One goal of the MediCaring Project is to create a detailed profile of end-of-life care in Medicare. The objectives of the proposed study are:
- To document in detail the cost and patterns of end-of-life care for Medicare beneficiaries within five broad categories (cancers, dementia, congestive heart failure, chronic obstructive pulmonary disease, all other deaths).
- To examine the geographic variations in cost and patterns of care within these categories, and determine the factors associated with variation in cost and patterns of care for these diseases.
- To demonstrate methods for prospectively identifying cohorts of beneficiaries likely to be nearing end of life, and to calculate prospective capitation rates for these cohorts.
The overall goal of this work is to obtain basic research needed to reshape Medicare payment policy for end-of-life care. Restructuring Medicare policy toward more integrated payment requires identifying individuals likely to benefit from special end-of-life care, determining services and providers to be covered under an integrated payment, calculating Medicare’s average cost for those services, and analyzing variation around that average cost. The proposed research will provide detailed data needed to discuss options for restructuring Medicare payment for end-of-life care.
The project includes a combination of descriptive analysis and hypothesis testing. A databook on Medicare end-of-life care will be created that represents a comprehensive profile of cost and use. Descriptive analysis will be guided by a National Advisory Board of experts in end-of-life care, with a goal of developing a useful reference on Medicare-financed end-of-life care. The second phase of the project will focus on testing specific hypotheses regarding cost and use.