Hospice patients could benefit if referred sooner

August 1, 2009
Michael McCue

Discussing hospice and palliative care with patients and families lowers healthcare costs and allows patients to realize maximum benefits of care

But there is no denying that death and dying are issues that need to be discussed-not just for psychological and emotional reasons, but for practical and economic ones as well. For most people-even healthcare professionals-there is still some confusion surrounding exactly what "end-of-life care" means. While the various terms used to describe end of life care might sound familiar-palliative care and hospice foremost among them-they are not interchangeable.

According to http://www.getpalliativecare.org/, palliative care is the medical specialty focused on relief of the pain, stress and other debilitating symptoms of serious illness. Its goal is to relieve suffering and provide the best possible quality of life for patients and their families, and may be provided at any time during a person's illness, even simultaneously with curative treatment.

According to the Centers for Medicare and Medicaid Services, the care provided to patients in their last year of life accounts for about 30% of all Medicare spending, totally nearly $100 billion annually. Given that the program is on pace to be bankrupt by the end of the next decade, it should come as no surprise that Medicare officials are taking a close look at ways to trim the amount spent on patients with less than 12 months to live.

"Because so much money is spent on patients in the last few years of their lives, the logical assumption-although probably an inaccurate one-is that the problem would be solved if we could just stop spending money on the dying," says Dr. Diane E. Meier, FACP, director of the Center to Advance Palliative Care (CAPC), a national organization devoted to increasing the number and quality of palliative care programs in the United States. "The problem is that we don't always know who is dying. And since we don't always know who is dying, we shouldn't be talking about 'end-of-life care,' but rather, about palliative care, which is needs-driven rather than prognosis-driven."

For example, imagine a Medicare beneficiary with emphysema, a history of prostate cancer, mild congestive heart failure, and mild dementia related to hypertension, diabetes and stroke.

"This is the patient driving the costs in our system, but he isn't dying and might not die for several years," Dr. Meier says. "The 5% to 10% of people living with multiple chronic conditions account for as much as two-thirds of healthcare spending, so if we attempt to define our targeted population as people 'at the end of life,' we're going to miss that Medicare beneficiary who is driving all of the costs."

And as Philip H. Santa-Emma, MD-who began specializing in palliative care back in 1995-said in the February 2009 issue of ACP Hospitalist, "[Palliative care] isn't just going in the room and holding [the patient's] hand and saying, 'Everything's going to be OK.' It's a lot of complicated medicine."

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