The "Two Week" Solution to End of Life Care
Health nuts are going to feel stupid someday, lying in hospitals dying of nothing.
Redd Foxx My last post discussed the problem of end of life care.
Now I offer another modest proposal to fix this problem.
I call it the "two week" solution.
Simply stated, "Medicare will not pay for any services rendered within two weeks of a patients death".
Medicare would pay for hospice, pain drugs, and previous medications, as well as one primary doctor, but no specialists.
Perhaps this would only apply to patients over a certain age at first, but this could be adjusted.
What would be the outcome? In one fell swoop, doctors, hospitals and nursing homes would change their behavior.
Patients will no longer be entered into the system by default.
Strong financial incentives will exist for patients to be closely evaluated at every level, and truly informed about their chances for improvement.
Specialists will need to carefully consider whether their recommended test, surgery or treatment helps.
Hospitals will be motivated to consider the behavior and performance of the physicians on their staff, to locate and remove the abusers.
Most patients would continue to get needed care, but, but many of the useless, invasive and frequently harmful diagnostic and therapeutic procedures done prior to death will end.
Soon the previously neglected aspects of end of life care will become far more important.
Nursing homes will need to manage dying patients better, and hospice care will need expansion.
Further burdens will be placed on emergency rooms and primary care providers.
Many hospitals would suffer financially, but soon processes would be in place to make certain only appropriate care would be given.
Like many other proposals, this one has little chance of passage, or even serious consideration.
I suspect the right to life and some senior groups would be deeply offended.
Hospitals and doctor groups would take up the mantle of moral indignation over what is really a financial issue.
Nevertheless, the proposal cuts to the heart of the real problem.
Incentives for end of life care are wrong.
The system is not designed for patients, but instead for the benefit of those caring for them.
When honestly discussed, few people wish to undergo the painful, costly and dehumanizing care often rendered in hospitals prior to death, but honest discussion is rarely a part of end of life care.
Until the incentives are changed, we will never be able to deal with end of life care, or other failures of our system, let us start here.
Redd Foxx My last post discussed the problem of end of life care.
Now I offer another modest proposal to fix this problem.
I call it the "two week" solution.
Simply stated, "Medicare will not pay for any services rendered within two weeks of a patients death".
Medicare would pay for hospice, pain drugs, and previous medications, as well as one primary doctor, but no specialists.
Perhaps this would only apply to patients over a certain age at first, but this could be adjusted.
What would be the outcome? In one fell swoop, doctors, hospitals and nursing homes would change their behavior.
Patients will no longer be entered into the system by default.
Strong financial incentives will exist for patients to be closely evaluated at every level, and truly informed about their chances for improvement.
Specialists will need to carefully consider whether their recommended test, surgery or treatment helps.
Hospitals will be motivated to consider the behavior and performance of the physicians on their staff, to locate and remove the abusers.
Most patients would continue to get needed care, but, but many of the useless, invasive and frequently harmful diagnostic and therapeutic procedures done prior to death will end.
Soon the previously neglected aspects of end of life care will become far more important.
Nursing homes will need to manage dying patients better, and hospice care will need expansion.
Further burdens will be placed on emergency rooms and primary care providers.
Many hospitals would suffer financially, but soon processes would be in place to make certain only appropriate care would be given.
Like many other proposals, this one has little chance of passage, or even serious consideration.
I suspect the right to life and some senior groups would be deeply offended.
Hospitals and doctor groups would take up the mantle of moral indignation over what is really a financial issue.
Nevertheless, the proposal cuts to the heart of the real problem.
Incentives for end of life care are wrong.
The system is not designed for patients, but instead for the benefit of those caring for them.
When honestly discussed, few people wish to undergo the painful, costly and dehumanizing care often rendered in hospitals prior to death, but honest discussion is rarely a part of end of life care.
Until the incentives are changed, we will never be able to deal with end of life care, or other failures of our system, let us start here.
Source...