Why This Wisconsin City Is The Best Place To Die"The Colberts complete the directives and the nurse summons witnesses to watch them sign. Then Wiedman enters them in the health system's computers. Now, anytime a doctor in this large health system pulls up their records, their wishes for end-of-life care will be prominently displayed. The result of all this attention is that nearly all adults who die in La Crosse, 96 percent of them, die with a completed advance directive. That's by far the highest rate in the country. Bud Hammes, the medical ethicist who started Respecting Choices, says "We believe that our patients deserve to have an opportunity at least to have these conversations."
"But it's expensive to spend time with patients filling out living wills. Medicare doesn't reimburse for the time the hospital's nurses, chaplains and social workers do this. Bud Hammes, the medical ethicist who started the program, called Respecting Choices, says it costs the hospital system millions of dollars a year. "We just build it into the overhead of the organization. We believe it's part of good patient care. We believe that our patients deserve to have an opportunity at least to have these conversations."
And that's how La Crosse unexpectedly got in the middle of the national debate over health care and the so-called "death panels."
"There's a proposal — it's in the health bill passed by the House of Representatives — that would pay for the kind of periodic and continued end-of-life discussions with patients that are routine in La Crosse. Gundersen Lutheran is pushing for it. Hammes says claims that government-run panels would pressure sick people to die are bizarre exaggerations — and that the experience of this Wisconsin city proves it. "These are conversations that we have with our patients. They're not done in a secret room," Hammes says. "These are open conversations involving family members, pastors, attorneys. It's part of our community fabric now, it's part of how we deliver care." One result of the way that care is delivered: At Gundersen Lutheran, less is spent on patients in the last two years of life than any other place in the country.
The Dartmouth Atlas of Health Care documents the vast difference in health care costs from one place in the country to another. At Gundersen Lutheran, the cost of care for someone in the last two years of life is about $18,000. The national average is close to $26,000. At one hospital in New York City, it's more than $75,000.
"When people see the low cost in La Crosse, there are assumptions about rationing care, about denying care, about limiting — that we limit care for our patients," says Hammes. But it's not that dying people in La Crosse are denied care, he says. It's that they've thought out their wishes in advance, so they get exactly the care they want. And often that means avoiding excessive and unwanted care."Full article:
http://www.npr.org/templates/story/story.php?storyId=120346411&ft=1&f=1001
Printer-friendly format
Email this thread to a friend
Bookmark this thread
(1000+ posts)
Send PM |
Profile |
Ignore
