Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration.

Journal Article (Journal Article)

CONTEXT: Palliative care improves patient and family outcomes and may reduce the cost of care, but this service is underutilized among Medicare beneficiaries. OBJECTIVES: To describe enrollment patterns and outcomes associated with the Center for Medicare and Medicaid Innovation expansion of a multisetting community palliative care program in North and South Carolina. METHODS: This observational study characterizes the Center for Medicare and Medicaid Innovation cohort's care and cost trajectories after enrollment. Program participants were age-eligible Medicare fee-for-service beneficiaries living in Western North Carolina and South Carolina who enrolled in a palliative care program from September 1, 2014, to August 31, 2017. End-of-life costs were compared between enrolled and nonenrolled decedents. Program administrative data and 100% Medicare claims data were used. RESULTS: A total of 5243 Medicare beneficiaries enrolled in the program from community (19%), facility (21%), small hospital (27%), or large hospital (33%) settings. Changes in Medicare expenditures in the 30 days after enrollment varied by setting. Adjusted odds of hospice use were 60% higher (OR = 1.60; CI = 1.47, 1.75) for enrolled decedents relative to nonenrolled decedents. Participants discharged to hospice vs. participants not had 17% (OR = 0.83 CI = 0.72, 0.94) lower costs. Among enrolled decedents those enrolled for at least 30 days vs. <30 days had 42% (OR = 0.58, CI = 0.49, 0.69) lower costs in the last 30 days of life. CONCLUSIONS: Expansion of community palliative care programs into multiple enrollment settings is feasible. It may improve hospice utilization among enrollees. Heterogeneous program participation by program setting pose challenges to a standardizing reimbursement policy.

Full Text

Duke Authors

Cited Authors

  • Taylor, DH; Kaufman, BG; Olson, A; Harker, M; Anderson, D; Cross, SH; Bonsignore, L; Bull, J

Published Date

  • October 2019

Published In

Volume / Issue

  • 58 / 4

Start / End Page

  • 654 - 661.e2

PubMed ID

  • 31254641

Electronic International Standard Serial Number (EISSN)

  • 1873-6513

Digital Object Identifier (DOI)

  • 10.1016/j.jpainsymman.2019.06.019


  • eng

Conference Location

  • United States