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Time praises Geisinger System on handling of end-of-life issues

By Andrew M. Seder
June 4, 2012

Those words appear in large white capital letters on a red background on this week’s cover of Time magazine. The cover story, written by columnist Joe Klein, details the decisions he faced as his parents’ health declined, and the role the Geisinger Health System played in those choices.

Klein’s parents lived in State College and eventually moved into the Fairways, a nursing home located within their retirement community. His first experience with Geisinger doctors and other system employees left him so impressed, he decided to write the personal story and share it with others.

Having to handle end-of-life issues with a loved one can be difficult, Klein wrote, but he found that the way Geisinger goes about doing it made the situation more bearable.

“In my parents’ case, Geisinger had worked with the nursing staff at the Fairways. I was consulted about every adjustment in medication and told about every time Dad tried to do a walkabout and inevitably fell down. By the third week, the staff and I were co-conspirators, laughing about Dad’s stubbornness and trying out new strategies to make him more content,” Klein wrote.

“The situation was, of course, horrific — Mom and Dad were both fading away — but I no longer felt so guilty and frustrated. I was part of a team making their passage as comfortable as possible. After the struggles I’d been through with Dad, it’s hard for me to describe what a relief this was.”.

Danville-based Geisinger operates several hospitals including those in Wilkes-Barre, Plains Township and Scranton.

In the piece, Klein goes on to say: “Geisinger has found, for example, that by adding case managers — nurses who work by phone and in person from doctors’ offices — to chronic elderly-care cases (like my parents before they entered the nursing home), they can give more individual attention and produce better results. The case managers call or visit the patients regularly to make sure they’ve taken their medication, weighed themselves (on Bluetooth scales that send the results to the Geisinger computers), are eating the right things and are aware of upcoming appointments. They are also there to listen to complaints, which, as those of us who’ve been through parent care know, are not infrequent.”

Geisinger’s approach has been highlighted during President Barack Obama’s first state of the union address, and Klein said he understands why it works and why it earned the president’s praise. And he understands why, what he calls “fee-for-service medicine” is expensive for health insurance companies and customers but hard to change.

“Doctors are trained to do whatever they can to save a patient, even an elderly one, and that is an excellent thing. But that Hippocratic impulse has been subtly undermined by the rewards of fee-for-service medicine and by the threat of malpractice suits, which militate in favor of ordering the extra MRI or blood test or dialysis even for a patient who probably has only weeks to live,” Klein wrote.

“Most doctors don’t like the (Geisinger) way of doing business. The culture of fee-for-service medicine, which features each doctor as the captain of his or her own ship, is incredibly powerful,” Klein said, calling Geisinger’s formula “the accountable-care-organization model.”

The story included comments by Dr. Glenn Steele Jr., a medical doctor and president of Geisinger.

On Monday, Steele said “Geisinger’s recognition by Time magazine is extremely gratifying, and a testament to our commitment to our patients and the hard work of our more than 17,000 employees. Joe Klein’s family’s experience – while very personal – is not atypical at Geisinger. The entire Geisinger family strives, every day, to bring this same level of compassionate, high-quality care to all the patients for whom we care. Mr. Klein’s touching report is affirmation that we are getting it right.”