Medicare to Experiment with Expansion of Hospice
Coverage Despite Death Panel Rumor
False death panels rumors about health care
legislation killed plan for helping senior citizens with end-of-life
decisions
By
Michelle Andrews
Sept.
7, 2010 - About this time last year, voters and politicians were
consumed by the rumor, fanned by health-care overhaul
opponents, that the legislation would include
"death panels" of government bureaucrats who could "pull the plug on
Grandma" if she needed costly care.
The outcry led legislators to scrap a provision of
the House bill that would have paid for voluntary consultations between
physicians and Medicare beneficiaries about end-of-life care: living
wills, hospice benefits and the like.
'Health care overhaul creates a three-year Medicare
demonstration project to test the home visit concept on 10,000 of the
sickest, most-expensive-to-treat Medicare enrollees'
By Michelle Andrews
July 15, 2010 - From the back window of his
rowhouse, Karl Schwengel can see the U.S. Capitol. But the 11
blocks might as well be so many miles, because he can barely
walk across his bedroom, let alone go for a stroll.
Read
more...
For older people: expanded Medicaid, coordinated care
for Medicare-Medicaid patients, help for employers to insure early
retirees, FDA can approve cheaper drugs
Since the furor died down, end-of-life care has
been mostly out of the spotlight. But misperceptions remain. A
July poll by the Kaiser Family Foundation found that 36 percent of
seniors still believe that the overhaul creates "death panels." Another
17 percent said they didn't know one way or the other.
Many people may not realize that, in some ways, the
new law will expand options for patients at the end of life.
One of these involves hospice care, in which a team
of specially trained providers treats dying patients' pain and other
symptoms but doesn't try to cure the underlying disease.
The team also
helps the patients' families, instructing them in caring techniques and
providing bereavement counseling after death. Under current Medicare
rules, beneficiaries whose doctors determine that they have less than
six months to live can choose hospice care - but only if they forgo any
further life-prolonging treatment related to their disease.
The new law establishes a three-year "concurrent
care" demonstration program at 15 sites nationwide, in which Medicare
would cover both kinds of treatment simultaneously.
Although the vast majority of patients seeking
hospice benefits are over 65, starting in 2013, the new law also allows
children who are enrolled in Medicaid or the Children's Health Insurance
Program (CHIP) to receive both hospice and curative care.
Some private insurers, such as Aetna and
UnitedHealthcare, have been offering concurrent care to their
private-market clients for years.
Experts agree that hospice benefits can provide
crucial support for both patients and families during a very difficult
time, and some research indicates they may extend the patient's life.
Yet fewer than 40 percent of patients are in hospice care when they die,
according to the
National Hospice and Palliative Care Organization.
Many terminally ill patients wait until death is
imminent to choose hospice care. The median length of time in hospice
was just over 20 days in 2008; more than a third of people died or were
discharged from hospice in seven days or less.
"We think it's far too short a period for patients
and their families to adjust to the realities of impending death," says
Jon Keyserling, vice president of public policy and counsel for the
NHPCO.
Adding support to the notion that providing
curative and supportive benefits together is good for patients is a
study published last month in the New England Journal of Medicine.
It found lung cancer patients who received specialized care to help
manage their physical and psychosocial symptoms while they were
undergoing standard cancer treatment received less aggressive end-of-
life care but lived longer than patients who received standard cancer
treatment alone.
After going through a couple of rounds of
chemotherapy and many radiation treatments to treat his lung cancer,
Crune Carawan finally decided hed had enough. Somewhat reluctantly, his
wife, Judith, whod been caring for him since his diagnosis in May 2009,
called a hospice center near their home in Columbus, Ohio. "I was
skeptical about hospice," she says.
She quickly changed her mind. Three hospice nurses
came to the home, evaluated her husband and adjusted his medications,
making sure he wasn't in any pain. They ordered a hospital bed and got
it set up that same day.
Over the course of the next week, a nurse visited
several times to help calm him when he felt anxious. They also talked
with her about what to expect and gave her a small book that described
the changes she might see in him. He died seven days after their first
visit.
"I kind of do wish they'd come in earlier," Judith
Caravan says. "He really enjoyed the nurses. They'd come in and laugh
with him."
Hospice professionals say patients and family
members are better served if they use hospice benefits for about two
months.
Experts agree that the requirement that
they forgo curative treatment stops some Medicare patients from
choosing hospice. Even when aggressive therapy may provide
little therapeutic benefit while severely diminishing the
patient's quality of life, it's not easy to say "no more." Once
the 15 demonstration sites are up and running, expected sometime
in 2012, participants won't have to make that choice.
July 15, 2010 - From the back window of his
rowhouse, Karl Schwengel can see the U.S. Capitol. But the 11
blocks might as well be so many miles, because he can barely
walk across his bedroom, let alone go for a stroll.
Read
more...
