Hospices Serve A Critical Need

J. Donald Schumacher

First posted 7/5/11 on Kaiser Health News

The author is responding to a recent Kaiser Health News story:  Concerns About Costs Rise With Hospices’ Use (Rau, 6/27).

As Congress works to come to terms with the economic challenges facing our nation, it’s inevitable that discussions focus on health care. With an estimated one third of Medicare spending going towards care of beneficiaries in the last year of life, attention has understandably turned to the rising costs of hospice care. Hospice is the leading provider of palliative care services for those facing serious and life-limiting illness.

Admittedly, there has been much growth over the past decade, from 700,000 patients receiving care in 2000, to more than 1.5 million people now. Current Medicare spending on hospice has increased to nearly $12 billion. Utilization of hospice and the costs of care have increased due to a variety of factors affecting the field.

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How To Achieve Compassionate End-Of-Life Care

Paul Levy

First published 3/14/11 on [Not] Running A Hospital

very special report is being released right now at the Boston Public Library from the Expert Panel on End-of-Life Care, a multidisciplinary group of 41 stakeholders, including health care professionals, service providers, policy makers, health care advocates and legislators. They were appointed by the state’s Executive Office of Health and Human Services, as directed by the Legislature.

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Pulling the Plug? Not So!


In a “reversal of an earlier reversal,” the Obama administration recently “pulled the plug” on its regulatory efforts to reimburse physicians for providing patients with counseling and advanced care planning information. This concept was jettisoned during ACA’s debate and ultimate passage. We all recall the “death panel” controversy and the ensuing debate that ultimately cost this reform provision its life.

Those of us who care for patients at the end of life cringed when the death panel image was resurrected. End-of-life care discussions can provoke emotion, fear and outright dread. Despite greater acceptance of hospice and palliative care in recent years, underlying attitudes and expectations have not changed much. The outcry in response to the news of the regulatory change reflected the distaste and discomfort with the mere mention of terminal illness, treatment and care options.

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Anti-Choice At The End Of Life

Ann Neumann

Originally published 1/19/11 on RH Reality Check

Ann Neuman's pictureEarlier this month, a regulation to provide Medicare coverage for advance care planning counseling—that is, offer reimbursement to doctors for time spent talking to patients about end-of-life care was abandoned… for the second time.

Section 1233 of the Patient Protection and Affordable Care Act (PPACA) died a first death in the summer of 2009 in the debate over healthcare reform, during which healthcare opponents characterized the provision as a call for government-run “death panels.” Former Lieutenant Governor of New York State Betsy McCaughey, who consulted with Philip Morris while working on the hit piece against the Clinton healthcare plan “No Exit,” coined the “death panel” moniker; Sarah Palin popularized it. Then John Boehner, at the time the House minority leader, claimed that the provision would lead the country down “a treacherous path toward government-encouraged euthanasia.” Fox & Friends repeated the “death panel” meme dozens of times, and soon, the provision was stripped from the healthcare bill.

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Atul Gawande, MD on Medicare Payment For End-Of-Life Counseling

In the wake of the Obama Administration’s retreat from allowing Medicare to pay physicians to counsel patients on their end-of-life options, here’s a short but powerful perspective by Atul Gawande, who wrote in depth last August in the New Yorker about how inadequate we are at helping patients negotiate death.

Gawande: Questions For Patients Facing Death

Here’s a 3 minute clip from Atul Gawande’s lecture at the New Yorker Festival in early October, titled “How To Live When You Have To Die.” I was extremely fortunate to be invited to be in that audience. It was not only informative and useful, but moving in a way and to a degree that exceeds any other professional presentation in my career. This taste provides some key information on questions worth posing to anyone facing death, but for anyone interested in the topic, I’d encourage you to invest $4.95 and an hour and a quarter, and watch the entire presentation here. I promise you that the experience will be well worth the investment.