Redeploying Physician Services at End-of-Life

A recent post (read here) suggesting that the "redeployment" of physician services for end-of-life care is one way to address the health care cost issue at once threatens the income potential of many physicians.

In a statement before the April 2009 US Senate Finance Committee Roundtable on Delivery System Reform, Allan Korn, M.D. ,Senior Vice President and Chief Medical Officer of Blue Cross and Blue Shield Association, called for the creation of "clinical pathways to help physicians provide compassionate and cost-effective end-of-life care." Among patients who died of cancer, Dr. Korn noted, a major contributor to cost and quality-of-life issues is the widespread use of chemotherapy in the last three months of life. Studies show that 15 to 20 percent of patients with incurable, end-stage cancer receive chemotherapy within 14 days of their death, a time when chemotherapy has no benefit. He went on to recommend funding a pilot starting in 2009 to identify the extent of overuse errors in treatment of cancer patients, for example by measuring non-palliative chemotherapy use in the last two weeks of life, and to establish best use of palliative care.

The American Hospital Association identified longer-term cost-containment strategies that will be pursued, as evidence, tools and nationally-endorsed measures emerge. One such strategy advanced by the AHA is to "Promote Efficient Resource Utilization" – more specifically, to promote palliative and hospice care through the use of advanced directives and best practices.

Indeed, palliative care should be better distributed throughout our communities. But palliative care is not an add-on. Rather, its value lies in its offering an alternative, or a substitute for another type of physician care/service already being provided to patients with advanced ilnesses. Lots of revenue/income is at stake. Is it any wonder why critics of health reform are associating palliative care with rationing?