Visits by Primary Care Physicians Reduce Medicare
Costs at End of Life
‘Decreasing just one hospital day for each Medicare
beneficiary at the end of life could have saved millions of dollars’
June
5, 2008 – About six percent of the people in Medicare die every year.
Surprisingly, they use up about 30 percent of the money Medicare spends
each year. A new study has found that more visits by the primary care
physician in these final months will significantly lower this cost and
result in fewer deaths in hospitals.
According to researchers from Boston University
School of Medicine (BUSM), the quality of end-of-life care is often
poor. The recently published study appears in the Journal of General
Internal Medicine.
Problems include late referrals to hospice,
undertreatment of pain, overtreatment with unwanted or ineffective
procedures, poor communications regarding prognosis and treatment
preferences, and in-hospital deaths that are inconsistent with stated
preferences.
Researchers measured hospital utilization during
the final six months of life and the number of primary care physician
visits in the 12 preceding months for 78,356 Medicare beneficiaries age
66 and older. Hospital days, costs, in-hospital death, and presence of
two types of preventable hospital admissions also were studied.
The study of visits by primary care physicians show
-
● 38 percent of adults
did not have any primary care visits during their final six months of
life,
● 22 percent had one to two primary care visits,
● 19 percent had three to five visits,
● 10 percent had six to eight visits and
● 11 percent had nine or more visits.
More primary care visits in the preceding year were
associated with -
● fewer hospital days
(15.3 days for those with no primary care visits vs. 13.4 days for those
with nine or more visits)
● lower costs ($24,400 vs. $23,400)
● less in-hospital death (44 percent vs. 40 percent) and
● fewer preventable hospitalizations for those with congestive heart
failure or chronic obstructive pulmonary disease.
"Primary care visits in the preceding year of life
are associated with less, and less costly, end of life hospital
utilization," said senior author Andrea Kronman, M.D., an attending
physician in the Section of General Internal Medicine at Boston Medical
Center and instructor of medicine at BUSM.
Researchers further concluded that providing more
primary care to Medicare beneficiaries may improve the quality of
end-of-life-care while reducing time spent in the hospital and overall
costs. In 2001, nine primary care visits cost Medicare $3,000; nine days
in the hospital cost Medicare $11,000.
"Decreasing just one hospital day for each Medicare
beneficiary at the end of life could have saved millions of dollars,"
added Kronman.
"More care at the end of life by a primary care
physician could enhance quality and reduce costs, since the provider may
have more opportunities to prevent medical complications, discuss
patient preferences, and coordinate home palliative care."
June
5, 2008 – About six percent of the people in Medicare die every year.
Surprisingly, they use up about 30 percent of the money Medicare spends
each year. A new study has found that more visits by the primary care
physician in these final months will significantly lower this cost and
result in fewer deaths in hospitals.