In areas of the country that have high Medicare expenditures, end-of-life Medicare spending decreases significantly for patients who have advance directives in place that limit treatment, a new study published in the Journal of the American Medical Association
"Our results indicate a statistically and economically significant relationship between advance directives and regional practice patterns," the study's authors wrote. "The regional variations literature has asserted that significant savings to the Medicare population could be achieved if high-spending regions practiced more like low-spending regions."
Medicare expenditures for patients living in high-spending regions and who had advance directives limiting their care were $33,933 in the last six months of life, on average, versus $39,518 for patients in those regions who did not have an advance directive in place. Directives also led to lower chances of in-hospital deaths in high- and medium-spending regions and an increased use of hospice care. However, healthcare costs overall remained the same in regions with low or medium levels of end-of-life spending.
The study, results of which appear in Wednesday's issue of JAMA, examined end-of-life treatment and costs—a frequent focus in attempts to curb Medicare spending. The research showed those spending less on end-of-life care were more likely (42%) to have a treatment-limited directive in place compared with those living in areas that spend more (36%). Advance directives include living wills and the appointment of a surrogate to make healthcare decisions if failing health impedes the patient from doing so.
"Regional Variation in the Association Between Advance Directives and End-of-Life Medicare Expenditures" was authored by University of Michigan researchers. The study analyzed Medicare and Health and Retirement Study data from 1998 to 2007 from 3,302 patients who died and qualified for Medicare through disability or end-stage renal disease. The patients' average age was 83. Researchers used hospital referral region data reported in the Dartmouth Atlas of Health Care to break down the geographical regions.