WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.
The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.
Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.
Dr. Allen S. Lichter
"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."
Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.
Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.
Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.
Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.
"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."
Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.