Art Caplan and I co-penned (computered?) a piece in USAToday recently urging an important hospice reform: Stop making dying patients choose between the hope of living a quality life in hospice, versus the potential for life-extending or curative care in treatment.
That “Hospice Cruel Choice” (HCC) was created by Medicare regulators decades ago, and then as these things tend to go, adopted by private insurance.
But people deserve both hospice and treatment. HCC is unnecessary in terms of costs and causes people to miss out on the tremendous benefits hospice offers in order not to lose all hope.
Since then, I have learned that we appear to be unique in imposing this unnecessary cruel choice. As the piece stated, the UK doesn’t. Neither, I have since learned, does Canada.
The good news: I have been contacted by readers telling me there are pilot programs under Medicare doing away with the HCC. Faster please.
Aetna also conducted a little research in this field–finding that doing away with the HCC improves lives and saves money.
Physician Atul Gawande discusses this in his best-selling book Being Mortal, which I will be reviewing soon. Get this at page 176:
A two-year study of this “concurrent case” program found that enrolled patients were much more likely to use hospice: the figure leaped from 26-70 percent. This was no surprise because they weren’t forced to give up anything. The surprising result was that they did give up things. They visited the emergency room half as often as the control patients did [that had to make the HCC]. Their use of hospitals and ICUs dropped by more than two-thirds. Overall, costs fell by almost a quarter.
So, why do we continue with rigidity when people can be given greater hope and quality of life by allowing more freedom?
Once again, stupid regulations and bureaucracy work as the enemy of humanity. End the Cruel Choice now!