End-of-life care spending linked to patient's curve of decline

It's expensive to provide care to an aging population. It's particularly costly during the last year of life.

That's the conclusion of a new study in the journal Health Affairs. The study, conducted by researchers at the University of Michigan and the Geisel School of Medicine at Dartmouth College concluded that the Medicare program's end-of-life spending runs about $40,000 to $50,000 in the last year, compared to about $7,000 per year among those beneficiaries who are not dying. But among those who were high-cost patients to begin with, the spending tended to trend even higher.

The study used a random sample of about 100,000 Medicare beneficiaries between the ages of 66 and 99 who died between 2011 and 2012. It broke them into three categories: Beneficiaries whose spending in the year before they died was persistently high; those whose spending was moderately higher than average; those whose spending ramped up gradually; and those whose spending soared suddenly as they approached death. Just under half of the group were considered persistently high spenders.

Costs were much higher for the persistently high spenders, averaging about $75,000--and that group was far more likely to be the recipients of life-extending measures, such as artificial ventilation. But the moderately persistent spenders only cost an average of about $25,000. Progressive spenders were in the middle, at about $50,000. By contrast, the late-risers had costs of only about $20,000.

Other studies have confirmed that many people in their last year of life with more pain than desired, primarily due to obstacles put up by family members to discuss end-of-life issues.

The study noted that the high persistent spenders used every kind of healthcare service more than any other group at the end of life – except for hospice care. However, most wound up dying in the same locale: Either a hospital or nursing home. Late-rise spenders were more likely to die in an intensive care unit.

Data have suggested that those patients more willing to discuss end-of-life options are more likely to die in a place they wish to, rather than a hospital or another clinical setting.

- read the Health Affairs study