End‐of‐Life Cost Trajectories in Cancer Patients Treated by Medicare versus the Veterans Health Administration
- 24 December 2020
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 69 (4), 916-923
- https://doi.org/10.1111/jgs.16941
Abstract
BACKGROUND/OBJECTIVES To evaluate differences in end‐of‐life cost trajectories for cancer patients treated through Medicare versus by the Veterans Health Administration (VA). DESIGN A retrospective analysis of VA and Medicare administrative data from FY 2010 to 2014. We employed three‐level generalized estimating equations to evaluate monthly cost trajectories experienced by patients in their last year of life, with patients nested within hospital referral region. SETTING Care received at VA facilities or by Medicare‐reimbursed providers nationwide. PARTICIPANTS A total of 36,401 patients dying from cancer and dually enrolled in VA and Medicare. MEASUREMENTS We evaluated trajectories for total, inpatient, outpatient, and drug costs, using the last 12 months of life. Cost trajectories were prioritized as costs are not directly comparable across Medicare and VA. Patients were assigned to be VA‐reliant, Medicare‐reliant or Mixed‐reliant based on their healthcare utilization in the last year of life. RESULTS All three groups experienced significantly different cost trajectories for total costs in the last year of life. Inpatient cost trajectories were significantly different between Medicare‐reliant and VA‐reliant patients, but did not differ between VA‐reliant and Mixed‐reliant patients. Outpatient and drug cost trajectories exhibited the inverse pattern: they were significantly different between VA‐reliant and Mixed‐reliant patients, but not between VA‐reliant and Medicare‐reliant patients. However, visual examination of cost trajectories revealed similar cost patterns in the last year of life among all three groups; there was a sharp rise in costs as patients approach death, largely due to inpatient care. CONCLUSION Despite substantially different financial incentives and organization, VA‐ and Medicare‐treated patients exhibit similar patterns of increasing end‐of‐life costs, largely driven by inpatient costs. Both systems require improvement to ensure quality of end‐of‐life care is aligned with recommended practice.Funding Information
- Health Services Research and Development (Merit Review Award Number I01 HX001627)
- U.S. Department of Veterans Affairs (98‐004, SDR 02‐237)
This publication has 37 references indexed in Scilit:
- Fee‐for‐Service Medicare‐Enrolled Elderly Veterans Are Increasingly Voting with Their Feet to Use More VA and Less Medicare, 2003–2014Health Services Research, 2018
- Quality Of End-Of-Life Care Is Higher In The VA Compared To Care Paid For By Traditional MedicareHealth Affairs, 2018
- Trends in end-of-life cancer care in the Medicare programJournal of Geriatric Oncology, 2016
- Washington State Cancer Patients Found To Be At Greater Risk For Bankruptcy Than People Without A Cancer DiagnosisHealth Affairs, 2013
- Change in End-of-Life Care for Medicare BeneficiariesJAMA, 2013
- National Estimates of Out-of-Pocket Health Care Expenditure Burdens Among Nonelderly Adults With Cancer: 2001 to 2008Journal of Clinical Oncology, 2011
- Long‐Term Trends in Medicare Payments in the Last Year of LifeHealth Services Research, 2010
- Impact of the Cost of Cancer Treatment: An Internet-Based SurveyJournal of Oncology Practice, 2010
- Dying Trajectory in the Last Year of Life: Does Cancer Trajectory Fit Other Diseases?Journal of Palliative Medicine, 2001
- Medicare Beneficiaries’ Costs Of Care In The Last Year Of LifeHealth Affairs, 2001