Health policymakers love the idea of hospice. Yet Medicare seems to be learning exactly the wrong lessons from the success of the program, which provides well-integrated patient-centered comfort care to people with terminal illness. Instead of trying to understand why hospice is growing in popularity, Medicare is instead making it harder to enroll. As often happens in its regulation of [...]
I recently had the opportunity to participate in a panel on end-of-life care jointly sponsored the Charles E. Smith Life Communities in Rockville MD, Suburban Hospital in Bethesda, MD,, and Sibley Hospital in Washington, D.C. The session was part of a day-long program on care transitions and highlighted the special importance of caring for the dying. My fellow panelists and I brought a wide [...]
Hospital-based palliative care programs that focus on patient comfort rather than simply medical treatment are growing rapidly. And for patients, their families, and hospitals themselves, that is a very good thing. A new study by the National Palliative Care Research Center finds the number of these important new programs has grown from 600 to more than 1500 over the past decade. Of the nation's [...]
I am a huge fan of efforts to increase awareness of palliative care among physicians, health systems, patients and their families. And I wanted to pass on information about three major efforts to do that. The first is a landmark study by the prestigious Institute of Medicine on the importance of managing pain. The report, Relieving Pain in America: A Blueprint [...]
We all know the sad story: Despite extensive rehab, a patient in a skilled nursing facility is failing. Instead of improving, she is finds herself returning to the local hospital with trouble breathing, heart failure, or unmanaged pain. Eventually, she may die in the hospital hooked up to a ventilator and feeding tube that she never wanted. A team at [...]
Hospital readmissions are bad for patients—especially seniors who may already be weakened by multiple chronic disease. They cost tens of billions of dollars. They are not even good for hospitals (at least not top-quality facilities that regularly fill their beds). About one in five Medicare patients are readmitted within 30 days, and one-third within 90 days, according to a New [...]
The Obama Administration has decided to pay doctors for discussing end of the life issues with their Medicare patients. You may recall that this would have been permitted by the 2010 health law, but the provision was dropped in the face of withering criticism by opponents of health reform, who dubbed these important conversations "death panels." The new rules are an important first step. Doctors absolutely [...]
An important new study finds that patients with metastatic lung cancer who received early palliative care both lived longer and reported a better quality of life than similar patients who had only standard cancer treatment. Palliative care focuses on treating symptoms, although, unlike hospice, patients may still receive treatment for their terminal disease if they wish. Palliative care also coordinates [...]
Mike Vitez at the Philadelphia Inquirer has done a great story on palliative care at a community hospital. Mike weaves the deeply touching story of Mary Tole, a 74-year-old woman who spent two months in the suburban Philadelphia hospital with an undiagnosed illness. She spent much of that time in an intensive care bed in a coma. Mike describes how the hospital's palliative care team [...]