State Can't Afford To Ignore Data on End Of Life Care

By Dale Johnson, Hospice of Central New York 

September 19, 2008

Examination of end-of-life care in Central New York raises a number of valid concerns that require community-wide reflection. 

It is common knowledge that, in general, the last year of life is the most expensive to the health care economy and the most intensive in its use of medical resources. There is wide geographic variation in terms of the expense, sites and types of care provided to patients at the end of life. 

Survey research shows that when asked what people want for end-of-life care, 83 percent said that they would like to spend their last days at home. This contrasts sharply with the fact that only about 25 percent of Americans actually die there. 

For the period 1999 to 2003, the average decedent in New York spent over 16 days in the hospital during the last six months of life, ranking New York as the second-highest of all states in the nation. This compares to a national average of just over 11 days. These high averages in utilization help to drive New York's high average costs. 

At the same time that our end-of-life medical expenses exceed the national averages, both at the state and local levels, the use of hospice services trails the national average. 

New York ranked 46th among the states in use of hospice care. Nationally approximately 36 percent of all decedents were in hospice care, compared to a local level of about 22 percent. 

Recent research from Duke University Medical School demonstrates that patients in hospice cost the economy on average $2,309 less than comparable patients in the non-hospice setting. This is despite findings that for a number of terminal diagnosis categories, patients in hospice live significantly longer than their counterparts receiving care elsewhere. 

These patients also more often get their wish to die at home nationally, less than 10 percent of hospice patients die in the hospital. And nationwide, over 95 percent of all families who have experienced hospice care for a loved one would recommend hospice to others. 

As the Duke researchers have noted, "Given that hospice has been widely demonstrated to improve the quality of life of patients and families . . . the . . . program appears to have a rare situation whereby something that improves quality of life also appears to reduce costs." 

The lesson here is that there are options available locally, and which are being used far more extensively elsewhere, that can align our community's shared interests in lower costs, patient preference and clinical quality. 

And while some statewide statistics are skewed by the substantial differences between Upstate and Downstate patterns, a simple principle holds New York's high costs for end-of-life care result from the choices New Yorkers make. 

On Oct. 1, at Weiskotten Hall at Upstate Medical University, Hospice of Central New York, collaborating with the Health Advancement Collaborative of Central New York, will host "Variations in End of Life Care," a presentation for our community colleagues to examine the variations in end-of-life care in New York state. 

Working with research compiled by the University of Rochester Medical Center, the participants will discuss some of the regional and local differences in the care provided to dying patients across the state.

Because the last stages of life consume such a disproportionate share of the health care budget, our community cannot afford to ignore the lessons available to us in the data that has already been collected and analyzed. 

Likewise we would be remiss if we failed to use that knowledge to make more effective use of the medically sound, cost-saving options already at hand. 

Dale Johnson, of Liverpool, is chief executive officer of Hospice of Central New York. 

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