(To Readers: A previous posting here in early 2016 discussed Life Expectancy. This is a re-write of that article as statistics have borne out for the first time in 23 years a decrease in Life Expectancy. This new directional movement I predict next year will the second shot fired off our national bow. When will the populace wake up?)
Many nations proudly tout Life Expectancy as a reflection of their healthcare. For over two decades in our country, this statistic has consistently edged upward due to expanding technology, doctors/patient education, and vibrant emphasis on healthy lifestyles.
But a recent report from the Centers for Disease Control and Prevention (CDC) claims an ominous downward shift in Life Expectancy (http://www.cdc.gov/nchs/data/databriefs/db267.pdf). Escaping public scrutiny yet contributing to CDC data are ill patients coerced by some hospitals into premature end-of-life hospice care.
As you might suspect, the most vulnerable ill patients are seniors.
In the past, more than 90% of my geriatric ICU patients eventually returned home. Now, however, a team approaches these patients and family members proclaiming “pain”, “suffering”, and “discomfort” can only be mitigated by palliative care, halting treatment and forcing them into hospice. This sometimes comes without a doctor order or discussion.
Why would targeting these patients be financially beneficial to hospital administrators?
Hospitals are paid a fixed amount by Medicare determined by a DRG code (Diagnosis-Related Group). If a patient stays a short time, hospitals make money. Should the patient stay too long, they can lose money. If a hospital administrator hopes to increase their salary, bonus, or retirement, what would be the most expeditious scheme of increasing profit margin? Get the patient out of the hospital ASAP.
For critically ill ICU patients, the following tactics are being used: Exploit patients and families when they are emotionally susceptible; take advantage of poor physician communication concerning end-of-life care; and enlist a palliative team urging movement toward hospice.
The CDC study based their conclusion on Death Certificates, which only list diseases as the cause of death and do not specify if patients were prematurely placed in hospice. These certificates therefore do not reveal halted treatment contributing to early patient deaths.
With the high cost of medical care, physicians have been criticized for saving lives that might not be salvageable. Who though should decide this? A hospital administrator, or the patient, family, and doctor?
Life Expectancy should be increasing. But financial benefits to hospitals can place seniors in the crosshairs of danger. Unlike doctors, hospital administrators don’t take the Hippocratic Oath. Their allegiance is to themselves, or to their shareholders. One reason for the decline in Life Expectancy might therefore be greed.
Patients and families must be on heightened alert when they face critical illness. Be sure to openly discuss end-of-life wishes with family members and your doctor well before hospital admission. Understand that illness brings on emotional stress, so decisions must be made with all options on the table. Don’t let hospital personnel under the guise of a palliative care banner persuade or manipulate your better judgement.
The practice of medicine has changed, and your healthcare interest may no longer be paramount in a hospital where you are admitted. In the future as Life Expectancy decreases, hospital propaganda will point a finger at the public insinuating obesity, lack of exercise, or non-compliance are the problem… and not greed.
Doctors, patients, and families must wade through this deception. Hospital administrators cannot be allowed to make us or our loved ones a declining statistic in Life Expectancy.
Gene Uzawa Dorio, M.D.