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In Reply Dr Young points out that we did not examine end-of-life care and suggests that we may have underestimated preventable spending. We agree that high-quality hospice or palliative care may reduce admissions at the end of life, including for conditions that are considered nonpreventable.
The frequency with which these costly inpatient services, such as hip replacement or major cardiac surgery, are occurring in people with advanced terminal illness is unknown. On the other hand, patients at the end of life may be sufficiently sick that their ED admission for typically preventable conditions, such as urinary tract infections, may actually be more difficult to avoid.
Joynt KE, Gawande AA, Jha AK. Preventable Acute Care Spending for Medicare Patients—Reply. JAMA. 2013;310(18):1985. doi:10.1001/jama.2013.278607