Expanded Access to End-of-Life Care Shows Promise for Improving Care Quality and Reducing Medicare Expenditures

New research published in Health Affairs found that allowing people access to supportive and palliative care services while still treating their terminal conditions resulted in better end-of-life care, increased use of hospice, fewer inpatient admissions and outpatient emergency department visits, and lower Medicare expenditures.

Medicare’s hospice benefit can be an important support for people at the end of their lives and their families, but only about half of the Medicare beneficiaries who qualify use it. Many who do use hospice tend to use it for a short time before they pass away. One of the barriers to hospice use is Medicare’s requirement that patients waive their right to Medicare payments for treating their terminal condition. Over six years, the Centers for Medicare & Medicaid Services tested the Medicare Care Choices Model, which offered qualifying candidates access to palliative care and hospice support services at the same time they were receiving treatment for their terminal condition.

“There was a demand for supportive and palliative care services among eligible beneficiaries who preferred to continue treating their terminal conditions,” said Mathematica’s Keith Kranker, principal researcher and lead author of the article. “The results of this study show that receiving access to end-of-life care earlier is a promising approach to transforming care delivery, improving quality of care, and reducing Medicare expenditures at the end of life.”

Mathematica evaluated the model and found that it reduced Medicare expenditures by $7,604 per enrollee (or 13 percent), which was driven in part by reduced use of acute care services. The model reduced emergency department visits by 12 percent and hospital admissions by 26 percent. It also served as a stepping stone to the traditional Medicare hospice benefit. Enrollees in our analysis (83 percent) were more likely to use hospice and tended to enter hospice earlier, ultimately spending more than twice as many days in hospice than matched comparison beneficiaries (42 versus 19 days). Enrollees were 15 percentage points less likely to receive an aggressive treatment at the end of life and spent 5.5 more days at home.

Though the Medicare Care Choices Model was not extended because of concerns about whether it could be generalized to the greater population, lessons from the model informed four more recent models from the Centers for Medicare & Medicaid Services Innovation Center that allow people to receive supportive and palliative care services along with treatments for terminal conditions.

A full report of the final evaluation findings is also available.