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Medicare Spending at the End of Life: A Snapshot of Beneficiaries Who Died in 2014 and the Cost of Their Care

Introduction
  1. National Center for Health Statistics, Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities, 2016, Table 19: “Leading causes of death and numbers of deaths, by sex, race, and Hispanic origin: United States, 1980 and 2014,” available at http://www.cdc.gov/nchs/data/hus/hus15.pdf#019.

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  2. Kaiser Family Foundation analysis of a five percent sample of 2014 Medicare claims from the Centers for Medicare & Medicaid Services’ Chronic Conditions Data Warehouse.

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  3. Gerald F. Riley and James D. Lubitz, “Long-Term Trends in Medicare Payments in the Last Year of Life,” Health Services Research April 2010; 45(2):565-576.

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  4. We exclude beneficiaries who are exactly age 65 from the analysis of spending by year of age and spending comparisons between beneficiaries under age 65 and over age 65 because many are enrolled for less than a full year, resulting in less than an entire year of Medicare spending data.

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  5. Medicare spending for Medicare Advantage enrollees takes the form of monthly capitation payments which are not based on actual service utilization.

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Findings
  1. We are unable to examine spending data that spans the last 12 months of life for decedents in our analysis because we are unable to disaggregate spending data for a given beneficiary for periods of time less than one calendar year. Had we been able to calculate Medicare spending for a 12-month period for both survivors and dependents, the difference in per capita spending between decedents and survivors and the estimate of spending on decedents as a share of total Medicare spending would have been larger.

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  2. Gretchen Jacobson, Giselle Casillas, Anthony Damico, Tricia Neuman, and Marsha Gold, “Medicare Advantage 2016 Spotlight: Enrollment Market Update,” Kaiser Family Foundation, May 2016, available at https://www.kff.org/medicare/issue-brief/medicare-advantage-2016-spotlight-enrollment-market-update/.

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  3. Elena Byhoff, John A. Harris, and John Z. Ayanian, “Characteristics of Decedents in Medicare Advantage and Traditional Medicare,” Research Letter, JAMA Internal Medicine June 2016; Published online ahead of print: E1-3.

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  4. For more information, see “10 FAQs: Medicare’s Role in End-of-Life Care,” Kaiser Family Foundation, November 2015, available at https://www.kff.org/medicare/fact-sheet/10-faqs-medicares-role-in-end-of-life-care/.

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