Health Reform, Too Tough on Hospital Readmission

First of all be careful what you wish for - I certainly hope that the average American will take head and thoughtfully consider what health care will look like if our government runs our healthcare plans. The horrors!!

Nevertheless, there are hugh misconceptions with regard to what palliative care is and what place it should have on the table of health care reform. While hospice provides palliative or comfort care, multidisciplinary palliative care teams provide casemanagement for persons with chronic or life-limiting illness. These are individuals who do not have a prognosis of 6-months or less to live; these are individuals who may continue to choose curative measures; these are individuals whose unmanaged symptoms lead them to frequent hospitalizations with little relief. Palliative care brings the family into the healthcare discussion and decision making just as hospice care does, palliative affirms life and regards dying as a normal process. The overall objective of palliative care is not to prolong life at all costs but to enhance the quality of life, positively influence the course of the illness, and is provided in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, while managing distressing clinical complications.

This is a medical model of service that is an extension of the Hospice model...this is a model that has proven to be cost effective while improving quality of life and patient satisfaction. If Palliative Care does not have a prominent place at the health care reform table we could all be in trouble!

Kimberly Connell of NY 11:39AM May 13, 2009

My Mother-in-law had diabetes and started poke her fingers twice daily to test her blood sugar level in her mid 50's. She had a heart attack at the age of 73 and went through triple bi-pass surgery. She eventually developed congested heart failure when she's 76 and passed away just half-month before of her 81st birthday last spring.

After her treatment at the hospital for congested heart failure, she was placed in a nursing home near her community to 'recuperate'. She never was able to leave the place even though it scared her to death to be staying in a strange place without her husband. She often cried herself to sleep. My Father-in-law had had two hip surgeries by then and was not able to take care of her at home.

He visited her twice a day for several years. I stayed with her during summer and winter breaks when I was a school teacher. My Sister-in-law, a nutrition professor, has been making an 8-hour round trip every other week to spend the weekends at my In-law's to help them out. My husband has not been working the past 6 years because my Father-in-law asked him to put off his job search. Now I am unemployed - after two brain tumor surgeries and two breast cancer surgeries - we are experiencing exactly what's described in the Book of Job.

During her 5 years stay in the nursing home, she only needed to be taken to the hospital once for some kind of acute care.

When her condition was deteriorating, she started getting hospice care. It stopped when she was getting better (we thought she might have gotten a natural by-pass after she was having a mini 'stroke') The hospice nurse showed up again four months later when Mom's condition deteriorated again. She eventually left us January 6 this year.

The 'government' needs to understand that nobody likes to stay in the hospital. The decision needs to be made by physicians and health care professionals. Discouraging hospital visits is only going to increase the medical cost because patients will require much more care with a worse illness. My In-laws has regular health insurance with medicare supplement. For those who are completely depending on medicare, I think they probably already have been putting off their medical care long enough.

Jackie Swenson of TX 6:48PM May 09, 2009

Dr. Healy's dismissal of Hospice/Palliative is breathtaking and rather shocking for someone so connected ino the world of American health care. Frequent hospitalization is often an important clue that honest discussions about disease/prognosis/treatment options have not occurred, resulting in poor discharge planning. Using a measure of "aliveness", the 93% figure quoted by Dr. Hearly ignores the fact that although we can keep people alive, the real question, especially for the chronically ill with declining function, is the patient and/or family-perceived quality of life. Far too often we keep alive patients without offering options of less agressive care. Go into any ICU in the United States and you will find the beds filled with frail elderly, with multiple chronic diseases, undergoing invasive life sustaining treatments. What you are far less likely to find is any documentation of an honest discussion with the patient or family about all the options, not just the life-prolonging options. The growth of the palliaive care movement in the past 10 years has been a direct result of the failure of American medicine to honestly inform patients and families about all their options, resulting in prolongationg of dying, rather improved quality of living. So rather than "ghoulish", as Dr. Healy suggests, palliative care consultations in hospitals have been demonstrated to help patients and families make difficulty decisions, improve their level of satisfaction with health care, assist the primary physician in making difficult decisions,and lower hospital costs.

David E. Weissman, MD; Palliative Care Center, Medical College of Wisconsin of WI 5:31PM May 04, 2009

Obama has been told that medicare costs are toohlgh in the last 6 mos of life. This is one way of reducing costs. Dont readmit and people will die earlier saving lots of money.

gordon doolittle of TN 5:14PM May 01, 2009