Medicare and End-of-Life Care

After railing on government programs yesterday, I will report something positive on one today.  End-of-life is a very difficult time for people and their families.  Care can be quite expensive at the end-of-life, expecially when multiple futile efforts are made to keep dying people alive for a few more days or weeks.  Payers have adopted numerous initiatives to have patients make decisions about the kind of end-of-life care they want well ahead of time and to minimize useless and expensive care.  Medicare requires that beneficiaries be encouraged to fill out advance care directives and has several programs aimed at ensuring that beneficiaries have information about their choices regarding end-of-life care and that beneficiary preferences regarding that care are respected.

One such program is the Medicare Care Choices Model which allowed beneficiaries to receive conventional care for terminal conditions along with supportive and palliative care from hospice providers.  Persons who choose this program spent five more days at home at the end of life than did matched controls who weren’t enrolled in the program.  The vast majority of people say they want to die at home.  These people were also 15 percentage points less likely to receive aggressive end-of-life care, which is typically expensive and futile.  Medicare expenditures went down by 13%, hospital admissions by 26% and ER visits by 12%, while hospice use increased 18 percentage points.  All very encouraging and aimed at educating people about their options and respecting their wishes.    (HA Article)

And then there is the Minnesota approach under Fat Timmy Walz, which is basically to encourage old people to kill themselves and if they won’t, make sure CV-19 runs rampant where they live, especially nursing homes and other congregate care settings.