Medicare Data Delivers Surprising News about Common Procedures for Elderly Patients
The statistics on healthcare spending on procedures for elderly patients are alarming.
- As much as 18% of a person’s lifetime medical expenses are spent during their last year of life.
- 30% of Medicare’s annual expenditures are spent caring for the 5% of recipients who will die during the same year.
- One-third of that money is spent during their last month of life.
How does all this end of life healthcare spending effect quality patient care?
It means many people spend their last year in and out of the hospital while suffering through intrusive and painful testing and treatments that will likely do little to extend their life – let alone improve the quality of their last days.
“A lot of the money being spent is not only not helping, it is making that patient endure more bad experiences on a daily basis. The patient’s quality of life is being sacrificed by increasing the cost of death,” according to Michael Bell, a contributor to Forbes.
The frequency of commonly performed procedures on these, and other hospitalized elderly healthcare patients increased significantly between 1997 and 2010 according to H-Cup, the Healthcare Cost and Utilization Project.
- Respiratory intubation and mechanical ventilation increased 44% for patients 85 and older.
- Blood transfusions rose by 91%.
- The number of patients receiving ICU services in their last three months of life grew seven percentage points between 2000 and 2009.
This in spite of the fact that these last ditch treatments are rarely effective.
“Only 6% of cancer patients who undergo CPR leave the hospital,” according to an article in the Yale Journal of Medicine & Law.
Often times, patients don’t understand the potential outcomes or the severity of their condition and opt for treatment that is expensive and does nothing to improve their chance of survival but uses up their precious time and resources.
According to the Yale Journal article, 70% of advanced lung cancer patients and 81% of late-stage colon cancer patients undergo chemotherapy that is unlikely to cure them. It is, however, likely to cost a lot of money and prevent them from having a quality end-of-life experience at home, as most people say they would prefer.
One solution to provide quality patient care rather than quantity at the end of one’s life is to discuss and plan for it in advance with family and doctors. The discussion should focus on the patient’s goals, values and fears around end-of-life care, rather than procedures, and how they relate to suffering, survival and quality of life.
“Patients who plan ahead are likelier to get the treatments they want as they near death. These patients tend to get less-aggressive care, earlier referral to hospice, are more satisfied with their care and see lower burdens placed on family members,” according to American Medical News.
The AMN also states that less than one-third of “Americans has a living will and only half of U.S. patients with terminal illnesses have such directives documented in their medical records.”
Part of the problem is that discussions about end-of-life care are difficult to start so many of them “occur during acute hospital care, with providers other than oncologists, and late in the course of illness,” according to AMN.
Another problem is that often times an elderly healthcare patient has a health care proxy who believes an existing Do Not Resuscitate Order addresses end-of-life care issues when it doesn’t.
A Serious Illness Communication Checklist exists to help oncologists discuss end-of-life care issues with their patients. But it isn’t widely used, and when it is, it isn’t until after the patient is diagnosed and likely to make emotionally charged rather than informed decisions.
General Medicine, The Post-Hospitalist Company, provides practitioners who specialize in caring for people in post-acute care settings. They focus on quality of life rather than quantity of treatments and procedures for their end-of-life patients.
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