NEW HAVEN, CT — Although fee-for-service Medicare does not allows simultaneous receipt of cancer treatment and hospice care—i.e, concurrent care—VHA does.
That raises the question, according to a presentation at the recent 2020 American Society of Clinical Oncology meeting, whether there is a “spillover” relation between end of life care in the VHA and Medicare systems at the regional level.
Researchers from The Ohio State University, Yale University and the Providence, RI, VAMC, pointed out that many physicians who care for patients in the VHA also care for private sector patients, it is unclear.1
To determine that, the study team examined temporal trends, as well as regional-level associations between Medicare and VHA EOL practice for patients with advanced lung cancer. A retrospective study was conducted on VHA and SEER-Medicare decedents from 2006-2012 with stage IV non-small cell lung cancer who received any lung cancer care.
For purposes of the study, aggressive care at EOL was defined as any of the following within 30 days of death, —intensive care unit admission, no-hospice care, cardiopulmonary resuscitation, mechanical ventilation, more than one inpatient admission and receipt of chemotherapy.
Researchers also analyzed the association between Medicare hospital referral region hospice admissions, Medicare HRR EOL spending and VHA aggressive care use adjusted for patient’s characteristics.
Results indicated that use of aggressive care significantly decreased during the study period, from 46% to 31% among 18,371 veterans and from 42% to 38% among 25,283 in the SEER-Medicare cohort, (t-test P < .05). At the same time, hospice use significantly increased within both cohorts (p < .001).
The authors reported that the receipt of chemotherapy at end-of-life was similar for both cohorts throughout the study period. Veterans who received care in regions with higher hospice admissions among Medicare beneficiaries were significantly less likely to receive aggressive care at end-of-life (adjusted Odds Ratio (aOR): 0.13 95%CI: 0.08-0.23, P < .001) than veterans in regions with lower Medicare hospice use, the study noted.
Researchers also determined that Medicare hospital referral region hospice spending at the end of life was not associated with receipt of aggressive care among Medicare beneficiaries (aOR): 1.004 95%CI: 1.00-1.009, P = 0.07).
“Perhaps due to availability of concurrent care, VHA patients received less aggressive care at EOL as compared to SM patients,” the authors concluded. “At the regional level, greater hospice use among Medicare beneficiaries was significantly associated with reduced AC within the VHA.”
Presley CJ, Kaur K, Han L, Soulos PR, et. al. (2020, May 29-31.) Aggressive care at end-of-life in the Veteran’s Health Administration versus fee-for-service Medicare among patients with advanced lung cancer. ASCO20 Virtual Scientific Program. https://meetinglibrary.asco.org/record/189223/abstract