Map of life expectancy at birth from Global Education Project.

Sunday, May 04, 2014

Actively Dying

That's a strange term of art I have recently come across in the field of hospice care. I'm not sure how you would define it -- we're all actively dying, it seems to me, it's only a matter of degree. But, hospice care means we aren't working at prolonging life or trying to treat underlying disease, but rather at making a dying person as comfortable as possible. The WaPo wants me to steer you to this investigative report that finds, based on billing records and supported by anecdote, that some Medicare hospice providers are taking the money, but not really doing that.

My colleague Joan Teno is quoted as endorsing their deduction that a hospice that claims no skilled nursing care and zero hospitalizations is skimping. Yes, we aren't trying to prolong lfe, but some painful crises do require active intervention for palliation.

The reason is financial incentives, apparently. Lower level care is more profitable. Medicare could try to fix this by realigning reimbursement or more active oversight, but meanwhile if you have a loved one in crisis be a squeaky wheel.

Cast comes off Tuesday and hopefully I'll get back to more regular posting. In other personal news, you might be interested in this article of mine that just went open access on PubMed central. Federally funded research has to be publicly available after one year. The publishers, who make billions, don't like that and they're trying to overturn it. Don't let them.


roger said...

i read your article. then tried to recall my recent conversations with my gp, oncologist, colonoscopy doc, and plastic surgeon. wow. what a lot of medical stuff. i like the framework of presentation as one part and resolution as another. my docs seem to be right on about asking me about symptoms. i'm possibly more informed than some patients, so i don't have very many questions about treatment. i mainly either agree to the treatment offered or decline it.

Cervantes said...

Declining is rare, BTW.