Poll: How to control costs in end of life, or terminal, care

It’s estimated that up to 30 percent of the 50 billion dollars Medicare spends on end of life care has no meaningful impact on patients.

Is there a rational way to control costs when it comes to terminal care?

Most patients want to spend their last days at home, but 75 percent die in either a hospital or nursing home. Almost 20 percent of terminal patients end up in intensive care settings.

Worse, when terminal patients are admitted to the hospital, numerous consultants are often involved in their care, each ordering a battery of tests – whether they’re needed or not. This drives up costs for unnecessary tests, and subjects patients to the discomfort of invasive tests — and exposes them to their complications.

Numerous reasons account for such dysfunctional end of life care. Doctors fear malpractice lawsuits, so they practice “defensive medicine.” Patients and families often cling to the hope of a medical miracle, which can feel easier than facing a conversation about how the patient wants to die.

Doctors need to take the time to individualize end of life care decisions. We should provide information so terminal patients and their families can make informed choices about more tests, hospice care, or simply leaving the hospital and going home.

Empowering terminal patients to carefully consider these options may be the most humane approach to controlling the cost of end of life care.

I encourage you to listen and vote in this week’s poll, located both below, and in the upper right column of the blog.

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  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    You write: ‘Is there a rational way to control costs when it comes to terminal care?’ The answer is hidden in your question ; ration. In my own blog this week, I post why I think that medical rationing shouldn’t be considered a radioactive expression. If there were a mechanism to eliminate, or markedly reduce, unnecessary medical care, then rationing could be minimized. The recent USPSTF debacle with Mammogate showed the country that comparative effectiveness research has been disabled even before it has been formally launched. So, Kevin, I see no way out of the end of life cost quagmire under the current system.

  • skeptikus

    Kevin, The notion that defensive medicine plays a role in the high cost of end-of-life care is ABSURD. Why? Because old, sick people generally can’t claim too much in damages. First, as they’re old and sick, there’s little economic damages as they have minimal earning potential. Second, most states cap pain and suffering awards. Further, old/sick people don’t make sympathetic plaintiffs compared to moms with severely disabled babies.

    When doctors can talk intelligently about healthcare policy, perhaps we’ll get reform.

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Skepticus, I think you may have missed the pointicus. Read my comment again. I never mentioned defensive medicine. On the contrary, your response seemed somewhat, shall we say, defensive.

  • Classof65

    In my limited experience it seems to me that some family members push for additional tests and procedures on elderly dying patients. Although part of their motivation may be guilt, it’s actually more likely that they do not want any other family member to be able to question whether everything possible was done. None of the family members wanted to be open to accusations of hurrying the elderly patient’s death, even when the elderly patient is comatose or delirious, completely unaware of their surroundings and circumstances. It is only after death has taken place do the family members think of malpractice claims… Just what I have actually seen and heard at deathbeds.

  • BobBapaso

    Probably, doctors don’t know that old sick, or dead, people can’t collect much in damages, and even so they still don’t want to be sued by disgruntled families. But the solutions is payment for their care from Health Care Savings Accounts, or out of pocket. This would force families to choose the amount of rationing they were comfortable with ahead of time and give them no one else to blame.

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