Joan Teno and her coauthors' analyzed the Medicare fee-for-service records of more than 840,000
people aged 66 or older who died in 2000, 2005, or 2009. They looked at
where seniors died, what medical services were provided during their last 90
days of life, and how long they received them.
In the latest issue of JAMA (free download), Teno et al. report that while more seniors are dying with hospice care than a decade ago, they
are increasingly doing so for very few days right after being in intensive
care. “For many patients, hospice is an ‘add-on’ to a very aggressive
pattern of care during the last days of life." “
The consequence of this pattern of
going from the ICU to hospice is that "these dying patients are getting symptom control
late and can’t benefit as much from the psychosocial supports available were
there a longer hospice stay." The authors blame both poor
communication and financial incentives.
1 comment:
The Age Discrimination Law and the Hospice Law and Palliative Entitlement in the 80's and the 1991 Patient Self Determination Act have caused problems for the elderly! ----that the elderly are NOT aware of.
The elderly are pgyrm OVERTREATED for profit when the providers KNOW that Medicare/Medicaid and the private insurers will pay for the treatment.
However the elderly are often undertreated in terms of withholding life-saving and life-extending care (overt and covert DNRs) when there is a question of whether or not the prescribed treatment will be reimbursed by CMS and the private insurers.
IPAB becomes necessary to prevent overtreatment of elderly patients and to prevent the shortening of the lives of our elderly without their informed consent.
WHY is their NO FEDERAL MANDATE for physicians to seek informed consent to Palliative Care OR Curative Care ---whichever is in the best interests of the patient, as determined by the physician-educated patient and the treating physician?
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