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Medicare Patients on Hemodialysis Have Poor Access to Hospice Care

Posted on Thursday, June 14, 2018 3:29 PM

According to a new paper, published in Health Affairs, Medicare patients who are on dialysis have poor access to hospice care in the last years of their lives.

“The paper, derived from a study of nearly 640,000 people in a national registry of end-stage renal disease who died between 2000 and 2014, grouped the patients into four classifications, depending on the health care expenses – fee-for-service Medicare Part A and B spending — and intensity of treatment. Those four groups were:

  • Group 1 (9 percent) had escalating spending during all four quarters of their final year;
  • Group 2 (41 percent) had relatively low spending for three quarters, with escalation in the last quarter;
  • Group 3 (37 percent) had moderate spending for three quarters, with escalation in the last quarter; and
  • Group 4 (13 percent) had consistently high spending during all four quarters.”

In each group, less than 25% received hospice care, and in each group the patients spent 5-6 days in hospice, far below the national average.

These results are not surprising considering that Medicare policy provides hospice only after all curative treatments are stopped.  However, if renal failure is not their primary health problem, the patient can continue dialysis in hospice. 

Currently, Center for Medicare and Medicaid Innovation (CMMI) is testing care models that could provide more palliative and hospice care to dialysis patients.

Source: NAHC Report

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