ABCD Exchange : January - February, 2001 : Policy Changes Can Improve EOL Care

How Changes in Public Policy Can Improve End-of-Life Care

Deficits in End-of-Life Care
Today's health care system has many shortcomings in treating serious, chronic disease, such as:

• Inadequate pain management, including underuse or incorrect prescribing of pain medications;
  
• Inadequate symptom management and palliative care;
  
• No payment or incentive for continuity and coordination of care;
  
• Absence of standard guidelines or procedures for advance care planning;
  
• Absence of a national standard for emergency medical services to people with serious chronic disease; and
  
• Inadequate education and training of physicians, nurses, and interdisciplinary staff in end-of-life care.

Federal Policy Changes to Improve End-of-Life Care
A coordinated national effort to improve care for people with chronic illness should start with pilot programs that demonstrate innovative, effective means of delivering such care. Patients and families should have access to any and all of the services they require--at a cost they can afford and society can willingly pay. Federal entities have a role in meeting these needs; for example:

• Hospice. Authorize the use of a severity criterion rather than prognosis, the six-month rule that has contributed to decreased lengths of stay. Encourage the Health Care Financing Administration (HCFA) to set more appropriate reimbursement rates.

• Centers of excellence. Contract for one or two excellent providers (in an urban area) who guarantee continuity of care for patients with fatal chronic illness. Track minimum performance criteria on patient education, follow-up, continuity, utilization, comfort, advance planning, and satisfaction.

• HCFA and/or HCFA/HRSA demonstrations. Fund demonstrations to learn how to effectively and efficiently deliver good care to the chronically ill, how to provide and maintain continuity for this population, and at what payment rates and strategies. Ultimately, a successful HCFA demonstration could become a permanent Medicare program.

• AHRQ demonstration/evaluation. Develop methods of measurement, translation of findings into usual practice, and guidelines on care of this population.

• Quality improvement and regional initiatives. Authorize a resource center to support widespread quality improvement in the coordination of care across programs, when patients need multiple programs over time.

Any one of these recommendations could improve care of the dying, and enrich our understanding of the programs and services most needed in this field. For more information on ABCD's legislative specifications, visit our website at www.abcd-caring.org, and join our discussion group or visit the board at www.befearles.com.

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