Will Congress Finally Invest in End-of-Life Care?

Blog,Public Health
Closeup of an old woman holding a teacup illustrates the concept of end-of-life care

End-of-life care doesn’t get much attention in Washington, despite the endless political posturing over rising healthcare costs. It’s hard to understand that indifference, given that 25 percent of Medicare spending goes toward care for people during their last year of life.

If ever there were a chance to bend the curve, hospice and palliative care would be a logical place to focus – and the Build Back Better plan offers a glimmer of hope that federal policymakers might be catching on.

As Senators debate the nearly $2 trillion spending bill, big provisions like universal pre-K and prescription price caps are getting most of the attention. But the bill also includes roughly $16 billion for public health infrastructure and workforce, and buried deep in that section is $90 million in funding to expand hospice and palliative care.

Yes, $90 million is a drop in the ocean of federal spending, but the money is strategically targeted for programs that expand the capacity for end-of-life care: education, communications, patient and family engagement, and integration with primary care and other specialties.

All of that “infrastructure” investment is needed because palliative medicine and hospice programs have long been an afterthought in the US healthcare system. Most providers in this country default to long, painful, and expensive treatments that offer no real hope of a cure to patients at the end of their life. It’s not something that patients and families necessarily want, but too often they don’t know the options, and they don’t know how to ask.

Over the past 20 years, I’ve worked with more than 30 hospice and palliative care programs, and through that work, I’ve become a kind of champion for better end-of-life care. Comfort, support, choice, and respect: These are a few of the benefits that families and patients cite over and over again when they discover the option of facing death with a focus on maximizing the quality of life over aggressive curative care that is often futile.

Beyond those very real and powerful human benefits, hospice and palliative care offer benefits to the healthcare system, as well. Multiple sources (here, here, and here, for instance) have cited that hospice and palliative care programs can lessen the use of unnecessary healthcare resources and in turn result in cost savings to the healthcare system overall.

Crucially, the cost savings grow with early intervention. One study found $975 in healthcare cost savings when patients consulted with a palliative specialist within seven days of death. But when the consultation occurred at least a month prior to death, the savings increased to $5,362.

This is why “infrastructure” investment is so important. With more trained specialists, better communication, and better system integration, healthcare providers can offer more compassionate and cost-effective options to patients and families facing end-of-life decisions. By Washington standards, $90 million might be insignificant, but that money could go a long way toward transforming healthcare delivery at its most crucial inflection point.

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