End-of-life care needs sweeping overhaul, panel says

The country’s system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released Wednesday.

The 21-member nonpartisan committee, appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences, calls for sweeping change.

“The health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and former U.S. comptroller general, who was a co-chairman of the panel.

Many of the recommendations could be accomplished without legislation. For example, the panel urged insurers to reimburse health care providers for conversations with patients about how they want to be cared for. Medicare, which covers 50 million Americans and whose members account for about 80 percent of deaths each year, is considering doing just that, prompted by a recent request from the American Medical Association for such coverage.

Some private insurers are already covering such conversations, and many more would if Medicare approves the association’s request.

But some recommendations – like changing the reimbursement structure so that Medicare would pay for home health services instead of emphasizing hospital care and provide better coverage of long-term care for the frail – would require congressional action.

The panel, which included doctors, nurses, insurers and experts on aging, says Medicare and other insurers should create financial incentives for health care providers to have continuing conversations with patients about their care.

The report, “Dying in America,” says its recommendations would improve the quality of care and better satisfy more patients and families. It also says the changes would produce significant cost savings that would help make health care more affordable.

The report’s linkage of end-of-life choices to economic savings is likely to fuel claims by critics of end-of-life planning who charge that the medical establishment and insurers will subtly pressure people to reject life-sustaining treatment to save money.

Burke Balch, the director of the National Right to Life Committee’s Powell Center for Medical Ethics, said in a statement, “The report’s emphasis on cost-slashing will intensify, rather than calm, the well-founded fears of older people and those with disabilities that the renewed push for government funding and promotion of advance care planning is less about discovering and applying their own wishes than about pushing them to accept premature deaths.”