End-of-Life Choice, Palliative Care and Counseling

Posts TaggedMedicare

Probe Reveals Claims of Unnecessary Therapies at Cleveland-Based Life Care Centers

by Kate Harrison and Todd South
Times Free Press
December 16, 2012

Details of an ongoing federal investigation into Life Care Centers of America reveal claims that elderly patients undergoing end-of-life care at several company facilities were pushed to high levels of unnecessary therapies so the company could bill maximum Medicare amounts for profit.

The examples in the federal complaint show a more personal side to the allegations of corporate-encouraged fraud that prosecutors have leveled against the Cleveland, Tenn.-based company.

One segment details the case of “Patient D,” a 92-year-old resident at a Life Care facility in Orlando, Fla., who was dying of melanoma in 2007. Though the cancer had spread to Patient D’s brain and lungs and radiation treatments had made him “medically fragile,” he still was administered two hours of therapy every day.

Two days before Patient D died, he was spitting out blood. Yet therapists recorded 48 minutes of physical therapy, 47 minutes of occupational therapy and 30 minutes of speech therapy in one day.

“The day Patient D died, Life Care therapists recorded 35 minutes of physical therapy and had him scheduled for occupational therapy later in the day,” court records state. More

Care at the End of Life

The New York Times
November 24, 2012

Three years ago, at the height of the debate over health care reform, there was an uproar over a voluntary provision that encouraged doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. That thoughtful provision was left out of the final bill after right-wing commentators and Republican politicians denounced it falsely as a step toward euthanasia and “death panels.”

Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.

Many people sign living wills that specify the care they want as death nears and powers of attorney that authorize relatives or trusted surrogates to make decisions if they become incapacitated. Those standard devices have been greatly improved in recent years by adding medical orders signed by a doctor — known as Physician Orders for Life Sustaining Treatment, or POLST — to ensure that a patient’s wishes are followed, and not misplaced or too vague for family members to be sure what a comatose patient would want.

Fifteen states, including New York, have already enacted laws or regulations to authorize use of these forms. Similar efforts are under development in another 28 states. The laws generally allow medical institutions to decide whether to offer the forms and always allow patients and families to decide voluntarily whether to use them.

With these physician orders, the doctor, or in some states a nurse practitioner or physician assistant, leads conversations with patients, family members and surrogates to determine whether a patient with advanced illness wants aggressive life-sustaining treatment, a limited intervention or simply palliative or hospice care. More

What Can We Learn From Eleanor Roosevelt’s Death?

by Barron H. Lerner
Huffington Post
October 23, 2012

Fifty years ago this November, when Eleanor Roosevelt’s doctor told her that her very debilitating disease was tuberculosis, and potentially curable, he expected her to be thrilled. But she instead uttered “I want to die” three times.

As the Affordable Health Care Act goes into effect, much attention is being paid to end-of-life care, and with good reason. Expenditures during patients’ last year of life are enormous — totaling roughly 25 percent of all Medicare costs – and often not very effective. Yet patients, health care providers and even insurers have a hard time saying no to such interventions.

Mrs. Roosevelt’s case vividly demonstrates how crucial it is for physicians to have frank end-of-life discussions about goals of care with patients and families — something that is still too often avoided. By challenging her physicians on this topic, she was, as usual, ahead of her time. More

Overtreatment Is Taking a Harmful Toll

By Tara Parker-Pope
The New York Times
August 27, 2012

When it comes to medical care, many patients and doctors believe more is better.

But an epidemic of overtreatment — too many scans, too many blood tests, too many procedures — is costing the nation’s health care system at least $210 billion a year, according to the Institute of Medicine, and taking a human toll in pain, emotional suffering, severe complications and even death.

“What people are not realizing is that sometimes the test poses harm,” said Shannon Brownlee, acting director of the health policy program at the New America Foundation and the author of “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.”

“Sometimes the test leads you down a path, a therapeutic cascade, where you start to tumble downstream to more and more testing, and more and more invasive testing, and possibly even treatment for things that should be left well enough alone.” More

Let’s Stop Paying for Unwanted Treatment at Life’s End

In 2002, an elderly client of Compassion & Choices, Margaret Furlong, went to the hospital armed with her advance directive, clearly stating she did not want elaborate, life-extending treatment.

The hospital delivered those treatments anyway. She spent ten miserable days in the ICU, tethered to machines and tubes and pleading for it all to stop. Finally it did, and Margaret died. Then the hospital billed Medicare for all her unwanted treatment and Medicare paid – without objection, with our taxpayer dollars.

Margaret’s story is far too common. At Compassion & Choices we intend to put teeth into advance directives, and we need your help.

It is well documented that although advance directives are offered and included in the medical chart – as the law requires – in the end they are usually ignored. The pattern is cruel and absurd, and even the medical profession is starting to understand that. Last year the Archives of Internal Medicine reported, “Persons dying in the hospital often receive burdensome care immediately before death that may not match patient preferences.”

Aggressive medical interventions in the setting of terminal illness do not prolong life, but they do increase the suffering of patients and their loved ones. Sadly, Medicare, Medicaid and private insurance carriers incentivize healthcare providers by paying for unnecessary and unwanted treatments.

This could end if public and private health payers required, as a condition of payment, that treatment in the weeks prior to death conform to the patient’s advance directive.

Here is one way you can help. Tell us if you know of a situation where a doctor or hospital disregarded a person’s explicit instructions or the instructions of a surrogate decision-maker. Your stories will help drive that point home with health insurers, hospitals, and health care providers.

As soon as providers realize the costly, unnecessary and painful procedures, tests and treatments they contemplate for a dying patient may be at their own expense, advance directives will acquire unprecedented power and authority. When providers choose treatment based on what patients want, we will have achieved real progress in shielding people near the end of life from the type of suffering Margaret Furlong endured.