Legislative, Regulatory, Finance

Care of the Patient with Severe Chronic Illness-An Online Report on the Medicare Program is a key critical report completed in 2006 by the Dartmouth Atlas Project. It reports that: “Almost one-third of Medicare spending for chronically ill is unnecessary… A fundamental problem, and one that contributes to both overspending and worse outcomes, is that most acute care hospitals have become first-line providers of services to chronically ill elderly people, whose care would be better managed, safer and less expensive outside the hospital setting. . . . Staggering variations in how hospitals care for chronically ill elderly patients indicate serious problems with quality of care and point toward unnecessary spending by Medicare. Lower utilization of acute care hospitals and physician visits could actually lead to better results for patients and prolong the solvency of the Medicare program.” The study calls for overhauling how the nation manages chronic illness, and proposes that hospitals take leadership in redesigning how they care for the chronically ill.

The Center for Practical Bioethics, formerly known as the Midwest Bioethics Center, has a 20 year history of raising and responding to ethical issues in health and healthcare and works specifically in the following areas. Researchers looking for Midwest Bioethics Center publications should contact the Center for Practical Bioethics.

Clinical and Organizational Ethics: solving moral problems by educating and empowering healthcare professionals and their institutions, advocating for patients’ rights, training ethics committees, and supporting change though ethics education and leadership.

Physician Orders for Life-Sustaining Treatment (POLST) is a document to help ensure that a patient’s wishes are known and honored toward the end of life. It uses a standardized medical order used to indicate which types of life-sustaining treatment a seriously ill patient wants or doesn’t want if his or her condition worsens.

POLST assists health care providers and patients or their surrogate to develop a transferable care plan of desired interventions when dealing with serious, life-limiting illness. Through focused conversations about preferences for nature and intensity of care, people are able to establish a customized standard of care across care settings. The bright pink card stock form travels with the patient and is legally binding in California when properly dated and signed.