REPORT: Few End Stage Renal Patients Receive Hospice Care
A new study published in the Journal of the American Medical Association found that few Medicare patients on dialysis receive hospice care at the end of their lives. And when those patients do receive care, most aren’t enrolled long enough to see the benefit.
The study examined 770,000 Medicare patients receiving dialysis between January 1st, 2000 and December 31, 2014. Overall, just 20% of those patient were receiving hospice care at the time of their deaths. And among those patients, 42% enrolled in hospice within 3 days of their death.
In a report accompanying the study, the authors note that end-stage disease patients receive categorically different end of life care than patients with other life-limited diseases. They note that while hospice use for end-stage renal patients increased from 11% – 27% between the 2000 and 2012, the numbers lag far behind other illnesses. For example, “hospice use for patients with cancer, chronic obstructive pulmonary disease, and dementia is higher at 60%, 39%, and 48% respectively.” So are why end-stage renal disease patients treated so differently? It comes down to Medicare policy and the nature of the disease.
No Easy Transition from Dialysis to Hospice
Under current guidelines, Medicare – the U.S. health insurance program for the elderly – will not pay for dialysis and hospice at the same time. Researchers note that this forces terminally-ill patients to choose between their dialysis treatments and accessing hospice care, which may provide more comfort at the end of their lives and help them avoid dying in a hospital intensive care unit. To make matters worse, doctors often coach their patients that missing even one dialysis treatment could mean death. So it takes tremendous courage for patients to stop dialysis and enter hospice care.
This is unfortunate, because end-stage renal disease patients often experience intense pain and can have worse quality-of-life than other end-stage cancer or dementia patients. It’s these patients that hospice can help the most.
No Cost Savings for Delayed Hospice Care
One of hospice care’s primary goals is to provide comfort measures and avoid unnecessary interventions that won’t prolong the patient’s life. The JAMA study found that Medicare costs were nearly identical for patients who didn’t receive hospice care and and those who received 3 days of care or fewer, at $10,871 and $10756 respectively. But researchers found that when patients spent more than 15 days in hospice before they died, average Medicare costs over the last week of life dropped to $3,221. This is just one more data point that shows the tremendous benefit hospice care provides to patients with life-limiting illnesses.
Hospice Care is Still Underutilized
This new report underscores the important role hospice plays in our health care system and serves as a reminder that it remains an underutilized benefit for most Americans. This is due in part to misconceptions surrounding the nature of hospice care and Medicare guidelines that force doctors to be more conservative when recommending hospice care. For now, it’s up to patients and their family members to understand their benefits and strongly advocate for their preferred outcomes.
If you live in the Phoenix area and have questions about end-stage renal disease and hospice, or about hospice care in general, we’d love to talk. You can contact us by phone at (602) 497-4100 or by email at firstname.lastname@example.org.