In an article that has received a good amount of advanced press, today’s Journal of the American Medical Association publishes research findings on end of life care, or more particularly, utilization of hospice care. The article, entitled, Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009, shares the findings of research seeking to determine changes in site of death, place of care and care transitions for Medicare decedents between 2000, 2005, and 2009.
Research results indicated that while more individuals aged 65 and older are dying at home, their utilization of intensive care services (i.e., hospital ICU) during the last month of life increased (29.2% of decedents utilized ICU in 2009). In addition, 11.5% of decedents in 2009 had three or greater hospitalizations during the last 90 days of their lives. And while hospice use increased, upwards of 28% used hospice services for three days or less in 2009.
A key finding of the research is that increased use of hospice may not lead to a reduction in resource utilization. The authors believe their findings could, “raise concerns that hospice is an ‘add-on’ to a growing pattern of more utilization of intensive services at the end of life.” Hospice providers hoping to avoid the sequestration axe take note: while your inherent value proposition of improving the quality of life, while easing the individual pain and family burden associated with end of life care is invaluable, getting paid for your efforts in this environment also requires demonstrable cost savings.
As I have written here before, the Death Panels moniker given to us courtesy of Sarah Palin has been a tremendous disservice to encouraging open and candid discussion on the personal, social and economic challenges of dealing with end of life care. But I see a huge opportunity here for hospice providers – and the trade associations that represent them – to seize this important initiative back from politicians and elected officials.
They should use this opportunity to take a leadership role in creating a national framework for encouraging candid dialogue, open sharing of concerns, fears and ideas – and for advancing policy initiatives that encourage knowledge and education regarding the alternatives available to individuals and their families facing end of life decisions.
Oscar Wilde wrote that, “life is too important to be taken seriously.” Well, I posit that death is too scary to run in fear from.