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Comment & Response
November 13, 2013

Preventable Acute Care Spending for Medicare Patients—Reply

Author Affiliations
  • 1Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
JAMA. 2013;310(18):1985. doi:10.1001/jama.2013.278607

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.