VA offers higher quality end-of-life care than Medicare: 5 things to know

Cancer patients who rely on Veterans Affairs facilities receive higher quality end-of-life care than cancer patients who receive care paid for by traditional Medicare, according to a study published in Health Affairs.

Researchers at Stanford (Calif.) University School of Medicine and VA Palo Alto (Calif.) Health Care System examined whether the way care is organized affects end-of-life care quality for veterans who are dying of cancer.

To examine difference in end-of-life care quality, researchers looked at 87,251 veterans over the age of 66 who had solid tumors and died between October 2009 and September 2014. Around half of the veterans in the study were reliant on Medicare.

Here are five things to know about the study.

1. The researchers analyzed care quality based on guidelines from the American Society of Clinical Oncology and the National Quality Forum. They also examined research on what end-of-life care practices patients find undesirable. In the last thirty days of life, the study found Medicare-reliant patients received more intensive (lower quality) end-of-life care services when compared to VA-reliant patients. Criteria for care quality included chemotherapy, number of days spent in the hospital, ICU admission and death in the hospital.

2. VA patients were more likely than Medicare patients to have two or more visits to the emergency department. VA-reliant patients may have had more ED visits because extended hours and access to appointments are not available at all VA facilities. Medicare patients are also hospitalized more frequently for care that VA patients receive in the ED, said lead study author Risha Gidwani-Marszowski, DrPH.

3. The higher quality care in the VA may result from the way the system selects patients and its focus on evaluating quality of end-of-life care, the authors wrote. The VA uses the Bereaved Family Survey to observe care and continuously work to improve end-of-life care.

4. Higher end-of-life care quality for VA patients did not appear to be related to palliative care investments. "We did not find that patients in facilities where more decedents received palliative care had less-intensive end-of-life care," the study authors wrote. "The lack of association may be because many of these services are directed by an oncologist rather than the palliative care team."

5. "To avoid putting VA-reliant veterans at risk of receiving lower-quality care, VA care-purchasing programs should develop coordination and quality monitoring programs to guard against overly intensive end-of-life care," the study authors concluded.

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