News & Commentary

ACOs Could Jump-Start Better End-of-Life Care


The potential for ACOs to improve care and save money has been examined from many vantage points, and here’s one more: how ACOs can facilitate better end-of-life (EOL) care. A post on the Health Affairs blog last month offered insight into just what ACOs can bring to this process.

Authors Julia Driessen of the Graduate School of Public Health at the University of Pittsburgh and Turner West, the director of the Palliative Care Leadership Center’s Bluegrass Care Navigators in Lexington, Ken., argued that while the applicability of ACOs to many areas of care delivery have been much examined, “discussions of the impact of ACOs on EOL care are conspicuously absent.”

There is a lot of variation in EOL care and in utilization of Medicare’s hospice benefit. The median length of stay (LOS) in hospice is 17 days; the average is about 72 days. “While some variation should be expected as the needs of individuals at the end of life are different, part of this variation is attributable to the design of the Medicare hospice benefit,” the study stated.

That’s mainly because Medicare hospice need is based on prognosis. That contributes to variation because “terminal illnesses do not always follow a predictable course,” Driessen and West pointed out. They specifically cited dementia, which can be difficult to predict and therefore lead to long and excessive LOS.

The authors also said that while ACOs cannot currently influence patients’ choice of hospice provider, it may be in their interest to work more closely with doctors who help patients and their families make those decisions. ACOs could, for example, provide physicians with information about the varying quality of hospice providers.

Driessen and West wrote that doctors steering patients to better hospice providers would have a two-part effect. “First, the EOL experiences for beneficiaries will improve as they will be receiving care from high-performing hospice providers. Second, poor-performing hospice providers will lose market share and consequently will be forced with the choice of improving or becoming irrelevant in their communities.”

In addition, Driessen and West argued that ACOs might also help improve palliative care, the step before hospice for people living with serious illness.