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Research published in the September 2004 issue of the Journal of Pain and Symptom Management (JPSM) reports that patients enrolled in hospice care cost Medicare less. The study, "Medicare Cost in Matched Hospice and Non-Hospice Cohorts," also revealed that hospice patients lived longer on the average than similar patients who did not choose hospice care.


Commissioned by the National Hospice and Palliative Care Organization and conducted by the actuarial firm of Milliman, USA, the goal of the study was to identify cost differences between patients who do and do not elect to receive Medicare-paid hospice benefits.


For the majority of patients with 16 of the most common terminal diagnoses, those choosing hospice, under most conditions, cost Medicare less. Cost savings ranged from $1,115 for rectal cancer patients to $8,879 for congestive heart failure patients.


Researchers also found that hospice patients lived longer on average. This ranged from 20 days for those with a diagnosis of gallbladder cancer to 69 days for the cohort of breast cancer patients. This pattern persisted across most of the disease states studied.


The cost analysis of patients receiving care under the Medicare Hospice Benefit has been debated since the benefit was introduced in 1982. This new research supports existing studies showing cost benefits of hospice.


A significant factor in this study is the unique methodology used to work toward eliminating selection bias. Selection bias has been a recognized problem in previous studies contrasting hospice versus nonhospice patients. Medicare health insurance claims and enrollment data was used to measure both costs and time until death, starting from narrowly defined dates. Indicative markers were identified that represented unambiguous points in the end stage of each disease. This study began tracking patients further upstream in a manner that researchers suggest addresses many selection bias concerns.


The data source was Medicare health insurance claims and enrollment data from 5% Sample Beneficiary Standard Analytic Files, for years 1998, 1999, and 2000. This 5% sample is created by CMS as a statistically representative, longitudinal data set. A total of 8700 patients met criteria for inclusion in the study.


The article in JPSM points out that a period of at least 2 to 3 months of hospice care may be optimal from both a cost and clinical standpoint.


Written by Bruce Pyenson, Stephen Connor, Kathryn Fitch, and Barry Kinzbrunner, studies such as these provide important information relating to compassionate and cost-effective care at the end of life.