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Receipt of Hospice With Dialysis Varies by Payer within the VA System

A higher proportion of veterans obtained concurrent dialysis and hospice care when the hospice payer was the Veteran’s Well being Administration (VA) somewhat than Medicare, a brand new examine finds. Longer hospice stays are believed to supply higher end-of-life care.

Investigators studied information from 18,420 veterans with end-stage kidney illness (ESKD) who obtained hospice companies from 2007 to 2016 (imply age 75.4 years; 94.8% males; 16.3% Black). The overwhelming majority of veterans (89%) obtained hospice companies underneath Medicare, whereas 8.6% obtained VA inpatient hospice, and a couple of.0% obtained VA group care hospice.

Solely 5231 of the veterans with kidney failure (28%) continued to obtain dialysis after hospice initiation. In adjusted analyses, the speed of concurrent care was greater amongst veterans enrolled within the VA inpatient hospice or VA group care hospice program in contrast with the Medicare hospice program: 55% and 42% vs 25%, Melissa W. Wachterman, MD, MSc, MPH, of Veterans Affairs Boston Well being Care System in Massachusetts, and colleagues reported in JAMA Well being Discussion board. Roughly half (46.8%) of Medicare hospice beneficiaries who didn’t obtain concurrent dialysis had ESKD as their hospice prognosis in contrast with solely 6.3% of beneficiaries who did obtain dialysis.

Proceed Studying

The VA’s 2009 Complete Finish-of-Life Care Initiative seeks to supply hospice entry to all veterans, together with these nonetheless receiving remedy for his or her illness.

“These findings spotlight the VA’s necessary function in supporting concurrent dialysis for veterans with ESKD and recommend that Medicare’s restrictive hospice coverage considerably limits entry to concurrent take care of beneficiaries with ESKD, even amongst veterans,” Dr Wachterman’s group wrote.

The VA paid for many of the dialysis therapies (87%) after hospice initiation, together with for the 63.1% of Medicare beneficiaries who had a hospice prognosis aside from ESKD, corresponding to most cancers.

Median hospice size of keep was considerably longer for veterans who did vs didn’t obtain concurrent dialysis: 43 vs 4 days, the investigators reported, which can point out higher end-of-life care.


Wachterman MC, Corneau EE, O’Hare AM, Keating NL, Mor V. Affiliation of hospice payer with concurrent receipt of hospice and dialysis amongst US veterans with end-stage kidney illness: A retrospective evaluation of a nationwide cohort. JAMA Well being Discussion board. Revealed on-line October 21, 2022. doi:10.1001/jamahealthforum.2022.3708

This text initially appeared on Renal and Urology Information



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