Medicare spending for chronically ill patients at the end of life increased more than 15 percent from 2007 to 2010, according to the Dartmouth Atlas Project. The data also show that Medicare patients spent fewer days in the hospital and received more hospice care in 2010 than they did in 2007.
Trends across regions and hospitals show that in 2010, compared with 2007, patients in the last six months of life were:
- less likely to be in the hospital;
- more likely to be enrolled in hospice care;
- less likely to die in the hospital;
- more likely to see more than 10 physicians;
- just as likely to spend time in intensive care units.
Overall, the average spending per chronically ill Medicare patient in the last two years of life increased from $60,694 in 2007 to $69,947 in 2010. Spending rates per Medicare beneficiary in 2010 varied from a high of $112,263 in Los Angeles to a low of $46,563 in Minot, N.D. Bloomington, Ill., was the only region in the nation showing a decrease: from $57,802 per patient in 2007 to $53,674 in 2010.
During this period, the percentage of chronically ill patients dying in hospitals and the average number of days they spent in the hospital before their deaths declined in most regions of the country and at most hospitals: from 28 to 25 percent. In 2010, the highest rates of death in a hospital remained in regions in and around New York City, including Manhattan (44 percent), the Bronx (38 percent), East Long Island (37 percent) and White Plains (36 percent), though all these regions showed decreased rates from 2007. Chronically ill patients were far less likely to die in a hospital in Dubuque, Iowa (15 percent), Cincinnati (17 percent), and Fort Lauderdale, Fla. (17 percent).
In general, chronically ill patients were significantly more likely to be treated by 10 or more physicians in the last six months of life in 2010 than they were in 2007, as the national rate increased from 36 to 42 percent. Regions with the most intensive care by this measure are East Long Island and Ridgewood, N.J. (62 percent). Regions with low rates included Idaho Falls, Idaho (15 percent), and Grand Junction, Colo. (18 percent). Only seven regions decreased in this measure during this period, including Neenah, Wis. (from 25 to 21 percent), and Santa Cruz, Calif. (from 32 to 29 percent).
For more, go to www.dartmouthatlas.org.