Healthcare Professionals Blog

A recent New York Times article fretted about the possibility that “For-Profits May Be Cherry-Picking Hospice Patients” (http://www.nytimes.com/aponline/2011/02/01/health/AP-US-MED-Hospices-Profit.html?_r=3&ref=health).   The concern was that for-profit hospices, which have been found to have longer lengths of stay and higher numbers of patients who survive for an extended period on hospice than do nonprofit hospices, are selecting the “easier,” less-costly patients to make a greater return on the daily Medicare reimbursement of $143 per day.

Last month the American Society for Clinical Oncology (ASCO) published a statement in the online version of the Journal of Clinical Oncology, entitled, “Toward Individualized Care of Patients with Advanced Cancer” (http://jco.ascopubs.org/content/early/2011/01/24/JCO.2010.33.1744.full.pdf+html) It reads almost as if one of the staff of Closure had written it.
ASCO suggests a radical change to the way cancer care is delivered.  The change begins with candid conversation about the person’s diagnosis and prognosis soon after the discovery of the cancer, when enough time remains to make clear-headed decisions.  It continues with offering palliative care to enhance the quality of life right from the start, even while providing the best curative treatments available.  It includes allowing the patient to weigh in on the goals and the course of treatment at every point, to change her mind, to opt out, or to seek alternatives.  It concludes with offering hospice care when curative options run out, while there is still time to die in peace and dignity.

Less is more – and sometimes more is less.
With our healthcare system in crisis mode, it seems like sheer fantasy that we could deliver more care and actually spend less money.  But according to an article in the March 2011 issue of Health Affairs, the use of high-quality palliative care in seriously ill patients might actually make that fantasy a reality.
The study looked at Medicaid-insured patients in four hospitals in New York state (New York City, Rochester, and Buffalo) who had a range of life-limiting illnesses.  It compared patients who had received palliative care during their hospitalization to patients who had the same condition but had only received “standard care.”