Dual eligibility for Medicare and Medicaid is associated with lower 30-day readmission rates in patients enrolled in a hospice program, found a recent study.1

“It makes sense that patients with more coverage for essential services outside of the hospital have lower readmissions near the end of life,” says study author Liz Chuang, MD, MPH. Chuang is an attending physician on the palliative care team at Montefiore Medical Center in Bronx, NY.

Of 2,755 inpatients who received palliative care consultation and were discharged with hospice services, 9.24% of patients with dual Medicare and Medicaid coverage were readmitted within 30 days, compared with 13.12% of others. “This matches my clinical experience working with patients and families quite well,” Chuang says.

However, the finding is somewhat surprising in another way: At other points in the trajectory of chronic illness, those who are dual eligible for Medicare and Medicaid have been shown to have high healthcare utilization, including hospital readmission.

“This is likely due both to their greater disease burden and to limited social resources,” says Chuang. The study’s findings show that with appropriate custodial care provided by Medicaid, these patients can achieve lower hospital utilization at the end of life.

“This finding has ethical implications for end-of-life care,” notes Chuang.

Multiple studies have shown that patients prefer to be cared for at home at the end of life. “Hospitalization near the end of life results in poorer quality of care and increased cost,” adds Chuang.

In Chuang’s view, providing custodial support — home attendants or nursing home care — through Medicaid, in addition to hospice care, can achieve the quality of care that dying patients deserve.

“One interesting point is that patients who are near poor or lower middle class tend to fare less well,” says Chuang. These patients cannot afford to pay for custodial care, but have income that’s too high to qualify for Medicaid.

“This speaks to the need for better long-term care coverage for the elderly in the U.S.,” says Chuang.

REFERENCE

  1. Whitney P, Chuang EJ. Relationship between insurance and 30-day readmission rates in patients 65 years and older discharged from an acute care hospital with hospice services. J Hosp Med 2016; 11(10):688-693.

SOURCE

  • Liz Chuang, MD, MPH, Assistant Professor, Department of Family and Social Medicine, Palliative Care Services, Montefiore Medical Center, Bronx, NY. Email: echuang@montefiore.org.