Last Tuesday I was honored to participate in the “Beyond Health Care Reform” event sponsored by Inforum. After listening to Jeff Goldsmith, healthcare futurist from Virginia; Nancy Schlichting, President & CEO of the Henry Ford Health System; and Dr. Patricia Maryland, President & CEO of the St. John’s Health System on their observations and insights on the future of health care and the impact to Southeast Michigan’s health systems, I thought about the future and its impact on the home health industry including hospice. Gauging health care reform and the trends that go with it – population shifts, the economy and employment - is a challenging proposition. 

 

For people facing chronic and terminal illness, the future of health care also holds opportunities and challenges. We see study after study confirming what we know from our patients and their families: people usually want to be treated at home and engaged in their lives as long as possible. They also want straight talk from their healthcare provider about their options. When patients know their end-of-life care options and discuss them with their physicians and loved ones, they are more likely to have an improved quality of life – and undergo less expensive and obtrusive medical procedures. 

 

The challenge with end of life care as currently provided is that like most of health care, we follow the money – the Medicare Benefit established in 1982 – as what we can and cannot provide to the patient and family. We know that by 2013 Medicare will change the way it pays us hospice providers for hospice services.  Some of the current proposals contained in the House and Senate versions of health care reform bill would positively impact hospice services. For example, proposals would allow physicians to be reimbursed for having end-of-life consultations with patients and families and would encourage them to have such discussions in a timely manner – all while also allowing hospice-eligible patients to continue to receive the Medicare-covered services that they received before their terminal prognosis. 

 

We welcome these changes. As of now, the hard choices patients often have to make are between accessing hospice care or: skilled days in a nursing facility (because Medicare pays for the room and board cost); a variety of treatments that can be cost prohibitive and may not improve quality of life or survival; or participating in a clinical trial. These are decisions best made ahead of time, not during a period of crisis.

 

We know through research that some patients with certain diagnoses lived an average of 30 days longer when they received hospice care. A recent study in the Archives of Internal Medicine found that the more spending that occurred during a patient’s last week directly corresponded to their worsened quality of life. So the concern that we are rationing medical services at the end of life as a way to save money and harm the patient is a false argument.

 

The health care reform debate – if we truly focus on health care reform and not health insurance reform – can open the conversation for all of us on how we want to live each day, and how services such as hospice and certified home care services can help us do just that without adding unnecessary burdens to the patient and their family and unnecessary cost to the health care system.