Hospice, Medicare and Politics

Dec 4, 2011 | 0 comments

Here’s part of an interesting story in the Los Angeles Times about hospice, living and dying, and end-of-life issues. The article, titled “Not ready to die, but prepared,” by Steve Lopez, provides an insightful look at palliative care and implications for Medicare costs as the population ages.

It opens with a look into the life of a cancer patient who is on hospice care through Kaiser’s healthcare system. But here’s the part about satisfaction with palliative care and politics of Medicare:

Susan Enguidanos, an assistant professor of gerontology at USC, specializes in end-of-life care and has helped monitor Kaiser’s in-home treatment programs. She said a study of Kaiser’s in-home palliative program about 10 years ago showed a 45% reduction in patient costs due to the avoidance of emergency room and hospital visits, and more important, there was also a sharp increase in patient satisfaction. Other such studies, she said, have shown that 71% of palliative care patients die at home, as most people say they would prefer to do, as opposed to only 50% of those not in such programs.

The national implications are enormous, given that a large portion of the debt crisis in the United States is due to rising healthcare costs. Enguidanos said roughly 27% to 30% of total Medicare costs go to the 10% of patients who are dying, and she estimated that by placing greater emphasis on in-home care, Medicare could save 25% of what it spends on patients in the last year of life.

So why isn’t this front and center in a presidential campaign season? Because many people don’t understand that hospice and palliative care are about both living and dying with dignity, and because any civil discussion about end-of-life policy is more difficult since Sarah Palin uttered the words “death panels.” Enguidanos and the medical staff at Kaiser — including Drs. Richard Brumley and Nancy Gibbs — told me they hope more research and education will convince the public and politicians that lower costs and greater patient satisfaction are both possible with greater emphasis on in-home care.

Click here to read the entire story.

A Good Goodbye