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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