Quality and cost at the end of life: no need for trade-off's

A major reason US health care costs are so much higher than anywhere else while outcomes lag is that we waste so much money is wasted on end-of-life care. An article by Angela Maas in Health Plan Week provides a cogent, concise treatment of the topic. Some takeaways:

  • Health plans cover palliative and hospice care but it is underutilized
    • Although palliative care discussions have a role early on, MDs don’t want patients to think they’re giving up on them
    • When terminal cancer patients come into hospice they may improve for a while –because they’re not coping with chemo effects– and such improvement may make them ineligible for reimbursement
  • Patients receiving palliative care for non-small cell lung cancer from shortly after their diagnosis enjoy better quality of life and live longer (according to a NEJM study)
  • High end-of-life costs are associated with worse quality of death in patients with advanced cancer (according to an Archives of Internal Medicine study)

One thing that’s not discussed directly in the article but that needs to be addressed: hopeless patients on their last legs can be highly profitable for providers and drugmakers, who in a fee for service environment can make money from the very high utilization. It would be interesting to break down an oncology practice’s profitability by stage of patient illness.

I understand that each case is different and am wary of a slippery slope leading to euthanasia. But I prefer a frank discussion of these topics and addressing the cost implications head on.

October 29, 2010

4 thoughts on “Quality and cost at the end of life: no need for trade-off's”

  1. The current medical system makes it very difficult for physicians to moderate the irrational use of care during the end of our patient’s lives. Even if patients themselves are not demanding “every possible intervention”, family members frequently do. Fear of litigation fuels provider’s use of medical futile interventions as much or more than desire for economic gain. In many cases, physicians are concerned that patient’s will leave their care if they do not offer all possible diagnostic and treatment resources. The hospitalist movement may be contributing to excessive spending – are physicians who provide care to patients with whom they have no long standing relationship less inclined to refer patients to hospice? As long as there is no system or set of guidelines that mandates restrictions on the use of medical resources in cases of where there is no reasonable hope of improving quality of life or meaningful extension of life, physicians will frequently pursue “all options”.

  2. Many of these patients, however, were wise enough to have a Living Will, saving the family from the emotional turmoil of making that decision. The problem is we can never find that piece of paper. It’s in the patient’s chart somewhere. So, I recommend simplify the system and put it where doctors can find it – like a notation in the drivers license, or an implanted computer chip

  3. Pingback: Rerun: Quality and cost at the end of life: no need for trade-off’s | Health Blog

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