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Commentary: 'Care' also includes the end of life

March 07, 2014|By Michael A. Uranga

Let's shift the national healthcare conversation from insurance exchanges to some of the other important components of the Affordable Care Act (ACA): delivering affordable, high-quality care with improved patient satisfaction.

While our first thoughts of "care" might be medical needs or wellness initiatives to prevent chronic diseases, "care" also includes end-of-life care.

Hospice is an inter-disciplinary, collaborative effort addressing complex physical, psychosocial and spiritual end-of-life issues. This is accomplished through a team composed of a physician, registered nurse, licensed vocational nurse, licensed clinical social worker, certified home health aide, chaplain, volunteers and other specialists, such as massage and music therapists. The underlying premise of hospice care dovetails well with what ACA intends to foster. Through hospice, we have the ability to provide the highest quality end-of-life comfort and care at the most affordable cost.

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Hospice is paid a flat rate per day and care must be rendered within that amount. This approach to payment is consistent with evolving models of care that seek to put the medical provider at some financial risk versus the traditional fee-for-service model that exists throughout much of the current healthcare profession. This makes hospice a less costly option.

Under ACA, it is anticipated that hospice use will increase due to bundling of payments, where systems are rewarded for coordinated quality care, rather than quantity of care. Health systems and hospitals now have greater incentive to encourage the use of hospice, which saves the healthcare system money. Indeed, a 2013 study conducted by Mt. Sinai School of Medicine confirmed the 2007 Duke University study that estimated $6,400 per beneficiary savings for Medicare for every hospice admission.

These cost savings are primarily attributed to the reduction in emergency room visits and resulting hospitalizations. Families and caregivers working in conjunction with the hospice staff allows for more coordinated delivery of care, which reduces the surprises that many times lead to ER visits.

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