Stays in Hospice Settings Longer for Medicare Beneficiaries in HMOs

May 8, 2003
Medicare beneficiaries with cancer who are enrolled in managed care plans are more likely to enter hospice care earlier and stay longer than those in traditional, fee-for-service Medicare, according to a study in the Journal of the American Medical Association.

Harvard Medical School researchers found that 32.4% of managed care patients versus 19.8% of fee-for-service patients used hospice care and that managed care patients stayed an average of 32 days versus 25 days for fee-for-service patients.

The high costs of end-of-life care give Medicare HMOs a financial incentive to transfer dying patients to hospice care, but researchers found no evidence that patients were inappropriately placed in hospice care.

The researchers said that while the differences "may reflect patient and family preferences," the findings suggest that Medicare HMOs may be better at facilitating and encouraging dying cancer patients to receive end-of-life, palliative care than the traditional Medicare program.

In the study, researchers studied 260,090 Medicare beneficiaries ages 66 and older who were diagnosed with one of eight primary cancers between 1973 and 1996 and died between 1988 and 1998.

Some experts suggest patients receive at least two months of hospice care before death, but "most receive a month or less," the researchers said.

The complete study is available at jama.ama-assn.org/cgi/content/full/289/17/2238