Major Medical Journal Sings Hospice Praise

JAMA JAMA: Hospice Care Offers Benefits, Is Cost Effective

New research published in The Journal of the American Medical Association shows there is a positive relationship between use of the Medicare Hospice Benefit and an overall reduction in health care costs for some cancer patients. The article, “Association Between the Medicare Hospice Benefit and Health Care Utilization and Costs for Patients With Poor-Prognosis Cancer,” concludes that patients who chose hospice “had significantly lower rates of hospitalization, intensive care unit admission, and invasive procedures at the end of life, along with significantly lower total costs during the last year of life.”

Later, National Hospice and Palliative Care Organization (NHPCO) issued a press release on the benefits of hospice care. NHPCO states that the study “reinforces the benefits of hospice care,” and points to the importance of a medical system in which hospice services are decoupled from cessation of curative care. “NHPCO…advocates for concurrent care, a model of healthcare delivery that would not require patients to forgo all curative treatment to access hospice services.” NHPCO urges CMS to act to create changes in federal end-of-life care policies.

NHPCO President and CEO J. Donald Schumacher sees a continuing need to encourage dying individuals to consider the benefits of hospice, and to select hospice sooner rather than later. “We know that many people access hospice care too late to fully take advantage of all this team-based, patient and family-focused model of care can offer. While patients with cancer still make up more than half of all those cared for by hospice providers, their lengths of stay in hospice are among the shortest. This points to the desperate need for clinicians treating cancer to have conversations about palliative care and hospice.”

The importance of this new data is also the focus of a New York Times blogpost by Paula Span. She suggests that an easier death could also be less costly. “Saving money isn’t really the point of hospice care,” writes Span. “Helping dying patients have the best possible remaining life, followed by a good death, is really the purpose.” Nevertheless, the question of the economic benefits of hospice care has long prompted debate on all sides of the issue. Wouldn’t providing the comfort care in homes that most Americans want in their last months of life also be less expensive than the common cycle of 911 calls and emergency-room deaths? In light of the new research published in JAMA, it seems that the data point to an affirmative answer. Span says, “Perhaps seeing hospice as a way to save Medicare dollars will lead to policies that encourage its use.” She points out that Dr. Obermeyer (lead author of the JAMA study) is planning another investigation, this time looking at the financial benefits that hospice may provide not just for the medical system as a whole, but for patients and families in particular. What if hospice provided not just a better, more dignified death, but also a more financially healthy family for those left behind?

[Transitions: New Jersey Hospice & Palliative Care Organization]