In 2011, Medicare spent $170 billion, or 28 percent of its total expenditures, on services for beneficiaries in their last six months of life. But a new report says many of these patients are not receiving the care they want and are undergoing costly and unnecessary tests, procedures, and hospital visits.
In 2011, Medicare spent $170 billion, or 28 percent of its total expenditures, on services for beneficiaries in their last six months of life. But a new report says many of these patients are not receiving the care they want and are undergoing costly and unnecessary tests, procedures, and hospital visits.
Revamping the end-of-life care system in the U.S. could better satisfy the wishes of patients and families and make health care more affordable.
The report, “Dying in America,” was put together by a 21-member commission of doctors, nurses, religious leaders and aging experts. The panel was appointed by the Institute of Medicine, an independent research arm of the National Academy of Sciences that provides information to the public and policymakers.
The commission’s co-chairs are David Walker, former Comptroller General of the United States and former CEO of the Comeback America Initiative, and Dr. Philip A. Pizzo, a former dean of the Stanford University School of Medicine.
The report points towards a mismatch between the more expensive services available to people near the end of their lives — such as acute hospital care — and the treatments they want, which is often less expensive supportive services like home health care and pain management. Correcting this mismatch can help patients and their families while creating significant savings for patients, payers and federal programs.
One reason for the mismatch is the fee-for-service system that reimburses providers for each separate intervention or procedure they perform. Health care economists suggest this encourages excessive treatment.
The report lists several recommendations to move away from fee-for-service reimbursement and better align end-of-life care with patient preferences. The recommendations include revamping financial incentives in ways that discourage the use of unnecessary services, or of expensive services that the patient might not wish to receive.
The report also recommends that the medical community improve the training for and expand access to palliative care, which focuses on quality of life and pain control for seriously ill patients.
One of the report’s recommendations to provide reimbursements for providers who have conversations with patients about planning for care at the end of their lives has previously been adopted by some private insurers. Other payers, including Medicare, are considering covering these reimbursements.
A bipartisan group of policymakers previously considered adding such reimbursements, and a provision to do so was included in an early version of the Affordable Care Act (ACA). The provision was taken out after it got caught up in a controversy over the ACA’s non-existent “Death Panels.”
The subject of end-of-life care is a deeply personal one, with many strong and divergent opinions on the subject. Previous national discussions about end-of-life care have caused controversy and division. However, as the report says in its final recommendation, there needs to be better public engagement on this topic to ensure that all patients receive quality health services until the end of their lives.
