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APHA Scientific Session and Event Listing

Recorded presentation

Charles E. Gessert, MD, MPH and Irina V. Haller, PhD, MS. Division of Education and Research, SMDC Health System, 400 E 3rd Street, Duluth, MN 55805-1983, 218-786-8176, cgessert@smdc.org

Background: Medicare beneficiaries incur 27-30% of their lifetime charges in the last year of life; most charges occur in the last quarter. Factors associated with high Medicare charges at the end of life include less advanced age, non-white race, absence of advanced directive, and urban residence. Methods: We analyzed Medicare charges in the last year of life for nursing home (NH) residents with severe cognitive impairment, focusing on rural-urban differences. The study population consisted of 3710 NH residents (1886 rural, 1824 urban) in MN and TX who died in 2000-2001. Data on Medicare charges were obtained from 1998-2001 CMS MedPAR files. Results: During the last year of life, unadjusted Medicare charges averaged $12,462 for rural subjects; $31,738 for urban. The charges were distributed across the four quarters of the year similarly for the two populations, with 15-20% of charges incurred in each of the first three quarters of the year, and 48% (rural) and 52% (urban) in the last quarter. The proportions of rural and urban subjects who were hospitalized in each quarter were similar: 15%-19% during each of the first three quarters; and 37% (rural) and 43% (urban) in the final quarter. The charges for hospitalized subjects (N = 1999) were distributed similarly to those of the entire study population. Discussion: Medicare charges during the last year of life were lower for rural NH residents with dementia than for their urban counterparts. This pattern was found in all four quarters of the last year of life.

Learning Objectives:

• Describe the difference between the Medicare charges for rural and urban nursing home residents with dementia in the last year of life.
• Describe the distribution of charges by quarter in the last year of life for rural and urban decedents with dementia.

Keywords: Cost Issues, End-of-Life Care

Awards: Excellence in Aging and Rural Health - Honorable Mention

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation