Revisiting the art in the science of medicine

Professor Paul Lauritzen has composed a compelling piece about end-of-life care. In it, the author recounts the story of his wife Lisa dying in hospice. One excerpt in particular stands out - where the attending physician explains how patients often premeditate their own death:

“Medically,” Dr. D said, “Lisa is much better. Her vital signs are strong, and she is not experiencing any nausea. This is the good news. The bad news,” he continued, “is that your wife called the nurses in the middle of the night to say that she saw her parents on a boat outside the window beckoning her to come. I know this may not make sense,” he went on, “but we see this repeatedly in our patients. When patients report a vision like this, they almost always die within a day or two. I’m so sorry.” Lisa died just over 24 hours later. As her husband recounted, “In my wife’s last days, it was not blood work or vital signs that foretold her death, it was a dream.” These "visions" are, apparently, routine for hospice caregivers. In fact, they even have a formal name: “end-of-life dreams and visions” (ELDVs). One expert has spent ten years conducting formal research on the occurrence and impact of these dreams and visions, and has documented that they are indeed predictive of imminent death. Unfortunately, this research has not been well received in the medical community. Perhaps medicine needs to return to its roots by remembering that patient care requires both art and science. If you're interested in such an approach, I encourage you to check out The Journey's End.

Why shouldn't everyone benefit from Hospice care improvement opportunity?

“CMS to Allow Hospice Care During VBID Extension.” That is the title of a recent article in Hospice News. In essence, it is declaring is that patients will now be eligible to receive both traditional Medicare and Hospice Care in Medicare Advantage Plans. My question is - why give this care improvement and cost savings opportunity to only private insurers?

Medicare is failing financially and it decides to give away the $2.3 billion dollar savings that Medicare gets from Hospice annually!

The policy logic of this strategy is flawed at best. The Hospice Benefit needs a major overhaul because evidence demonstrates it could improve end-of-life care and save Medicare billions of dollars. Major changes like:

1. Eliminating the six-month death certification and replace it with a terminal diagnosis

2. Allowing patients to receive curative care and comfort care simultaneously

3. Expand the home care benefit in hospice to make it a more viable option for families.

Going into Hospice compared to receiving ineffective and expensive hospital care, drugs, and treatments would save money and improve care.

Medicare funding challenges will not be solved with incremental change. End-of-life care in our nation will not improve without dramatic and simple payment and insurance change by Medicare. My book, The Journey’s End offers a thoughtful analysis and concrete recommendations based on sound economics to address these concerns.

Hospice saves money. Why the time limit?

Hospice saves Medicare billions annually. This is the conclusion of research reported by author Jim Parker in Hospice News. One might argue these research conclusions are merely common sense observations. Think about it - if a patient selects hospice care they avoid much more expensive hospital care. The longer the patient is in hospice the greater the savings to Medicare. Yet the Office of Inspector General for the United States Department of Health and Human Services (OIG) considers stays of longer than 6 months in hospice to be grounds for fraud. Medicare and the OIG need to support hospice, not investigate it, if they wish to save billions for Medicare. Furthermore, Medicare should pay for hospice based on an hourly cost - and not pay hospice based on a complex coding system that encourages fraud and needless OIG oversight. To learn more details on these observations read The Journey’s End.