END-OF-LIFE CARE: Task Force Issues Call to Action
The National Task Force on End-of-Life in Managed Care yesterday challenged managed care organizations to take the lead on improving care for dying patients. In their report, "Meeting the Challenge: Twelve Recommendations for Improving End-Of-Life Care in Managed Care," the task force, targeted three areas for reform: increased access to humane end-of-life care, strengthened plan and provider accountability, and fully developed payment methods that adequately compensate plans and providers. Noting that "[m]anaged care forms of health care delivery present special opportunities for reform," Task Force Chair Mildred Solomon, director of the Center for Applied Ethics and Professional Practice, which prepared the report, said, "End- of-life care has been an intractable problem across the United States, and many sectors of society have to contribute to improvements." Compounding the problem is the trend toward increasingly late referrals to hospices, which robs families and patients of quality end-of-life care, and the "six-month eligibility rule," whereby doctors must certify that a patient has a maximum of six months to live before a hospice referral is warranted. Task force member Bruce Jennings, executive president of The Hastings Center, said, "This requirement creates an unnecessary dilemma for physicians who do not want to deprive patients of hope and for patients who may not yet want to declare themselves terminally ill, but who could greatly benefit from palliative care services." But managed care may have some answers. Task force member Dr. Sam Ho, vice president and corporate medical director of PacifiCare Health Systems, notes, "Managed care has the ability to institute systems of accountability, disseminate clinical guidelines, develop interdisciplinary team approaches and the ability to provide comprehensive, continuous care across diverse care settings." Aetna US Healthcare, Allina Health System, Fallon Health Care Plan, HealthPartners, and Harvard Pilgrim Healthcare have voiced initial support for the recommendations and promised to study possible means of implementation.
Recipe for Success
To tap into managed care's reservoir of aid, the task force recommends they take the following course of action:
- Provide a range of end-of-life coverage options enabling care for patients and their families.
- Create specific programs for patients dying of chronic conditions.
- Focus continuous quality improvement efforts toward clinical, rather than administrative, aspects of end-of-life care.
- Enhance the knowledge and skills of palliative care staff.
In addition, the task force recommends that policymakers develop means of assessing palliative care, investigate alternative payment methods and "foster more creative relationships between managed care organizations and hospices to ensure that palliative care services are offered soon enough to patients who can benefit" (release, 5/13). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.