Rebecca Pifer
June 26, 2018
Dive
Brief:
- More Medicare fee-for-service and
Medicare Advantage beneficiaries are dying at home or in community
settings than in acute care hospitals, according to new
findings published in JAMA.
- The study showed proportions of
fee-for-service beneficiary deaths occurring in an acute care hospital
decreased from 32.6% in 2000 to 19.8% in 2015. Proportions of deaths
occurring in the home or in a community setting (foster care home,
assisted living facilities) increased from 30.7% to 40.1% in the same time
span.
- Medicare Advantage
beneficiaries were less likely to be hospitalized overall than those
in traditional fee-for-service plans and, in the last 30 days of life, the
difference in the hospitalization rates was 9.3% — a difference
study author Joan Teno called “huge.”
Dive
Insight:
Although
most Americans over 65 say that they’d prefer to die at home, in 2009 only 24% of them actually did. Yet,
in recent years, more and more Americans are choosing to live out their last
days in their home or community instead of being admitted to a hospital.
The
JAMA study reveals a potential patient response to the current inadequacy of
end-of-life care as, for some older Americans, ending up in a hospital can mean
high-cost and aggressive treatment in their final days.
Such
treatment does not always equal better care. When it comes to their elderly
patients, incumbent healthcare systems increasingly specialize in expensive,
often unnecessary services as opposed to a value-based approach.
The
findings come on the tide of the so-called “silver tsunami” as the American
population skews ever older. The number of Americans aged 65 or older is projected to more than double by 2060,
when they will eventually account for 24% of the total population.
New
startups have emerged looking to address the institutional inadequacy of
end-of-life care, viewing the aging population as a business opportunity. The growing companies zero in on
technology-driven solutions in home health, chronic illness and end-of-life
care as they look to scale to combat industry issues.
Such
startups are a potential wake-up call for traditional healthcare organizations.
“Innovation
comes from the private sector,” Teno, a professor of medicine at
the University of Washington, told Healthcare Dive.
“I
think the implication of this is that hospitals are going to have to change how
they’re practicing. They’re going to have to come into new population-based
business models that don’t have their entire survival based on their number of
admissions,” she said.
On
the hospital side, Teno called for multifaceted interventions that address the
issue of care overuse and fragmentation in hospitals, such as care bundling and
coordination, surveys measuring patient satisfaction and public reporting of
readmission rates.
Despite
the challenges, Teno was optimistic about study’s implications.
“We’re
on the right path,” she said. “We need to wean ourselves off of this
fee-for-service world of paying for a procedure and paying for volume, to
paying for value.”
“The
fee-for-service world provides perverse incentives,” Teno stressed, also
noting that it tends to lead to hospital disorganization and miscommunication.
Teno
cited the growth of Medicare Advantage as a program (it accounts for a third of Medicare enrollees and spending), and
the 9.3% difference in hospitalization rates between MA and fee-for-service as
a good sign for the future of healthcare.
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