VA Better Than Medicare in End-of-Life Care for Patients With Cancer

01/10/18

Patients with cancer treated through the Department of Veterans Affairs (VA) are less likely to receive excessive end-of-life interventions than patients treated through Medicare, according to a recent study published in Health Affairs (online January 8, 2018; doi:10.1377/hlthaff.2017.0883).

Many patients with cancer have admitted to preferring to die at home and foregoing intensive medical care at the end of their lives. However, a few studies have shown that the use and cost of health care increases in the last month of life for these patients. Some estimates have 4% of the federal budget allocated to Medicare patients in the last year of life.

Risha Gidwani-Marszowski, DrPH, consulting assistant professor of medicine, Stanford University, and colleagues conducted a study to compare the quality of care provided through VA and Medicare to veterans dying of cancer from 2009 through 2014. Researchers examined 87,251 veterans older than 66 years who had solid tumors. Specific criteria for undesirable or burdensome services at the end of life included chemotherapy administration, ED visits, hospital admissions and days spent in the hospital, death in the hospital, and admission to intensive care.

In the study, higher number of veterans receiving these services indicated lower quality of care.

Results of the study showed that Medicare patients were more likely to receive burdensome intensive care at the end of life including chemotherapy, hospitalization, admission to the intensive care unit, longer stays in the hospital, and death in the hospital, compared with those who received care through the VA.

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Contrarily, Medicare patients were significantly less likely to have multiple ED visits than VA patients.

Dr Gidwani-Marszowski and colleagues noted that higher-intensity end of life care may be driven by financial incentives present in fee-for-service Medicare but not in the VA’s system. “The findings are not just important for veterans and VA policy, but for anybody who needs medical care at the end of life, which is a majority of us,” she said in a press release (January 8, 2018). “We as a society need to ensure we are setting up the organization of health care and its financial incentives to ensure that the services patients receive are the ones that are in their best interests at the end of life.”—Zachary Bessette