Medicare and End of Life Care

For the past several years, the Arizona Hospital and Healthcare Association’s Thoughtful Life Conversations (TLC) program has been working to do community outreach and education across the state about the importance of planning for end-of-life care. Another focus has been to provide education for healthcare professionals, doctors, nurses, and social workers, on how to initiate serious illness conversations to determine their patients’ goals so they can be honored.

End of life data for Medicare FFS Beneficiaries with Parts A & B who resided in Arizona (for the year 2016) were collected and reviewed. While there are some positive findings, there are also opportunities for improvement. Findings include:

  • Arizona has one of the highest rates of utilization of Hospice services but patients are referred to Hospice late with the majority (71%) using Hospice services less than 30 days
  • Inpatient mortalities are low
  • A little over 50% of patients had an ED visit in their last 30 days of life
  • Patients had a median of 26 days between last inpatient admission and death
  • Cancer care opportunities exist as beneficiaries:
    • 85% seeing greater than 10 health care providers in their last 6 months of life
    • 60% had an ED stay within the last 30 days of life
    • 40% had an inpatient ICU stay in the last 30 days of life
    • 17% had Hospice Care 30 days before death?
    • 9% had chemo in the last 30 days of life, 5% in the last 2 weeks of life

This data correlates with a physician survey done by the Arizona Medical Association and the Arizona Osteopathic Association End-of-Life Task Force published in January 2018, showing conversations between Arizona physicians and their patients often happen too little and too late. Their recommendations are for earlier referrals to Palliative Care and Hospice, interdisciplinary training on how to talk to patients who are seriously ill, and community education on the importance of advance care planning. These actions will improve symptom management, improve wellbeing, reduce suffering and result in reduced utilization of acute care services.

Many people feel that we, as a society, have not come to terms with dying as a natural part of living. The technological capabilities of medicine have outstripped our moral capacity to distinguish what can be done versus what should be done. This results in end-of-life care that is often aggressive, expensive and not aligned with what the patient and their loved ones want.

When given the opportunity to talk about their wishes, most people choose quality over quantity of life. But we rarely ask people who are seriously ill about their wishes and just listen to what they want. Whether we are clinicians, advocates, caregivers or family members, we can all get so busy rushing forward that we forget to ask and to listen. This is why we created Thoughtful Life Conversations (TLC), a statewide initiative to radically change the way we live and die in Arizona. Help us spread the word. Share this blog. Be part of the movement to improve end-of-life care in Arizona. Working together to find innovative ways to change the way we think about health issues in our state is another way we are working toward our long-term goal of one day making Arizona the Healthiest State in the Nation!

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