Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Care Quality in Veterans Dying of Cancer Studied

Health Aff; 2018 Jan; Gidwani-Marszowski, et al

Veterans dying of cancer who were treated under Medicare fee-for-service were more likely to receive high-intensity care than those treated under VA direct care, according to a recent analysis.Investigators evaluated veterans treated under the 2 systems between 2010 and 2014. Among the results:

  • Medicare-treated veterans were more likely to receive chemotherapy, and experience hospital stays, ICU admission, more days in the hospital, and in-hospital death.
  • They were significantly less likely than to have multiple emergency department visits.

The authors noted that higher-intensity end-of-life care in Medicare-treated veterans may be due to Medicare fee-for-service financial incentives that do not exist in the VA's integrated system. They suggested that this could be minimized through the development of coordination and quality monitoring programs.


Gidwani-Marszowski R, Needleman J, Mor V, et al. Quality of end-of-life care is higher in the VA compared to care paid for by traditional Medicare. Health Aff. 2018 Jan;37(1):95-103. doi:10.1377/hlthaff.2017.0883.