esearchers at The Yale School of Public Health and Mount Sinai School of Medicine have found that the costs of care for patients with cancer who disenrolled from hospice were nearly five times higher than costs for patients who remained with hospice.
Patients who disenroll are also far more likely to end up using emergency department care, ICU care and to be hospitalized. The results are published in the October 1 issue of the Journal of Clinical Oncology.
“This is particularly important given the latest evidence comparing patients who die in ICUs and hospitals experience far more physical and emotional distress than patients who die at home with hospice,” said Elizabeth H. Bradley, professor of public health at Yale and senior author on the paper. “For decades, we have seen better outcomes for patients and families who use hospice, but here we also find clear evidence in a group initially using hospice that leaving hospice is also costly financially.”
The research team evaluated data from 90,826 patients with cancer who were served by 1,384 hospices between 1998 and 2002. They found that nearly 11 percent of the patients who disenrolled from hospice and had considerably higher health care use and costs than those who remained with hospice until death.
“Rather than focusing on how to decrease Medicare expenditures by restricting access to the Medicare Hospice Benefit, policy makers should focus on how to decrease the potential barriers to remaining enrolled with hospice until death, with an eye to both decreasing Medicare costs and potentially improving patient and family outcomes.” Said lead author Melissa D.A. Carlson, assistant professor of Geriatrics and Palliative Medicine at Mount Sinai.
The researchers found that 33.9 percent of the patients who had disenrolled from hospice care were admitted to an emergency department, while only 3.1 percent of those who remained in hospice care until death were. Additionally, 39.8 percent of disenrolled patients were admitted to the hospital as an inpatient where only 1.6 percent of enrolled patients were. Disenrolled patients also spent an average of 19.3 days in the hospital, whereas enrolled patients spent an average of 6.7 days.
Patients who stayed with hospice incurred $6,537 in expenses from the time of hospice enrollment to death, while those who did not incurred $30,848 in expenses. The Medicare expenditures that the researchers evaluated included hospice care, hospitalizations, physician visits, outpatient care, medical equipment and supplies and home health care services.
For cancer patients who disenroll, the study recommend that oncologists connect with palliative care teams where available and try to ensure that the patient and their family continue to receive support. The study did not investigate why patients disenroll from hospice.