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Hospice effect on government expenditures among nursing home residents
Gozalo PL, Miller SC, Intrator O, Barber JP, Mor V.. Health services research, 2008-02-01
Topic: Risk, prevention and care in population studies
Objective To examine the effect of the Medicare hospice benefit on Medicare and Medicaid expenditures by dual-eligible Medicare-Medicaid nursing home (NH) residents. Data sources/study setting Secondary data for NH residents for 1998-1999. Study design Retrospective cohort study of NH residents in the state of Florida who died between July and December 1999 (N=5,774). Medicare claims identified hospice enrollment, and Medicare and Medicaid claims identified expenditures by categories of care. Nursing home resident assessments were used to control for case-mix differences. Geocoding of nursing homes, hospice providers and hospitals was used to identify and characterize local health care markets. Data collection/extraction methods A file was constructed linking Medicare and Medicaid claims to Minimum Data Set assessments of NH residents, and NH provider (Online Survey and Certification Automated Record) and hospice provider files. Principal findings Hospice enrollment results in substantial savings in government expenditures (22 percent) among all short-stay (< or =90 days) dying NH residents. For long-stay (>90 days) dying NH residents, hospice provides some savings (8 percent) among cancer residents while it is cost-neutral among dementia residents and adds some cost (10 percent) for residents with a diagnosis other than cancer or dementia. There is evidence of selection bias, particularly among residents with cancer (19 percent savings unadjusted versus 8 percent adjusted). Among short-stay NH residents, hospice greatly reduces Medicare expenditures but increases Medicaid expenditures. Conclusions Hospice enrollment results in lower combined Medicare/Medicaid expenditures in the last month of life, particularly among short-stay NH residents. This effect, however, varies by diagnosis and NH length of stay. In addition, for short-stay NH residents, current payment policy creates a Medicare incentive and Medicaid disincentive for promoting residents' referral to hospice.
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APA 7th
Gozalo, P. L., Miller, S. C., Intrator, O., Barber, J. P., & Mor, V. (2008). Hospice effect on government expenditures among nursing home residents. Health services research. https://doi.org/10.1111/j.1475-6773.2007.00746.x
Vancouver
Gozalo PL, Miller SC, Intrator O, Barber JP, Mor V. Hospice effect on government expenditures among nursing home residents. Health services research. 2008. doi:10.1111/j.1475-6773.2007.00746.x. PMID: 18211522.
BibTeX
@article{gozalo2008-18211522,
author = {Gozalo, P. L. and Miller, S. C. and Intrator, O. and Barber, J. P. and Mor, V.},
title = {{Hospice effect on government expenditures among nursing home residents}},
journal = {Health services research},
year = {2008},
doi = {10.1111/j.1475-6773.2007.00746.x},
pmid = {18211522},
url = {https://doi.org/10.1111/j.1475-6773.2007.00746.x}
}
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Key findings
- Principal findings Hospice enrollment results in substantial savings in government expenditures (22 percent) among all short-stay (< or =90 days) dying NH residents.
- There is evidence of selection bias, particularly among residents with cancer (19 percent savings unadjusted versus 8 percent adjusted).
- Conclusions Hospice enrollment results in lower combined Medicare/Medicaid expenditures in the last month of life, particularly among short-stay NH residents.
Study details
- Study designcohort study
- Participants5,774
- Evidence strengthModerate
How this study scored 62/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for effect reported and randomized / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multicenter collaboration, so those were left out: it earned 36 of the 58 points we could judge it on, which is 62 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Health services research) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2008 — within 20 year(s) of the newest study here |
| Sample size | 3 / 4 | 5,774 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multicenter collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 18211522) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 36 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 36 of the 58 points we could judge it on is 62 out of 100. |
| Total | 62 / 100 | — |
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