Report: Medicare Patients Spend Less Time in Hospital for End-of-Life Care, but Treatment Is Expensive


A new report released Tuesday by the Dartmouth Atlas Project shows that elderly Medicare patients are spending fewer days in the hospital at the end of life, but the care they received is more aggressive and expensive.

The findings are significant as debate grows over how much money the federal government spends on Medicare, and whether there should be cuts to the program to bring down the ballooning budget deficit.

The researchers compared the number of days seniors spent in the hospital in their final days in 2003 with records kept in the year 2007. Overall, chronically ill Medicare patients spent slightly less time in the hospital than they did in 2003 but there were also wide variations from one community to another and from one hospital to another.

For example, in 2007, chronically ill Medicare patients spent an average of 20.6 days in the hospital in the Manhattan borough of New York City, while in Ogden, Utah, the average stay was 5.2 days. The Manhattan hospital stays were four times higher than those in Utah, the study found.

Researchers said there are wide variations in the way physicians and hospitals practice medicine across the country. Over the past decade, the number of intensive care unit beds has increased, along with the number of doctors who practice a specialty like cardiology or neurology.

The report also said that, overall, Medicare patients were significantly more likely to be treated by 10 or more doctors in the last six months of life in 2007 than they were in 2003.

Dr. David Goodman, one of the principal investigators for the Dartmouth report, said the research shows that unnecessary aggressive medical treatment for the elderly in the final days carries a “high financial cost.” About one-fourth of all Medicare spending on seniors goes to pay for care in the last year of life.

Goodman said often doctors “aren’t doing a very good job of listening to patients” when very “robust research” shows most elderly patients do not want intensive treatments at the end of life but would prefer “to be at home with their families.”

“There are times when patients value living well more than they do living longer,” he said.

The Dartmouth report also shows more Medicare patients are using their Medicare hospice benefit and deciding to die at home or in a hospice setting than ever before. Goodman thinks that’s because the number of hospice facilities in the U.S. has grown quickly in recent years and both consumers and physicians are more aware of the comfort they provide patients at the end of life.

Goodman says that many physicians come from a culture that dictates they should be “life saving and curative even when it’s not helpful” and that if doctors were better trained to be good listeners, there would be less wasted care at the end-of-life and more respect for what seniors want.

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