End-of-life spending for Medicare patients jumped 15 percent from 2007-2010

Average Medicare spending per patient in the last two years of life rose 15 percent from $60,694 to $69,947 between 2007 and 2010, according to a June 12 brief published by the Dartmouth Atlas Project. Researchers examined the last two years of claims records of 1,107,702 Medicare patients who died in 2010, both among 306 hospital referral regions and among more than 2,400 hospitals.

While spending increased, Medicare patients in the final months of their lives spent fewer days in the hospital and received more hospice care in 2010 compared to 2007, according to lead author David Goodman, MD, MS, co-principal investigator for the Dartmouth Atlas Project, and colleagues.

“These changes reflect the preferences of most patients to spend their last weeks and months in a homelike environment whenever possible, avoiding procedures that have little chance of improving the quality or length of their lives,” Goodman et al wrote. To that end, the authors cited a 40 percent increase in the average number of hospice days per patient in academic medical centers, including increases of 55 percent at the Hospital of the University of Pennsylvania in Philadelphia and 50 percent at Johns Hopkins Hospital in Baltimore.

The pace of change varied across hospitals, with some experiencing rapid change while other health systems showed little improvement, the report also found. In 2010, the highest rates of death in a hospital setting were found in and around New York City, including Manhattan (43.7 percent) and the Bronx (37.7 percent), but patients were far less likely to die in a hospital in Dubuque, Iowa (15.2 percent) or Cincinnati, Ohio (16.8 percent), according to the brief.        

“We continue to see that where patients live and receive care are some of the most significant factors in how they spend their last years,” Goodman said in a related press release.