Virnig BA, Morgan RO, Persily NA, DeVito CA, Xue L; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1997; 14: 241.
University of Miami, FL 33140, USA.
RESEARCH OBJECTIVES: To examine whether beneficiaries enrolled in Medicare HMOs have different patterns of hospice use compared to persons in Fee-for-service (FFS) Medicare. BACKGROUNG: Elderly (age 65+) Medicare beneficiaries can choose to receive their care under the usual, FFS system or through a Medicare HMO. Receiving care through a Medicare HMO often costs beneficiaries less due to reduced copayments and increased services provided (e.g., medications, medical consumables). However, there is concern that beneficiaries in HMOs receive less care due to the different incentives associated with the two systems. Under HMOs, physicians are encouraged to be frugal with their treatment and avoid care that might be unnecessary. Under FFS there is less motivation to limit care for which the physician or hospital might reasonably expect reimbursement. However, under Medicare, hospice care is reimbursed directly by HCFA for care they provide, regardless of whether the beneficiary is enrolled in FFS Medicare or a Medicare HMO. Thus, differences in patterns of hospice use for beneficiaries enrolled in the two programs might reflect differences in care philosophy rather than responses to incentives. STUDY DESIGN: We examined 1993 Medicare Hospice claims for elderly (age 65+) beneficiaries residing in South Florida (Dade, Broward, Monroe and Palm Beach Counties). Demographic information (age, sex, race) and HMO enrollment status were obtained from the comprehensive enrollment (denominator) file. Information on duration of hospice use was obtained from hospice claims records. Kaplan-Meier techniques were used to calculate survival in hospice while taking censoring into account. Cox Proportional Hazards modeling was used to test differences in survival in hospice while simultaneously adjusting for demographic factors. PRINCIPAL FINDINGS: In 1993, 19,251 beneficiaries enrolled in Medicare hospice. Of these, 3,778 (19.6%) were enrolled in Medicare HMOs. After adjusting for differences in age, sex and race distributions, a higher percentage of deaths occurred in hospice for HMO enrollees than for FFS Medicare (27% and 14% respectively). FFS and HMO hospice users were similar with respect to their age (median 78 years for both groups). However, a higher percentage of HMO enrollees were non-white (12% vs. 7%) or male (62% vs. 59%). Median time in hospice prior to death was 24 days for both HMO and FFS enrolled beneficiaries. Similarly, in both groups, 26% of enrollees died within 7 days of entering hospice. A higher percentage of HMO enrollees than FFS survived at least 180 days after entering hospice (12.7% vs. 10.1%). Overall differences in survival between the two groups were observed after adjustment for age, sex and race, with longer survival among HMO enrollees. CONCLUSIONS: It is clear that for both HMO and FFS Medicare, beneficiaries are entered into hospice far too late in the course of their illness (as evidenced by high 7 day mortality rates). Differences between FFS and HMOs were slight. This suggests that hospice use is not overly affected by different incentives or care philosophies across the two Medicare options. RELEVANCE TO CLINICAL PRACTICE AND POLICY: It is important to understand whether different care philosophies or physician incentives in Medicare HMOs and Medicare FFS affect care provided. Terminally ill elderly are a particularly vulnerable group for whom hospice care is a valuable service that should not be under used.
Publication Types:
Keywords:
- Aged
- Fee-for-Service Plans
- Florida
- Health Maintenance Organizations
- Hospice Care
- Hospices
- Hospitals
- Humans
- Male
- Medicare
- Terminally Ill
- economics
- utilization
- hsrmtgs
Other ID:
UI: 102233757
From Meeting Abstracts