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.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK. He blogs regularly at Health Business Blog, where this post first appeared.

9 replies »

  1. how right you are John. Most supporters of the LCP earn their living by it.
    They make false and unscientific claims and engage in scare mongering, saying such things as it is kinder to put the patient on the LCP ( Is there proof that a patient feels better, just because they are too spaced out to express themselves) or that the medication relieves symptoms-let us be clear here that the death rattle is painless, and the only people that it helpps to remove this symptom is the relatives or nursing staff, and as a relative, I was not told the facts. False claim number 3 form proponents of the LCP is that death itself is painful. IT is not. … and so it goes on.

  2. barbara, its not the patients who choose palliative care it is chosen for them, by the euthanasia tick box team, not diagnosed if a patient does not feed him or herself thats one tick against them if the patient is too ill to get out of bed thats 2 from 4 and its down the pathway back door murder, the two remaining are not able to swallow tablets, the other catheterized , if a patient is to ill they should be fed and given water, its rubbish that they will drown on a intravenus drip, before this lazarus pathway came into being, they were cared for not starved, dehydrated and syringe driven to death, it does save money but its an early grave, it dont save precious lives. the wages of sin is death.

  3. its common sense if someone is ill you dont just give them painkillers and starve them, you treat them if they cannot feed on their own its a straw or drip fed you have got to give them water and food to survive not to let them waste away sedated.

  4. Reply to Margalit & Nate:
    Those that choose palliative care are “accepting death” . Most Americans do not recognize the slow painful process of dying by wasting away in an institution that could continue for years. Most do not believe it could happen to them or to their loved one. If we understood ourselves and our institutions for the dying, then we might have the discussion “we need to have”.

  5. The figures are hard to understand. In England sometimes palliative care is used as a euphemism for the Liverpool Care Pathway and sometimes not. In my husband’s case it was as he had no symptoms they would be relieving.
    Except later the death rattle/ pulmonary oedema which is a natural part of the dying process. (I found out later).

  6. “So the study, in my opinion, is not indicative of cost cutting abilities of palliative care per se, but may be indicative of cost cutting abilities of accepting death at an earlier point then most Americans currently do.”

    great quote

  7. Let’s take another look at those numbers.
    The study looked at 2212 patients – 1717 who were discharged alive and 495 who died in the hospital.
    It seems that 161 of those who died in the hospital where discarded for lack of matching, leaving us with a total of 2051 matched patients, 1717 alive and 334 dead.
    Slicing and dicing the results tables in the appendix, yields 1576 patients with no palliative care, of whom 149 (9.45%) died, and 475 patients receiving palliative care, of whom 185 (38.95%) have died.

    If I were Sarah Palin, I would conclude that palliative care increases your chances of dying by over 400%.
    Since I am not Sarah Palin, and noticing that folks were not randomly assigned to palliative care, but chose to do so themselves, I would conclude that those who received palliative care were either further along in their illness and/or more accepting of death, and this particular combination of factors is what decreases costs of care.
    So the study, in my opinion, is not indicative of cost cutting abilities of palliative care per se, but may be indicative of cost cutting abilities of accepting death at an earlier point then most Americans currently do.
    This is the discussion we need to have. Diverting the conversation to palliative care’s magic powers is a disservice to all of us.

  8. David just because you lack the knowledge and experience to grasp the potential outcomes doesn’t mean it lacks truth and reason. You appear to be one of those naive people that believe whatever a p[politician writes on the top of the bill must be the end result.

    Sorry if someone of us know better.

    When Medicare was passed physicians were told not to worry, the legislation clearly and specifically said Medicare must negotiate and reimburse them a fair rate. How long did that last? PPACA was suppose to lower the cost of insurance, how’s that working out?

    Do you think when Liverpool Care Pathway was created they titled it “plan to starve and dehydrate potentially expensive patients to death”? or “Plan to watch as premature babies under 22 weeks die with no assistance to save them”?

    Intelligent people know it’s not what’s in the bill that matters. It’s the non elected bureaucrats that write the regulations, the courts that “interrupt” them, then future politicians that warp them that really matters. Only the naïve public falls for the sound bites.

    “patients and the country as a whole are ready for that conversation.”

    Instead of twisting an intelligent argument into your simplistic attack lets have that conversation, starting with;

    How do we prevent this program from turning into a Liverpool Care Pathway where people are murdered?

    How do we insure in a future managed by ACOs with capitated compensation the doctors providing the palliative care have the patients best interest in mind and not the ACOs?

    FDA is already taking cost effectiveness into consideration when considering new drugs, how do we create a fire wall between those decisions and the governments obligations to pay, or do we want to tell people even if they have the means and effectiveness is proven that there are treatments they are not allowed to have.

    Much more to discuss but that should be plenty to start the conversation. If you spent half as much time answering these questions as you did attacking Palin we might already have this resolved.