Medicare Trends in End-of-Life Care for Californians
Californians who died in 2014 were analyzed in terms of Medicare coverage, spending at the end of life, and hospice care utilization. The data shows a decrease in the share of total Medicare spending, variations in spending with age, and an increase in hospice use and spending over the years. Furthermore, a significant percentage of physicians in California have not received training to discuss end-of-life care.
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Figure 1 4 of 5 Californians who died in 2014 were covered by Medicare 196,000 Total Medicare Beneficiary Deaths in California 246,000 Total Deaths in California NOTE: Estimates rounded to the nearest thousand. SOURCE: Kaiser Family Foundation analysis of a 5 percent sample of Medicare claims from CMS Chronic Conditions Data Warehouse, 2014 (for total Medicare beneficiary deaths in California in 2014); State of California, Department of Public Health, Death Records (for total deaths in California in 2014).
Figure 2 The share of total Medicare spending for Californians at the end of life has decreased Share of total Medicare spending in California 22% 19.1% 20% 18.3% 18% 16.4% 14.8% 14.8% 14.5% 14.3%13.9% 16% 14% 12% 10% 8% 6% 4% 2% 0% 2000 2002 2004 2006 2008 2010 2012 2014 NOTE: Excludes beneficiaries in Medicare Advantage. SOURCE: Kaiser Family Foundation analysis of a 5 percent sample of Medicare claims from CMS Chronic Conditions Data Warehouse, 2000-2014.
Figure 3 Medicare spending was higher for Californians at the end of life in 2014 $42,048 per person $9,466 per person Others with Medicare in California Decedents with Medicare in California NOTE: Excludes beneficiaries in Medicare Advantage. SOURCE: Kaiser Family Foundation analysis of a 5 percent sample of Medicare claims from CMS Chronic Conditions Data Warehouse, 2014.
Figure 4 Medicare spending for Californians end-of-life care decreased with age in 2014 Decedents with Medicare in California $50,000 $49,456 Spending per Californian $40,000 $24,676 $30,000 $20,000 Others with Medicare in California $10,000 $5,919 $11,719 $0 66-69 70-74 75-79 80-84 85-89 90-94 95+ Age Group in Years NOTE: Excludes beneficiaries in Medicare Advantage. 65-year-olds excluded because most are enrolled for less than one year. SOURCE: Kaiser Family Foundation analysis of a 5 percent sample of Medicare claims from CMS Chronic Conditions Data Warehouse, 2014.
Figure 5 Medicare hospice use and spending in California has increased Share of California Decedents with Medicare who Received Hospice Care Total Medicare Hospice Spending in California $814.4 Million 39% 20% $142.5 Million 2000 2014 2000 2014 NOTE: Excludes beneficiaries in Medicare Advantage. SOURCE: Kaiser Family Foundation analysis of a 5 percent sample of Medicare claims from CMS Chronic Conditions Data Warehouse, 2000 and 2014.
Figure 6 Most physicians in California report not having had training to discuss end-of-life care Report NOT having had training 63% 3% - Don t know 34% Report having had training Before January 1, 2016, Medicare did not reimburse physicians for patient visits to discuss EOL care. SOURCE: California Health Care Foundation, Cambia Health Foundation, John A. Hartford Foundation, Topline Results: Survey of Physicians on Advance Care Planning Conversations, fielded February 18-March 7, 2016.
