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3.10.2004

Entering death with dignity instead of being dragged kicking and screaming 

From today's Wall Street Journal (subscription required):



Unlikely Way to Cut Hospital Costs: Comfort the Dying

Palliative-Care Unit Offers Painkillers and Support, Fewer Tests, Treatments

RICHMOND, Va. -- The palliative-care unit at Virginia Commonwealth University Medical Center offers plush carpeting, original watercolors and a kitchen for visiting families. A massage therapist drops by often, and a chaplain is available 24 hours. And there's High Anxiety, a fluffy white Lhasa apso that patients love to pet.

In an era of skyrocketing health-care costs, such perks might seem misplaced. In fact, it is all part of an approach that has helped VCU save millions of dollars in an area that is notoriously expensive: treatment of patients diagnosed with incurable illnesses.

Palliative care focuses on comfort, not cure. It tries to relieve a patient's physical and psychological distress, instead of preserving life at any cost. Though palliative care is standard practice in some countries, especially in Britain, it has been slow to catch on in the U.S., where many doctors prefer to use the latest technology or drug to prolong a patient's life, if only for a few months. Fewer than 20% of community hospitals in the U.S. use the approach, according to the American Hospital Association.

"It's counterintuitive to the high-tech American model of health care," says Sheldon Retchin, chief executive officer of the VCU health system.

Now, palliative care is getting new attention, not just because proponents view it as humane, but because it is usually cheaper than standard care. In 2002, there were palliative-care programs in 844 community hospitals, 18% more than in the previous year. In palliative programs, less money is spent on drugs, diagnostics, tests and last-ditch treatments.

At VCU, for instance, a typical five-day stint for a cancer patient cost $5,312 in the palliative wing -- 57% less than it cost to house a similar patient elsewhere in the hospital. VCU officials calculate that the 11-bed unit, which opened in May 2000, saved the hospital $1 million last year, when the palliative wing broke even for the first time.

As they spread, palliative-care programs promise to fuel the debate over how to ration the nation's limited health-care resources -- especially in the expensive last days of life in a hospital. The VCU unit has been chosen as a model for other hospitals by the Center to Advance Palliative Care, based at New York's Mount Sinai School of Medicine, which wants to popularize the concept by emphasizing both the humane and economic case for such care.

Though palliative care has been recognized as a medical specialty in Britain since 1987, it doesn't enjoy the same stature here. Most hospital CEOs in the U.S. are more familiar with making a profit by, say, installing a new CAT-scan machine. Others worry that palliative care could turn into a ploy for saving money off the backs of dying patients. Many physicians -- and patients -- simply don't like the idea of giving up until all possible avenues of treatment have been exhausted.

Even so, end-of-life care in the U.S. remains "woefully inadequate," according to a national study of such treatment, published last year in the Journal of the American Medical Association. One in four people who died didn't receive enough pain medication and sometimes received none at all, according to researchers at Brown University and the University of Massachusetts at Boston.

Aging populations in the developed world will fuel demand for better end-of-life care: By 2030, the number of Americans over the age of 85 is expected to double to 8.5 million.


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