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Intense End-of-Life Care Found to Be Less Likely for VA Patients

TUESDAY, Jan. 9, 2018 -- Higher-intensity end-of-life care may be driven by financial incentives present in fee-for-service Medicare but not in the Veteran Affairs (VA) integrated system, according to a report published in the January issue of Health Affairs.

Risha Gidwani-Marszowski, Dr. P.H., from the Veterans Affairs Palo Alto Health Care System in Menlo Park, Calif., and colleagues used indicators of overly intensive end-of-life care to compare the quality of care provided to veterans dying of cancer through the VA system and fee-for-service Medicare in fiscal years 2010 to 2014.

The researchers found that Medicare-reliant veterans were significantly more likely to receive high-intensity care, in the form of chemotherapy, hospital stays, admission to the intensive care unit, more days spent in the hospital, and death in the hospital. However, compared to VA-reliant patients, Medicare-reliant veterans were significantly less likely to have multiple emergency department visits. The investigators suggested that financial incentives may drive higher-intensity end-of-life care in fee-for-service Medicare but not in the VA integrated system.

"After adjusting for a variety of covariates shown to influence selection into the VA versus Medicare, we found veterans with solid tumors treated under fee-for-service Medicare were more likely to get unduly intensive health care at the end of life compared to those treated by the VA," the authors write. "To avoid putting VA-reliant veterans at risk of receiving lower-quality care, VA care-purchasing programs should develop coordination and quality monitoring programs to guard against overly intensive end-of-life care."

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Posted: January 2018