News Briefs – JANUARY 2025
by INELDA
Longevity Is Up, But Years of Healthful Life Are Not
Globally, life expectancy continues to rise. But another figure rises in tandem: the health span-lifespan gap, defined as the disparity between life expectancy (lifespan) and years of healthy longevity (health span). The gap has risen from 8.5 years in 2000 to 9.6 years in 2019, a 13% increase, reveals research published in JAMA Network Open.
“Growing older often means more years of life burdened with disease,” Dr. Andre Terzic, coauthor of the study along with Armin Garmany, told the news network of the Mayo Clinic, where the research was conducted. “This research has important practice and policy implications by bringing attention to a growing threat to the quality of longevity and the need to close the health span-lifespan gap.”
Of the 183 nations included in the research, the United States had the largest gap (12.4 years), followed by Australia (12.1 years) and New Zealand (11.8 years). The smallest gaps were found in Lesotho (6.5 years), Central African Republic (6.7 years) and Somalia (6.8 years). Women had a larger gap than men, living a mean of 2.4 years longer in poor health at end of life.
Medicare Hospice Utilization Rises—as Does Fraud
Hospice utilization among people who died while on Medicare hit nearly 52% in 2023, surpassing 50% for the first time since the beginning of the pandemic. This increase applies across a variety of populations, regardless of race, sex, and urban or rural location. In addition to utilization, rates of care days, length of stay, and patient visits per week rose—all to the tune of $25.7 billion in total Medicare hospice payments for the year, according to Hospice News.
The 2023 readout of Medicare hospice use also revealed that fraud is likely on the rise in states already known to be rife with Medicare fraud, including Arizona, California, Nevada, and Texas. This rise is indicated in part by a rush of new hospices in areas where there was not a need for more hospice care.
For-profit hospices saw a 16% profit margin in 2023, with nonprofit hospices realizing around 0.3%. Nearly all of the 10% increase in last year’s number of hospices were for-profit organizations.
“The number of providers entirely reflects an increase in the number of for-profit providers,” Kim Neuman, principal policy analyst for the Medicare Payment Advisory Commission, said at a meeting in December. Of the five states that had large increases in the number of providers, four announced that they would implement enhanced integrity oversight for new hospices, she said.
Advance Care Planning Interventions Can Bring Unexpected Concerns
When two health care systems facilitated advance care planning among patients over age 65 as a part of a study led by Johns Hopkins University, more people documented their end-of-life preferences. But another factor rose in tandem: burdensome care.
Study participants in the intervention group received access to a trained advance care planning facilitator, literature about the practice, and access to a patient portal, while the control group received standard care. Twelve percent of people in the intervention group documented their EOL preferences, compared with 6.6% in the control group. Documentation was particularly high among patients with dementia. Other vulnerable groups, including Black patients and older patients, also saw somewhat improved documentation.
The rise in documentation also ushered in a rise in burdensome care, or care that prolongs suffering or adds discomfort without significantly boosting the patient’s quality of life. Just over 20% of patients in the control group who were seriously ill and who died during the study received burdensome care; 28.8% of those with the same conditions in the intervention group received burdensome care.
“This finding underscores that documenting end-of-life preferences isn’t always sufficient on its own,” lead author Dr. Jennifer L. Wolff told a reporter with Johns Hopkins. “End-of-life care decisions are deeply personal, and patients may choose different paths depending on circumstances. However, it does emphasize the need for continuous, nuanced conversations between patients and their health care providers.”