After a half-century as a Medicare benefit, hospice care still has had only limited success in improving the quality of patients’ lives as they approach their deaths. While more people are enrolling in hospice (about 1.7 million in 2020), they often do so only days before dying. Thus, they fail to benefit from the best of what hospice has to [...]
We Americans love to compete. We bet in March Madness office pools on who will win the annual college basketball championship. We pay a pretty penny for the best manicured lawn in the neighborhood or the biggest flat screen in the condo. Some of us will pay bribes to get our kids into the best colleges. And, now it seems, [...]
You probably have heard the statistic: One-quarter of Medicare spending is for patients in the last year of life. It is cited as a major reason for excessive medical spending in the US and leads to a widely-accepted conclusion: If only we would stop “wasting” dollars on futile care for those who soon will die anyway, we could significantly slow [...]
Increasingly, older Americans are likely to die at home, and not in a hospital. And more seniors are using hospice care as they near end of life. However, stubbornly large numbers of Medicare beneficiaries still land in intensive care units or find themselves shuttled from home to hospital and back again in their last months of life. A fascinating and [...]
We may be about to have a new debate over “death panels.” If we do, it would be a tragedy for tens of millions of Americans and their families. You may remember this small piece of the Affordable Care Act that garnered outsized attention back in 2010. It allowed Medicare to pay physicians for having end-of-life conversations with their patients. [...]
In recent years, it has become conventional wisdom that physicians avoid the end-of-life mistakes that many of the rest of us make. The story: They die at home rather than in hospital intensive care units. And they rely on comfort care such as hospice or palliative care rather than often-futile high tech medicine. That conventional wisdom, it turns out, is [...]
Dying is trendy. I got an email the other morning about “celebrity deaths.” After the recent demise of David Bowie, Glenn Frey, and “Grizzly Adams,” it seems that everyone is doing it—dying, that is. Apparently, people have been live tweeting the deaths of loved ones at least since 2013. Rock star docs such as Atul Gawande have created their own [...]
The public overwhelmingly thinks doctors should have end-of-life conversations with older patients. It even thinks Medicare ought to pay for those talks. It just doesn’t want to have them, at least not yet. Those are results of a new Kaiser Family Foundation poll, which found that 89 percent of respondents felt physicians should discuss end-of-life choices with them. But only [...]
A new Medicare pilot program will make it easier for patients to access some hospice benefits without giving up standard medical treatment for a terminal disease. It is an important step towards building a health system that fully integrates social, spiritual, and palliative care such as pain management with health care. But it doesn’t get all the way there. Today, [...]
Ever since the death of Brittany Maynard--the 30-year old with terminal brain cancer who ended her own life last November-- the issue of physician-assisted suicide has received an enormous amount of attention. Now it is back in the headlines as many states consider laws permitting the practice. It is an important and passionate debate, but for the vast majority of people, it misses [...]