NPR’s Joseph Shapiro has unearthed an outlier in the nation’s health care cost numbers, one which demonstrates the reality of regular end-of-life-care discussions that extremists once branded “death panels.”
In La Crosse, Wis., 96 percent of adults die with a living will, a rate far higher than anywhere else in the country. It seems to be no coincidence, then, that at the city’s Gundersen Lutheran hospital, Shapiro writes, “less is spent on patients in the last two years of life than any other place in the country.”
Right now, Gunderson officials say, it’s expensive to take the time to spend the time necessary to educate patients on their end-of-life options, and Medicare doesn’t reimburse the hospital for such activities. Driven by ethical considerations, the hospital spends millions on the program anyway. There’s a provision in the reform package passed by the House of Representatives to pay for these activities, and La Crosse hospital officials are pushing for its success.
“When people see the low cost in La Crosse, there are assumptions about rationing care, about denying care, about limiting — that we limit care for our patients,” says Hammes. But it’s not that dying people in La Crosse are denied care, he says. It’s that they’ve thought out their wishes in advance, so they get exactly the care they want. And often that means avoiding excessive and unwanted care.
Shapiro closes his piece with an elegant summation of the lessons the rest of America can learn from La Crosse:
(That’s) why doctors and patients keep talking about end-of-life care in La Crosse: because choices are complicated. Because people’s feelings change about the treatment they want. And the best way to handle that is to know all your options, well in advance of a health care crisis.
Related
Steve Kroft of 60 Minutes reports on end-of-life care, finding that “many Americans spend their last days in an intensive care unit, subjected to uncomfortable machines or surgeries to prolong their lives at enormous cost.”
He talks to experts about the process of dying and why so many people end up “dying badly,” that is, suffering and connected to machines in hospitals, despite the fact that most people say they want to die at home.
