Hospice Saves Medicare Dollars: New Study from Mount Sinai

Hospice benefit produces $2,561 in savings to Medicare for each patient enrolled for 53-105 days before death compared to a non-hospice control group, according to new research by the Brookdale Department of Geriatrics and Palliative Medicine at Mt. Sinai Medical Center published in the March issue of Health Affairs.

Even higher savings were seen with shorter — more common — enrollment periods:

1–7 days prior to death: $2,650 per patient.
8–14 days prior to death: $5,040 per patient.
15–30 days prior to death: $6,430 per patient.

To put it another way, if 1,000 additional beneficiaries enrolled in hospice 15-30 days prior to death, Medicare could save more than $6.4 million dollars annually, while those beneficiaries would be spared 4,100 hospital days.

Alternatively, if 1,000 additional beneficiaries enrolled in hospice 53-105 days before death, the overall savings to Medicare would be over $2.5 million dollars.

“Considerable evidence supports that hospice significantly enhances quality of care for patients and their families near the end of life, but the impact of hospice on Medicare costs remains an ongoing debate,” Amy S. Kelley, M.D., the study’s lead author, said in a press release. “Our study is the first to combine rich survey data and Medicare claims to demonstrate that an investment in the Medicare hospice benefit could translate into millions of dollars saved annually for the Medicare system and higher quality care for patients and families.”

Based on this study, as well as previous studies on hospice, such as the 2007 Duke University Study, the Centers for Medicare and Medicaid Services (CMS) should focus on ensuring the timely enrollment of qualified patients who desire the benefit.
How was the hospice study conducted?

According to Mt. Sinai, researchers used survey data from 3,069 subjects within the National Institute of Aging’s Health and Retirement Study as well as their individual Medicare claims to compare the Medicare costs of patients who received hospice care to those of patients who did not.

Researchers examined 4 different periods of hospice enrollment: the 3 most common enrollment periods, 1-7, 8-14, and 15-30 days before death, as well as 53-105 days prior to death.

They also investigated both the source of hospice-related savings such as hospital admissions, hospital and intensive care unit days and hospice’s impact on selected measures of quality of care at the end of life such as 30-day readmission rate and in-hospital death.