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From Health Affairs:

New Methodology To Examine Spending Patterns For End-Of-Life Care

Bethesda, MD—According to the Medicare Payment Advisory Commission, end-of-life care in the United States accounts for some 30 percent of Medicare spending. A new study, released as a Web First by Health Affairs, looked at 2012 Medicare administrative claims data and identified four unique spending trajectories. Nearly half (48.7 percent) of older Medicare beneficiaries were classified as “high persistent,” maintaining high spending throughout the year. Another 10.2 percent showed a “progressive” pattern, starting low but increasing steeply. A third group, 29.0 percent of decedents, were “moderate persistent,” mimicking the “high persistent” pattern except for a spending dip a few months prior to death; and the final group, 12.1 percent of the sample, exhibited a “late rise” in the final four months of life after very low spending in the earlier months of that final year.

©2016 Health Affairs

Identification Of Four Unique Spending Patterns Among Older Adults In The Last Year Of Life Challenges Standard Assumptions

By Matthew A. Davis, Brahmajee K. Nallamothu, Mousumi Banerjee, and Julie P.W. Bynum

Davis, Nallamothu, and Mousumi are affiliated with the University of Michigan, in Ann Arbor; Bynum is with Dartmouth College in Hanover, New Hampshire.

This study, which will also appear in the July issue of Health Affairs, was funded by the National Institute on Aging at the National Institutes of Health.

“Insight into the patterns of health care spending occurring at the end of life has important health policy implications,” the authors concluded. “Strategies such as hospice that target people exhibiting a rapid clinical decline might apply to fewer than 20 percent of older decedents. Therefore, future strategies directed at meeting the care needs of older Americans with multiple chronic conditions—not necessarily those with a poor immediate prognosis—could have the largest impact on national spending.”

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with frequent Web First studies and health policy briefs published at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, it then switches to pay-per-view for nonsubscribers. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the iPad app.

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