(HealthDay News) — Among Medicare beneficiaries on hemodialysis, few patients are enrolled in hospice at the end of life, regardless of the spending trajectory during the last year of life, according to a study published in the June issue of Health Affairs.

Ann M. O’Hare, MD, from the University of Washington in Seattle, and colleagues examined hospice use and timing in a national cohort of Medicare beneficiaries on hemodialysis with distinct spending trajectories during their last year of life.

The researchers identified 4 distinct spending trajectories, which represented different intensities of care. Within the cohort, 9, 13, 41, and 37% had escalated spending, persistently high spending, relatively low spending with late escalation, and moderate spending with late escalation. The percentages of patients enrolled in hospice at the time of death were universally low across the groups, varying from 19 to 21% of those with persistently high costs and moderate costs, respectively. The median number of days spent in hospice during the last year of life was almost the same (5 or 6 days) across the groups.

“These findings likely reflect the impact of policy and perhaps other barriers to the receipt of hospice care for patients on hemodialysis and signal the need for more flexible approaches to the provision of end-of-life care for members of this population,” the authors write.

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O’Hare AM, Hailpern SM, Wachterman M, et al. Hospice Use And End-Of-Life Spending Trajectories In Medicare Beneficiaries On Hemodialysis. JAMA Surg. DOI: 0.1377/hlthaff.2017.1181