditures and medical care in the last year of life. JAMA. 2001;286(11): 1349-55.
25. Jones BL, Nagin DS. A note on a Stata plugin for estimating groupbased trajectory models. Socio Meth Res. 2013;42(4):608-13.
26. Kelley AS, McGarry K, Fahle S, Marshall SM, Du Q, Skinner JS. Out of-pocket spending in the last five years of life. J Gen Intern Med. 2013;28(2):304-9.
27. Zhang B, Wright AA, Huskamp HA, Nilsson ME, Maciejewski ML, Earle CC, et al. Health care costs in the last week of life: associations with end of-life conversations. Arch Intern Med. 2009;169(5):480-8.
28. Ferrante LE, Pisani MA, Murphy TE, Gahbauer EA, Leo-Summers LS, Gill TM. Functional trajectories among older persons before and after critical illness. JAMA Intern Med. 2015; 175(4):523-9.
29. Gill TM, Gahbauer EA, Han L, Allore HG. Trajectories of disability in the last year of life. N Engl J Med. 2010; 362(13):1173-80.
30. Stabenau HF, Morrison LJ, Gahbauer EA, Leo-Summers L, Allore HG, Gill TM. Functional trajectories in the year before hospice. Ann Fam Med. 2015;13(1):33-40.
31. Lunney JR, Lynn J, Hogan C. Profiles of older Medicare decedents. J Am Geriatr Soc. 2002;50(6):1108-12.
32. Lubitz JD, Riley GF. Trends in Medicare payments in the last year of life. N Engl J Med. 1993;328(15): 1092-6.
33. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy [Internet]. Washington (DC): MedPAC; 2014 Mar. Chapter 3: hospital inpatient and outpatient services) [cited 2016 May 12]. Available from: http://medpac.gov/documents/reports/mar14_entirereport.pdf
34. Lochner KA, Cox CS. Prevalence of multiple chronic conditions among Medicare beneficiaries, United States, 2010. Prev Chronic Dis. 2013;10: E61.
35. Steiner CA, Barrett ML, Weiss AJ, Andrews RM. Trends and projections in hospital stays for adults with multiple chronic conditions, 2003-2014. Rockville (MD): Healthcare Cost and Utilization Project; 2014 Nov. (Statistical Brief No. 183).
36. Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22(Suppl 3):391-5.
37. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Inn Med. 2002;162(20):2269-76.
38. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138(4): 273-87.
39. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138(4): 288-98.
40. Barnato AE, Herndon MB, Anthony DL, Gallagher PM, Skinner JS, Bynum JP, et al. Are regional variations in end-of-life care intensity explained by patient preferences?: A study of the US Medicare population. Med Care. 2007;45(5):386-93.
41. Wennberg JE. Tracking medicine: a researcher's quest to understand health care. New York (NY): Oxford University Press; 2010.
42. Emanuel EJ. Cost savings at the end of life. What do the data show? JAMA. 1996;275(24):1907-14.
43. Emanuel EJ, Emanuel LL. The economics of dying. The illusion of cost savings at the end of life. N Engl J Med. 1994;330(8):540-4.
44. Parekh AK, Goodman RA, Gordon C, Koh HK. Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life. Public Health Rep. 2011;126(4):460-71.