Aggressive Care, Not Palliative Care, the Norm in New York Academic Hospitals
Posted Sep 04 2009 10:35am
It's very unfortunate that part of the discussion about healthcare reform has been steered by some, notably Sarah Palin, toward an unenlightened discussion about end-of-life issues. A recent article presented data for New York academic hospitals about palliative care using an interesting statistic. It presented the percentage of dying patients who entered hospice care and for how many days (see: At the End, Offering Not a Cure but Comfort ). Below is an excerpt from it:
While palliative care is available to give patients a chance to die without being tormented by excessive medical care, statistics suggest that in New York, the world center of academic medicine, aggressive treatment is still the rule. At Montefiore, only 12 percent of dying patients from 2001 to 2005 entered hospice care, for an average of 4.9 days, during their last six months of life, according to the latest data from the Dartmouth Atlas of Health Care. At Mount Sinai, it was 14 percent of patients for 4.6 days; at NewYork-Presbyterian, 15 percent for 5.2 days; and at New York University Medical Center, 20 percent for 6.7 days, according to the Dartmouth data. Nationally, nearly 32 percent of dying patients had hospice care during the same period, for an average of 11.6 days.... While treatments that try to extend lives produce more fees for doctors and hospitals, they may be given for reasons besides money. “Many clinicians don’t want to send the message that they’re giving up on their patients,” said [an expert on the topic] “They see palliative care as diminishing hope.” [He also] suggested that family finances also played a part in decisions on hospice care, because Medicare typically covers only a few hours a day of such care at home. The health care bill being discussed in the House would ensure Medicare reimbursement for consultations about end-of-life treatment between patients and their doctors, nurse practitioners or physician assistants every five years, or more often in the case of a life-threatening change. The bill would help validate the work of palliative care doctors, who often work on salary and whose services are often subsidized by the rest of the hospital because they do not generate much revenue.
I don't believe that the aggressive end-of-life care that seems to be the norm in New York academic centers is driven by a goal of increasing hospital revenue. Many of the clinical decisions are made in such hospitals by house officers for whom a dying patient will often be viewed as a challenge. As noted above, young physicians don't want to give up on their patients and may not have the experience and maturity to think otherwise. Clearly the answer to this problem is to change the culture of such institutions by elevating the status of palliative care.This will not be an easy task for various reasons.
One step in the right direction, also as noted above, will be adequate compensation for end-of-life consultations. I hope that the political demagoguery surrounding this topic will not act as a barrier to discussion of this topic, at least by the decision-makers. Meanwhile, I am going to keep firmly in mind the national
average for the percentage and duration of patients entering hospice care quoted above: about 32 percent
of dying patients had hospice care from 2001-2005 for an
average of 11.6 days. This will be a useful benchmark for subsequent discussions about this topic.
It's very unfortunate that part of the discussion about healthcare reform has been steered by some, notably Sarah Palin, toward an unenlightened discussion about end-of-life issues. A recent article presented data for New York academic hospitals about palliative care using an interesting statistic. It presented the percentage of dying patients who entered hospice care and for how many days (see: At the End, Offering Not a Cure but Comfort ). Below is an excerpt from it:
I don't believe that the aggressive end-of-life care that seems to be the norm in New York academic centers is driven by a goal of increasing hospital revenue. Many of the clinical decisions are made in such hospitals by house officers for whom a dying patient will often be viewed as a challenge. As noted above, young physicians don't want to give up on their patients and may not have the experience and maturity to think otherwise. Clearly the answer to this problem is to change the culture of such institutions by elevating the status of palliative care.This will not be an easy task for various reasons.
One step in the right direction, also as noted above, will be adequate compensation for end-of-life consultations. I hope that the political demagoguery surrounding this topic will not act as a barrier to discussion of this topic, at least by the decision-makers. Meanwhile, I am going to keep firmly in mind the national average for the percentage and duration of patients entering hospice care quoted above: about 32 percent of dying patients had hospice care from 2001-2005 for an average of 11.6 days. This will be a useful benchmark for subsequent discussions about this topic.