Increase in Medicare Beneficiaries Discharged to Hospice Care

A recent study published in the Annals of the American Thoracic Society reveals a significant increase in the number of Medicare beneficiaries discharged to hospice care after admission to intensive care units (ICUs) from 2011 to 2023. Led by Dr. Anica C. Law from the Boston University School of Medicine, the research analyzed data from 10.6 million Medicare beneficiaries over the age of 65 who were enrolled in fee-for-service Medicare and admitted to ICUs during this period.

The analysis found that hospice discharges increased from 388 to 572 per 100,000 beneficiaries, with the percentage of ICU patients discharged to hospice rising from 5.6% to 6.8%. In-hospital mortality and 30-day mortality rates remained stable, changing from 16.0% to 15.0% and 23.9% to 22.0%, respectively. Do-not-resuscitate orders grew from 10.6% to 24.9%, while palliative care delivery rose from 6.8% to 14.8%, though the median ICU length of stay stayed consistent at five to six days.

The study also observed a rise in the median rate of hospice discharge, standardized by 30-day mortality at the hospital level, from 0.19 to 0.27, suggesting a trend toward shifting a larger proportion of short-term decedents to hospice care. Dr. Law emphasized the importance of these findings, as they highlight an increasing hospital focus on directing patients at high risk of mortality towards comfort-focused care options. These patterns saw temporary deviations during the COVID-19 pandemic.