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Bulat Shcherbakov
Bulat Shcherbakov

The Last

Several developments in the last few decades may have altered patterns of care among dying patients, possibly reducing the percent of Medicare payments incurred in the last year of life. For example, the hospice benefit was introduced to Medicare in 1983 and provides care focusing on palliative and support services for terminally ill patients. Hospice use has increased rapidly in recent years, although evidence of its impact on costs in the last year of life is mixed (Medicare Payment Advisory Commission 2008). In addition, life expectancy has increased among the elderly (Federal Interagency Forum on Aging-Related Statistics 2008). Because acute care costs are lower among persons dying at older ages (Lubitz and Riley 1993; Levinsky et al. 2001;), the percentage of Medicare payments spent on the last 12 months of life may be gradually declining. Changes in medical care related to chronic disease may also have affected the share of Medicare payments going to end-of-life care, given that the highest increases in spending have been among beneficiaries in better health and with fewer functional limitations (Chernew et al. 2005; Thorpe and Howard 2006;).

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Our primary goal was to assign Medicare payments either to decedents (persons in their last year) or to survivors (all others) for each calendar year, following methods used in an earlier study (Lubitz and Riley 1993). In the case of calendar year 2006, for example, persons who survived through December 31, 2007 were identified as survivors for 2006 (see nos. 3 and 6 in Diagram 1). Their person-years of enrollment in 2006 and all their Medicare payments for services provided in 2006 were assigned to survivors. For persons who died in 2006, person-years of enrollment and payments in 2006 were assigned to decedents (nos. 1 and 4). For those dying in 2007 (nos. 2 and 5), a portion of the payments and person-years of enrollment for calendar 2006 was assigned to survivors and a portion to decedents. The portion assigned to decedents (with the exception of hospice payments, as described below) depended on the proportion of calendar 2006 that was spent within 365 days of death. Thus, if person no. 2 in Diagram 1 died on the 100th day of 2007, then 265/365 of their 2006 enrollment and nonhospice payments were assigned to decedents and 100/365 to survivors. This method differs from that used in the earlier study, where dates of discharge were used to assign inpatient hospital and skilled nursing facility services to decedent and survivor categories. In the current study, payments for all services were prorated because dates of discharge are no longer available on the CMHS database. Payments assigned to decedents may therefore be understated because service use tends to increase as death approaches; prorating payments by days may result in too few payments being assigned to the last year of life. A comparison of overlapping years (1980, 1985, and 1988) between this analysis and the earlier study suggests that the change in methodology reduced the estimated payments going to the last year of life by less than two percentage points. For hospice services, all 2006 payments for 2007 decedents were assigned to decedents rather than being prorated between decedents and survivors, because it was assumed that all hospice services were provided close to death. The same methodology was used to assign person-months and payments to decedents and survivors for all years of the study.

The percent of March decedents who were hospitalized in their last few months did not show a significant trend, remaining near 63 percent in most years (Table 1). The percent with multiple hospitalizations increased between 1978 and 2006, however, from 20.3 to 27.0 percent. The percent using ICU/CCU services increased both for decedents (from 26.1 percent in 1983 to 33.1 percent in 2006) and for survivors (from 4.0 to 6.3 percent). Survivors had much lower levels of hospitalization and there was no significant trend with respect to percent hospitalized or percent with multiple hospitalizations.

Our findings suggest there have been increases in both aggressive care and nonaggressive care at the end of life among the elderly. Multiple hospitalizations increased in the last few months of life, as did the use of ICU/CCU services, suggesting a general increase in intensity of care. Other studies have also found an increase in the aggressiveness of care at the end of life (Barnato et al. 2004; Earle et al. 2004;). On the other hand, the substantial growth in hospice payments indicates that palliative and supportive care is becoming more common. Some patients receive both styles of care, undergoing aggressive treatment for some time, then enrolling in hospice a short time before death (Earle et al. 2004). The relationship between hospice utilization and other services is not clear; in some cases hospice may substitute for other types of care, and in others it may be used in addition to conventional care services.

Economic uncertainty continues to bring mortgage rates down. Over the last several weeks, declining rates have brought borrowers back to the market but, as the spring homebuying season gets underway, low inventory remains a key challenge for prospective buyers.

The following table shows the 100 most popular given names for male and female babies born during the last 100 years, 1922-2021. For each rank and sex, the table shows the name and the number of occurrences of that name. These time-tested popular names were taken from a universe that includes 177,238,032 male births and 172,053,794 female births.

Please note that popular names listed below are not necessarily consistently popular in every year. For example, the name James, ranked as the most popular male name overthe last 100 years, has been ranked as low as number 19. Similarly, the most popular female name in the table, Mary, ranked as low as 133.

As of March 30, 2023, there are 25 (0.8%) counties, districts, or territories with a high COVID-19 Community Level, 279 (8.7%) with a medium Community Level, and 2,915 (90.5%) with a low Community Level. Compared with last week, the number of counties, districts, or territories in the high level decreased by 0.1%, the medium level increased by 2.8%, and in the low level decreased by 2.7%. Overall, 35 out of 52 jurisdictions** had high- or medium-level counties this week. California, Connecticut, Delaware, District of Columbia, Kentucky, Maine, Maryland, Massachusetts, Nevada, New Jersey, North Carolina, Oregon, Puerto Rico, Rhode Island, South Carolina, Utah, and Washington are the jurisdictions that have all counties at low Community Levels.

The last twenty years have seen the number of major floods more than double, from 1,389 to 3,254, while the incidence of storms grew from 1,457 to 2,034. Floods and storms were the most prevalent events.

For example, when used with a data source containing a large table with 1 million records, Last will be subject to the non-delegation limit and will not return the last record of the entire data source. Likewise, using Index to request a record in the middle of 1 million records will result in an error because the index is out of range based on the non-delegation limit.

The Last Supper Museum completes its reopening to the public, thanks in part to the hiring of new staff that has taken place in recent months: starting November 6, 2022, the Museum will return to being open all day on Sundays as well, from 8:15 a.m. until 7:00 p.m. with extended hours (last entry at 6:45 p.m.).

In 2019, the last year for which the CDC has information, four women in the U.S. died due to complications from induced abortions, according to the CDC. Two women died in this way in 2018, and three women in 2017. (These deaths all followed legal abortions.) In 2016, the CDC reported seven deaths due to either legal (six) or illegal (one) induced abortions. Since 1990, the annual number of deaths among women due to induced abortion has ranged from two to 12, according to the CDC.

The annual number of reported deaths from induced abortions tended to be higher in the 1980s, when it ranged from nine to 16, and from 1972 to 1979, when it ranged from 13 to 54 (1972 was the first year the CDC began collecting this data). One driver of the decline was the drop in deaths from illegal abortions. There were 35 deaths from illegal abortions in 1972, the last full year before Roe v. Wade. The total fell to 19 in 1973 and to single digits or zero every year after that. (The number of deaths from legal abortions has also declined since then, though with some slight variation over time.)

The Last Supper of Leonardo da Vinci (Cenacolo Vinciano) is one of the most famous paintings in the world. This artwork was painted between 1494 and 1498 under the government of Ludovico il Moro and represents the last "dinner" between Jesus and his disciples.

Several measures have now been implemented to protect the paint from deterioration. To ensure that the fresco is maintained at room temperature, since the last restoration, visitor's' entry has been restricted to a group of 25 people every 15 minutes. 041b061a72


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