Tuesday, November 20, 2012

A Medicare Mistake Worth "Giving Up" On

Evidence is mounting that Medicare policies saddling hospice with "giving up" baggage need to change.

Recentlyi Dr. Ira Byock described Medicare payment decisions that, while well intended, created an unfortunate either-or choice between therapy and hospice, which apparently is what gave hospice such a bleak reputation in the first place.

Would smarter spending allow Medicare payment for hospice while therapy continues? Given the need to cut costs in health care, that may seem counterintuitive. And yet palliative care increases both quality of life and time, studies indicate, and not only for the terminally ill, and does so cost-effectively. 

Significantly, the American Cancer Society took note of this when it named Dr. Diane E. Meier one of four recipients of its Medal of Honor. Meier teaches and practices at Mount Sinai in New York and is director of the Center to Advance Palliative Care. She received the award for "Cancer Control in recognition of her pioneering leadership of the effort to bring non-hospice palliative care into mainstream medicine."

As Meier’s award notes, palliative care is not exclusive to hospice, and yet it is a big part of what makes hospice so effective.

Jane Brody touched on this on Monday in the NY Times Personal Health column. Brody writes about a study in the New England Journal of Medicine finding that most patients with Stage 4 lung and colon cancers did not understand "that chemotherapy was not at all likely to cure their cancer." Without this understanding, the authors note, consent is hardly informed.

In many cases, continuing chemotherapy rules out hospice.

Brody writes: "When patients pursue chemotherapy under the false belief that they still have a chance for a cure, it often delays their transition to the comfort care of hospice. When patients spend only a few days or a week in hospice, caretakers don't have enough time to get to know them and their families and offer the physical, emotional and practical benefits hospice can provide."

Also Monday, in the Boston Globe, a story by Karen Weintraub began: "People often have one regret about hospice care: that they didn't get it sooner."

Some don't get it sooner because they believe choosing hospice means giving up hope. That unfortunate belief is fueled by Medicare policy that makes patients choose between therapy or hospice. 

As hospice executive Mark M. Murray tells Weintraub about hospice, "It's not about death and dying, but it's about improving quality of living, not just for the patient but for the entire family."


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