Medicare HMOs use end-of-life care cautiously

Patients enrolled in a Medicare HMO are less likely to receive unnecessary or expensive end-of-life care than those in traditional fee-for-service plans. The results appeared in the Sept. 24 issue of the Journal of the American Medical Association. Researchers at the Palo Alto Veterans Affairs Health Care System and colleagues at other California institutions reviewed the billing records of more than 80,000 Medicare patients hospitalized in intensive care units in 1994.

Almost 5% of patients received care deemed potentially ineffective, defined as the "concurrence of prolonged, high-intensity medical treatment and short-term death" by the researchers. The same 5%, however, used 21% of the total intensive care resources for the year studied.

Medicare HMO enrollees, in contrast, were almost 25% less likely than those enrolled in traditional Medicare plans to receive potentially ineffective care. These patients were no more likely than their fee-for-service counterparts to experience in-hospital death. Additionally, these patients were only slightly more likely to die within 100 days of hospital discharge.

The researchers concluded that critical care technology can either extend life or extend the dying process and the suffering that often accompanies it. They emphasized the impact of the physician’s judgments about when critical care is likely to be ineffective. Researchers also allude that care provided in Medicare HMOs may be better than care provided in traditional Medicare methods.

[Editor’s note: For a complete copy of the study, see the full published report on the JAMA page on the World Wide Web: Print copies of individual articles are available from Genuine Article/Institute for Scientific Information. Telephone: (215) 386-0100, ext. 1536. Fax: (215) 386-4343. E-mail:]