Is Medicare too expensive at the end of life?

[okarol]

05/05/2008
Is Medicare too expensive at the end of life?

Biweekly medical commentary from Robert J. White, M.D., Ph.D.

The status of our medical health care system has increasingly become of major concern to each American, the government and the candidates for president.

As a retired physician who practiced in Northeast Ohio for more than 37 years, I can tell you that changing anything in our present health care system is going to be extremely difficult. Alterations in the medical framework of our long established patient-doctor-office-hospital relationships could have dire consequences.

The primary problems within our contemporary health network are affordability and availability. If the central issue is cost - and many people will say it is - there is some evidence which demonstrates how complicated it would be to reduce the financing of medicine.

Large groups of Medicare patients were studied to examine the possibility that by idealizing their health care, the cost would be reduced by limiting hospital admissions and providing the availability of specially-educated nurse practitioners who would conduct physical examinations and provide instruction on prescribed medications. Nurse practitioners could also follow-up on patient conformity to their drug schedule. The goal of this assistance and subsequent patient care would be to save money by reducing the number of visits to physician offices or emergency rooms, as well as expensive hospital stays.

About 160,000 patients were enrolled in a program known as "Medicare Health Support." There are slightly less than 70,000 patients remaining in this group today. The initial clinical method was developed on the theory that this form of patient management would result in a significant financial savings for the Medicare system. During several years of functioning, this medical management technology actually caused an increase in the cost of handling Medicare patients utilizing maximum patient management techniques. They had planned on saving the Medicare system $20 billion to $30 billion per year. In all fairness, we must remember Medicare patients are, obviously, older individuals, and a higher percentage of them suffer from chronic diseases such as diabetes and heart failure.

Obviously, a great deal of money is spent during the last two years of a patient's life, based on data from patients who died from 2001 to 2005. A recent study examines the financial rate of chronically ill Medicare patients during that period. Patient statistics were taken from five top ranked academic medical centers that included the Mayo Clinic, The Cleveland Clinic, University of California at Los Angeles, Massachusetts General Hospital and Johns Hopkins Hospital. It's believed these institutions offer the last word in current medical care in this country - and the world.

I have visited all of them, and worked in most of them. I found intense programs in place to treat elderly chronically ill patients. The cost of hospital care for two years at the five stellar institutions that were examined showed there was a wide gap between the UCLA Hospital and St. Mary's Hospital at the Mayo Clinic.
For example, the average two year cost for terminally ill Medicare patients at UCLA was $93,824, while at the Mayo Clinic that cost was only $53,432. Incidentally, the Cleveland Clinic came in second least expensive in this prestigious group at $55,333.

Medical experts feel that by examining the large discrepancies in cost between institutions there may be a way documented that will assist in reducing the cost of hospitalization at the end of life.

The expense of dying in a hospital from a chronic disease has always been high. If doctors treat patients under orders such as "do everything possible to save this patient" then, of course, the price of life escalates rapidly. We must begin to realize that the extended price of living can become costly.

In order to address this "life and death" equation in elderly patients, a number of bioethicists have suggested to limit the access of expensive instrumentation and medications after the age of 80. In other words, the final solution to the control of escalating medical prices is to reduce them by denying the elderly patient sophisticated and costly medical and surgical treatments.

They would not be able to have expensive chemotherapy for cancer and open heart surgery after the age of 80.

Welcome to the new age of medical care.

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[stauffenberg]

In 1930 the average American doctor earned half as much as the average American lawyer, and now, through intensive lobbying and self-promotion, the average doctor earns twice as much as the average lawyer.  The first place to start to deal with America's burgeoning healthcare costs is to cut drastically the bloated fees demanded by the medical profession rather than to begin by letting patients die for lack of care to prop up physicians' wages.