Last Updated: 2003-05-06 16:34:15 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Older Americans dying of cancer are more likely to enter hospice care earlier and stay longer if they are in a managed care plan versus traditional Medicare, researchers said Tuesday.

The results of the study, published in the May 7th issue of the Journal of the American Medical Association, suggest Medicare HMOs do a better job of helping and encouraging dying patients to get end-of-life, palliative care than the traditional fee-for-service program does.

Seniors in managed care, as a result, have a better chance of realizing the benefits of hospice care.

"There's just better systems in place for patients enrolled in managed care," said Dr. Ellen P. McCarthy, an epidemiologist and health services researcher at Boston's Beth Israel Deaconess Medical Center and an instructor at Harvard Medical School.

"It's a net positive for HMO patients. They're getting palliative care services, and it's probably leading to a better death," she added.

Congress created a Medicare hospice benefit in 1982, providing coverage for end-of-life care for the terminally ill. It is one of just a handful of services "carved out" of managed care, which means the federal government reimburses hospices directly for their services.

U.S. hospices admitted 775,000 patients in 2001, according to the latest data from the National Hospice and Palliative Care Organization, based in Alexandria, Virginia.

McCarthy and colleagues studied more than 260,000 Medicare beneficiaries with cancer who died between 1988 and 1998. Managed care enrollees had consistently higher rates of hospice use than did patients in traditional Medicare.

While hospice care has increased over time, many terminally ill patients do not enroll or enroll too late to reap the full benefit of those services. Some experts say patients should use hospice care for at least two months before death, yet most receive a month or less.

"We found fee-for-service patients were more likely to enroll very late in hospice than managed care patients," McCarthy said.

There is a financial incentive for managed care plans to transfer dying patients to hospice care to avoid the high costs of care that pile up at the end of life. But researchers found no evidence to suggest patients were being placed in hospice care inappropriately.

Amber Jones, a consultant to the Center to Advance Palliative Care at New York's Mount Sinai School of Medicine, believes managed care companies have been reluctant to publicize their success in arranging hospice care for fear that it would appear they are getting a financial benefit.

"I think they've done a great job so people make informed choices," Jones told Reuters Health.

Patients who choose hospice care can opt out any time, she added. "The managed care company can't mandate these patients into hospice (care)."

Jones said the study points to an opportunity for better hospice training for patients and providers alike. "The good managed care providers educate their staff and affiliated providers and their patients well," she said.