Recent Weekly Columns
Sep 26 2008
The fact is that dying is a universal experience. Clearly there is more that we can do in this country to relieve suffering, respect personal choice and dignity, and provide opportunities for people to find meaning and comfort at life’s conclusion.
Unfortunately, most patients and their physicians do not currently discuss death or routinely make advance plans for end-of-life care. As a consequence, about one-fourth of Medicare funds are now spent on care at the end of life that is geared toward expensive, high-tech interventions and “rescue care.” While most Americans say that they would prefer to die at home, studies show that almost 80 percent die in institutions where they may be in pain and where they may be subjected to high-tech treatments that merely prolong suffering.
I have worked with my friend and colleague from West Virginia, Senator Jay Rockefeller, on a number of initiatives designed to improve the way our health care system cares for patients at the end of their lives. The Medicare bill passed by Congress earlier this year includes one of our bills and requires physicians to include a discussion regarding advance directives during the initial “Welcome to Medicare” physician visit to which all Medicare beneficiaries are entitled. We have also joined together to introduce the broader Advanced Planning and Compassionate Care Act, which is also intended to facilitate appropriate discussions and individual autonomy in making decisions about end-of-life care.
For example, our bill requires that every Medicare beneficiary receiving care in a hospital, nursing home, or other health care facility be given the opportunity to discuss end-of-life care and the preparation of an advance directive with a professional within the health care institution. The legislation also requires that, if the patient has an advance directive, it must be displayed in a prominent place in the medical record so that all of the doctors and nurses can clearly see it.
Patients and their families should be able to trust that the care they receive at the end of their lives is not only of high quality, but also that it respects their desire for peace, autonomy, and dignity. At the invitation of Dr. Katherine Pope, I had the opportunity recently to visit the Hospice of Southern Maine’s Gosnell Memorial Hospice House, which is the product of an extraordinary collaborative effort on the part of health care providers throughout Southern Maine to improve the quality of end-of-life care for patients and their families.
In most cases, hospice care enables dying patients to remain in the comfort of their own homes, free from unnecessary pain and surrounded by friends and families. The Gosnell Memorial Hospice House provides an alternative for those individuals for whom care in the home is no longer sufficient. It provides a very comfortable and attractive home-like setting for hospice patients and their families where they can receive advanced professional palliative and end-of-life care in their final days. This facility is making such a positive difference for so many patients and their families, and should serve as a model for the rest of the nation.
Hospice care can offer tremendous advantages over traditional, hospital-based end-of-life care. Hospice focuses on caring, not curing. Moreover, hospice not only improves the quality of life for both the patient and their family, but has also been shown to be less costly than the alternative ways of caring for the terminally ill. A recent Duke University study demonstrated that hospice saves Medicare an average of $2,300 per patient, amounting to more than $2 billion annually.
That is why I find it so ironic that the Medicare hospice benefit is once again under attack. The Centers for Medicare and Medicaid Services has proposed cutting Medicare payments to hospices by more than $2 billion over the next five years.
This cut in hospice reimbursements is both short-sighted and irresponsible, and I am fighting this battle on two fronts. First, I have sent a letter to Health and Human Services Secretary Leavitt expressing concern about the potential effect that such a cut will have on the quality of end-of-life care for our nation’s most vulnerable population and urging that he reconsider. Second, I have sponsored legislation, the Hospice Protection Act, to block these devastating cuts.