Medicare Spending and Care Intensity at the End of Life Increases, While Time in the Hospital Declines

Dartmouth Atlas: June 12, 2013

New findings show longitudinal change for care provided to chronically ill Medicare patients

Lebanon, N.H. (June 12, 2013) – Medicare spending for chronically ill patients at the end of life increased more than 15 percent from 2007 to 2010, according to a new brief from the Dartmouth Atlas Project. The updated data also shows that Medicare patients spent fewer days in the hospital and received more hospice care in 2010 than they did in 2007.

The trends across regions and hospitals show that in 2010, compared to 2007, patients were:

  • Less likely to be in the hospital during the last six months of life;
  • More likely to be enrolled in hospice care during the last six months of life;
  • Less likely to die in the hospital;
  • More likely to see more than ten physicians during the last six months of life; and
  • Just as likely to spend time in intensive care units (ICUs) during the last six months of life, with

    virtually no change from 2007 to 2010.

    There were substantial changes in many individual hospitals and regions, but not in the same direction; some increased the intensity of care, while others provided less intensive care over time.

    “The growing use of hospice care and decrease in hospital use at the end of life are promising trends that may reflect attempts to provide care that aligns more closely with patients’ preferences,” said David C. Goodman, M.D., M.S., co-principal investigator for the Dartmouth Atlas Project. “However, improvements in care are not even across regions and hospitals, and many are changing at a much slower pace, or not at all. We continue to see that where patients live and receive care are some of the most significant factors in how they spend their last years.”   Read more