Letters to the Editors

March 18, 2005

No thanks to universal coverage; in defense of hospice

No thanks to universal coverage I just can't believe that rank-and-file physicians want universal coverage, as "Washington Outlook: Any action on healthcare?" [Jan. 21 http://www.memag.com/memag/article/articleDetail.jsp?id=143137] suggests. I don't doubt that the political leadership (AAFP or ACP) finds it attractive. Here in Washington State, Medicare recipients can't find a doctor who will accept them. Why? Because Medicare generates increased overhead while mandating reduced fees. A physician is better off going to the beach than seeing Medicare patients! Plus, we're accused of billing fraud while charging 50 cents for a dollar's worth of service.

Who would want a world where essentially everyone is a Medicare recipient? No doctor I know. Health savings accounts are the only viable policy to pursue.
Stuart Andrews, MD Bellingham, WA

In defense of hospice I read with interest and an increasing sense of dismay the article "My new view of hospice" [Jan. 7 http://www.memag.com/memag/article/articleDetail.jsp?id=141348]. My concern is not with the cautions elaborated by family physician Todd Crump, but rather with the narrow view the article puts forth.

As a physician who has spent the past 20 years caring for dying patients, I believe the most responsible decision we can make, in concert with our dying patients and their families, is to strongly recommend hospice care. Do some research: Take advantage of resources available from professional groups; consult other physicians; and talk to families of patients who have utilized hospice and visit those programs. As patients face the end of life, it is the best medicine we can practice.
Perry Fine, MD VP of Medical Affairs National Hospice and Palliative Care OrganizationAlexandria, VA

I understand Dr. Crump's aversion to feeling like a shill for a company that values profits over patients. But, I don't believe that corporate profit is truly usurping good care as the motivation for hospice.

Physicians believe they know when to refer patients to hospice, but their estimates of life expectancy of even terminally ill patients are often inaccurate. The median length of hospice care is only 22 days. Since the ability of hospice to provide care is dependent on physician referral, responsible hospices educate physicians about what benefits patients may be eligible for, and when.

Hospices provide more than delivery of medications and equipment. They provide palliative care expertise, monitoring and assessment, anticipatory guidance, caregiver education, personal care, emotional and bereavement support, spiritual solace, and around-the-clock availability.

Some patients' needs may outstrip the Medicare reimbursement-per diem payment for all care related to the hospice diagnosis. Others will not. Those who see pure profit in caring for patients who need fewer expensive items are missing the balance designed into the system.

Why would nursing-home patients need hospice, when they already get round-the-clock care? Besides being entitled to it, hospice expertise and support to the patient, family, and even nursing-home staff helps alleviate common burdens of pain, emotional distress, and unnecessary transfers to hospitals at the end of life.

A quality hospice advocates for appropriate benefits whenever the patient and family need them. That is putting the patient ahead of profit.
Joan K. Harrold, MD Lancaster, PA

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