IOM committee calls for overhaul of end-of-life care system

A nonpartisan panel released a report this week calling for an overhaul of the nation’s system for handling end-of-life care (Source: “Panel Urges Overhauling Health Care at End of Life,” New York Times, Sept. 18, 2014).

 The 507-page report, titled “Dying in America,” was authored by a 21-member committee that was appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences.

“The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and a former United States comptroller general, who was a chairman of the panel. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly.”

Many of the report’s recommendations could be accomplished without legislation. For example, the panel urged insurers to reimburse health care providers for conversations with patients on advance care planning. Medicare, which covers 50 million Americans and whose members account for about 80 percent of deaths each year, is considering doing just that, prompted by a recent request from the American Medical Association.

But some recommendations — like changing the reimbursement structure so that Medicare would pay for home health services instead of emphasizing hospital care, and so that Medicaid would provide better coverage of long-term care for the frail elderly — would require congressional action.