Most experts on end-of-life care insist that focusing so intently on end-of-life costs won't fix what ails our healthcare system. "We don't want to save on the backs of the dying," Morrison says. "The larger issue is cost associated with people living with serious illness."
Palliative care programs have proliferated throughout U.S. hospitals over the last decade. As of 2005, 70% of large hospitals reported having such a program, up 96% from 2000. Still, few patients are gaining access.
There are a number of reasons for this, Morrison says. Most hospital-based palliative care programs are quite small and depend on primary physicians to make the referral. For that to happen, many more doctors need training on how to treat people with serious illness and discuss end-of-life care. There are several national initiatives underway to meet that training need, he says.
The healthcare reform bills now being debated in Congress include a number of demonstration projects aimed at reining in costs and improving the quality of healthcare received by terminally ill Medicare beneficiaries. If successful, such programs might later become a permanent part of the Medicare benefit.
One project would allow hospice-eligible patients to continue to receive all Medicare covered services for which they were eligible prior to entering hospice. Under current guidelines, once a recipient enters hospice care, Medicare no longer pays for services to treat the terminal illness that put them there.
Other measures contained in both the House and Senate bills, if passed, ultimately may improve efficiency of care, as well as foster better communication among physicians, hospitals, long-term service providers and patients, says Peter Notarstefano, director of home and community-based services for the American Assn. of Homes and Services for the Aging.
By placing a greater emphasis on coordination of care, patients at the end of their lives are more likely to die in comfort and with dignity, he says.
"Congress is saying we have to break down the silos and the mind-set of 'this provider does this and that provider does that,' " Notarstefano says. "It's losing the fee-for-service mentality and recognizing that we need to learn how to best treat people at the end of their life."