A greater proportion of veterans received concurrent dialysis and hospice care when the hospice payer was the Veteran’s Health Administration (VA) rather than Medicare, a new study finds. Longer hospice stays are believed to provide better end-of-life care.

Investigators studied data from 18,420 veterans with end-stage kidney disease (ESKD) who received hospice services from 2007 to 2016 (mean age 75.4 years; 94.8% men; 16.3% Black). The vast majority of veterans (89%) received hospice services under Medicare, whereas 8.6% received VA inpatient hospice, and 2.0% received VA community care hospice.

Only 5231 of the veterans with kidney failure (28%) continued to receive dialysis after hospice initiation. In adjusted analyses, the rate of concurrent care was higher among veterans enrolled in the VA inpatient hospice or VA community care hospice program compared with the Medicare hospice program: 55% and 42% vs 25%, Melissa W. Wachterman, MD, MSc, MPH, of Veterans Affairs Boston Health Care System in Massachusetts, and colleagues reported in JAMA Health Forum. Approximately half (46.8%) of Medicare hospice beneficiaries who did not receive concurrent dialysis had ESKD as their hospice diagnosis compared with only 6.3% of beneficiaries who did receive dialysis.

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The VA’s 2009 Comprehensive End-of-Life Care Initiative seeks to provide hospice access to all veterans, including those still receiving treatment for their disease.

“These findings highlight the VA’s important role in supporting concurrent dialysis for veterans with ESKD and suggest that Medicare’s restrictive hospice policy substantially limits access to concurrent care for beneficiaries with ESKD, even among veterans,” Dr Wachterman’s team wrote.

The VA paid for most of the dialysis treatments (87%) after hospice initiation, including for the 63.1% of Medicare beneficiaries who had a hospice diagnosis other than ESKD, such as cancer.

Median hospice length of stay was substantially longer for veterans who did vs did not receive concurrent dialysis: 43 vs 4 days, the investigators reported, which may indicate better end-of-life care.


Wachterman MC, Corneau EE, O’Hare AM, Keating NL, Mor V. Association of hospice payer with concurrent receipt of hospice and dialysis among US veterans with end-stage kidney disease: A retrospective analysis of a national cohort. JAMA Health Forum. Published online October 21, 2022. doi:10.1001/jamahealthforum.2022.3708