The Endless Treadmill of End-of-Life Care - Pharmaceutical Executive


The Endless Treadmill of End-of-Life Care

Pharmaceutical Executive


As difficult as communication is, the issue of compensation may be a stickier one, requiring major system change. Oncologists are among the highest paid medical specialists and studies based on Medicare data have indicated that some practicing oncologists select chemotherapy for their patients to maximize income. Services coded as "evaluation and management" do not reimburse as generously. To help solve the problem, some organizations are experimenting with new approaches. United Healthcare is testing an episode management program in which oncologists are not financially incentivized for choosing chemotherapy, while McKesson's US Oncology has implemented a pathway-driven care process. Hopefully these experiments will result in findings that can lead to best practices that other organizations can adopt.

Constructive innovation

There are times that aggressive treatment is warranted. Over the past century, life expectancy in the United States has risen from 49 years to 79 years because of innovations in public health and improvements in patient diagnosis and treatment. "Miracles" have occurred because of scientific breakthroughs. Scientists and pharma companies must be realistic when it comes to "miracles," however.

Hope is an emotion but it also must be rational, effective, and cost-effective. It must prove that an innovation is worthy of registration, and, importantly, reimbursement, based on evidence that a treatment improves outcomes at a price that can be justified. This means research that includes the target population. Many diseases are age-related and disproportionately affect persons 65 years of age and older, the group least likely to be included in randomized clinical trials. Scientists and drug companies need to creatively identify options for the conduct of rigorous and scientifically valid studies that will improve decision-making for this group, which is growing larger every year. And that means thinking outside the box.

To sum it up, just as any given disease may be associated with multiple risk factors, so does the policy disease called skyrocketing healthcare costs. There is no single cure for the economic chaos, but a focus on three other C words—communication, compensation, and constructive innovation—could help mitigate the problem and improve patient outcomes and satisfaction at the same time.

Robin Hertz, PhD, an epidemiologist and specialist in comparative effectiveness and outcomes research, is principal at Observational Outcomes LLC. She can be reached at


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