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End-of-Life Care is Often Futile, Costly

Cheryl Clark, for HealthLeaders Media, November 18, 2010

Goodman suggested this is because far too often the decisions of what care services to invest in are driven more by reimbursement than by what's best for the patient. That because, he speculates, Medicare pays a lot less for hospice care than it does for curative care.

These palliative programs are such that "many institutions are concerned that these are going to be cost centers that will lose money," Goodman said.

"Considering that the payment for palliative care and hospice care is much less than it is for more aggressive care, including chemotherapy and procedures and such, so these places feel often that the reimbursement system isn't in their favor," he said.

But hospitals need to be part of community-based efforts to build that capacity, he added.

He added that it's also true that for some doctors, not offering something in those last few days is tantamount to giving up hope, which isn't in their culture.  "That's language that's caused a lot of harm in cancer care," he said.

 
I know this from first hand experience, but that's a tale for another time.

The cancer report's numerous tables beg these questions about the wide variability in end-of-life care.

 

  • Why is it that 12.2% of end-stage cancer patients at Lenox Hill Hospital in Manhattan are getting chemotherapy during their last two weeks of life, while only 3.8% of patients undergo that aggressive care at Johns Hopkins Hospital in Baltimore, or 2.9% at the Cleveland Clinic?

     

     

  • Why do 42% of patients in Tupelo, MS die in a hospital when in Bradenton, FL, only 18.5% are in a hospital at the time of death.

     

     Why are 63.6% of cancer patients in Elgin, IL seeing 10 or more physicians during their last six months of life, when in Idaho Falls it's only 14.3%.

     

  • Why are 77.4% of patients in Mesa, AZ enrolled in hospice during the last month of life, but in Modesto, CA, where my father died at the Alexander Cohen Hospice House, it's only 39.1%?

     

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    4 comments on "End-of-Life Care is Often Futile, Costly"


    Karl Vanhooten (11/19/2010 at 11:49 AM)
    One comment: MDs and hospitals get paid (by somebody) whether grandma dies or not. And the more they do to her, the more they can charge.

    The Ratings Guy (11/19/2010 at 8:27 AM)
    First of all, this was a sampling of 20% of Medicare cases. Secondly they only looked at those who died...so yes I guess ALL care would have been FUTILE. If you want to drink Dartmouth's Kool Aid, you will have to believe that providers are all evil, uninformed and stupid. This sampling never had any contact with the patients, so ALL of the commentary about what patients wanted or knew is conjecture. We all know that bad stuff happens at death, and Dartmouth has done nothing to inform anyone about how to manage or predict it any better. This is another example of spin coming out of the Dartmouth Working Group. Let me guess...and all of the patients expired too, wow, what a finding!

    John Rosenstock (11/19/2010 at 7:09 AM)
    Patrick doesn't have a clue as to what he is saying. It's not really the money being spent (alhough that has a side benifit) it's the futility of the treatment which is often painful and futile instead of having a peaceful death at home or in hospice with family and/or friends present. To die in the ICU hooked to life support is never peaceful and comfortable.