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A Thoughtful Approach to Healthcare’s Most Difficult Decisions

March 06, 2014
5:23 pm

As policymakers look for ways to address Medicare’s financial challenges and make the program more cost-efficient, it’s inevitable that the discussion will turn at some point to end-of-life care.  And it’s easy to understand why.

As you break down Medicare spending, it becomes clear that a disproportionate amount of resources are devoted to providing care to beneficiaries in their final year of life.  The Centers for Medicare and Medicaid Services (CMS) has estimated that 25 percent of Medicare expenditures are spent on services for the five percent of beneficiaries who die each year.

But, as Premier Healthcare Alliance president and CEO Susan DeVore wrote in a thoughtful essay in the Wall Street Journal, the key to effectively addressing this issue is not to look at end-of-life care as a cost challenge.  Rather, the focus must be on empowering patients and their families to fully understand their healthcare options.  “If this is done well, the rest will follow,” she wrote.

In her WSJ piece, Ms. DeVore, a Healthcare Leadership Council member, addresses the variation in end-of-life care among hospitals, pointing out that some terminally ill patients were spending their final days in intensive care settings even though there were no medical solutions that could improve their health outcomes.  Better, she wrote, that patients and families have the information and the conversations with caregivers to make educated choices about whether a patient’s final days should be spent in a hospital or at home.

I recommend that individuals, particularly those who are in caregiving roles, read Ms. DeVore’s essay.  As she put it so well, “This topic (of end-of-life care) shouldn’t center on cost.  It’s about dignity, compassion, comfort and making the most out of the last days of a terminal patient’s life.”

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