Death Panels Everyone Can Live With

Chief among Sarah Palin’s assaults on truth and reason is her contention that providing reimbursement for end-of-life planning sessions with a health care provider is tantamount to a “death panel” where a “bureaucrat can decide based on a subjective judgment of [a person’s] ‘level of productivity in society,’ whether they are worthy of health care.”

A Health Affairs article (Palliative Care Consultation Teams Cut Hospital Costs for Medicaid Beneficiaries) makes a far more level-headed and evidence-based contribution to the discussion. The authors studies the use of palliative care teams at four urban hospitals in New York State. To be clear on what these teams do:

Palliative care aims to relieve suffering and improve quality of life for patients with advanced illness and for their families. It does so through assessing and treating pain and other symptoms; communicating about care goals and providing support for complex medical decision making; providing practical, spiritual, and psychosocial support; coordinating care; and offering bereavement services.

Palliative care is provided in conjunction with all other appropriate medical treatments, including curative and life-prolonging therapies. It is optimally delivered through an interdisciplinary team consisting of appropriately trained physicians, nurses, and social workers, with support and contributions from other professionals as indicated.

The authors found that patients who received palliative care cost Medicaid almost $7000 less in hospital costs per admission than a matched control group that didn’t receive palliative care. Patients receiving palliative care spent less time in the intensive care unit and were less likely to die there. They were also more likely to receive hospice care after discharge and to be discharged to appropriate settings.

If these results were generalized to New York State, the total cost savings could be $85 million to $250 million in Medicaid without reducing benefit levels and while improving quality of life (and death). As states look for ways to put the kibosh on Medicaid spending solutions like this become more and more appealing and are likely to be rolled out.

This study focuses on a relatively small proportion of the end-of-life population. Medicare has many more of them. If these patients received palliative care consultations more systematically, the impact on Medicare hospital costs would be even more substantial. Notwithstanding Palin et al’s histrionics, patients and the country as a whole are ready for that conversation.