Current financial incentives don't encourage the idea of letting dementia patients die peacefully at a nursing home, Dr. Sachs said. “When the [nursing home] patient has pneumonia and is getting close to dying, the nursing home has to provide more care … but they are not reimbursed more. Depending on where they are and if the patient is on Medicaid, if they send the patient to the hospital they can actually be paid a 'bed-hold,' and they are actually making money while the patient is in the hospital, rather than losing money from having to provide additional care.”
In addition, the physician, instead of being paid at a lower rate and doing less frequent visits, “hospitalizes the patient and makes more money by seeing the patient on a daily basis and gets reimbursed at a higher rate,” he continued.
“All the financial incentives are aligned for this patient to be transferred to the hospital rather than being cared for in the nursing home and being allowed to die peacefully,” he said.
The September meeting was the last one at which Leon Kass, M.D., a fellow at the American Enterprise Institute, would serve as council chairman. The new chairman is Edmund Pellegrino, M.D., professor emeritus of medicine and medical ethics at Georgetown.