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

Publication ,  Journal Article
Taylor, DH; Kaufman, BG; Olson, A; Harker, M; Anderson, D; Cross, SH; Bonsignore, L; Bull, J
Published in: J Pain Symptom Manage
October 2019

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.

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Published In

J Pain Symptom Manage

DOI

EISSN

1873-6513

Publication Date

October 2019

Volume

58

Issue

4

Start / End Page

654 / 661.e2

Location

United States

Related Subject Headings

  • United States
  • South Carolina
  • Palliative Care
  • North Carolina
  • Medicare
  • Male
  • Humans
  • Health Expenditures
  • Female
  • Community Health Services
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Taylor, D. H., Kaufman, B. G., Olson, A., Harker, M., Anderson, D., Cross, S. H., … Bull, J. (2019). Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration. J Pain Symptom Manage, 58(4), 654-661.e2. https://doi.org/10.1016/j.jpainsymman.2019.06.019
Taylor, Donald H., Brystana G. Kaufman, Andrew Olson, Matthew Harker, David Anderson, Sarah H. Cross, Lindsay Bonsignore, and Janet Bull. “Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration.J Pain Symptom Manage 58, no. 4 (October 2019): 654-661.e2. https://doi.org/10.1016/j.jpainsymman.2019.06.019.
Taylor DH, Kaufman BG, Olson A, Harker M, Anderson D, Cross SH, et al. Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration. J Pain Symptom Manage. 2019 Oct;58(4):654-661.e2.
Taylor, Donald H., et al. “Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration.J Pain Symptom Manage, vol. 58, no. 4, Oct. 2019, pp. 654-661.e2. Pubmed, doi:10.1016/j.jpainsymman.2019.06.019.
Taylor DH, Kaufman BG, Olson A, Harker M, Anderson D, Cross SH, Bonsignore L, Bull J. Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration. J Pain Symptom Manage. 2019 Oct;58(4):654-661.e2.
Journal cover image

Published In

J Pain Symptom Manage

DOI

EISSN

1873-6513

Publication Date

October 2019

Volume

58

Issue

4

Start / End Page

654 / 661.e2

Location

United States

Related Subject Headings

  • United States
  • South Carolina
  • Palliative Care
  • North Carolina
  • Medicare
  • Male
  • Humans
  • Health Expenditures
  • Female
  • Community Health Services