I was recently at the AARP Health Innovation @50+ event, emceeing it actually, when one of the speakers put up a slide with only the giant number 100% on it. After the requisite audience murmur, she pointed out that this was the percentage of people that will inevitably die. Kind of funny, but also starkly accurate. Efforts to the contrary notwithstanding, it’s probably going to be a long time before this number changes.
It’s not as if this is a new piece of news, and yet the chatter about death, and specifically about end of life, has recently become far more pronounced. During the early Obamacare days, one couldn’t event mention planning for end of life without Sarah Palin leaping out and accusing you of sponsoring death panels. Into the closet went this topic, and out of the closet came the avalanche of statistics that ultimately pushed her, mercifully, back into the cave from whence she came, hopefully with a trap door opening to send her back to her neighboring Russia.
The most poignant statistics on this topic, in my view, are these, many referenced from this Kaiser Family Foundation report:
- most adults (90%) say they would prefer to receive end-of-life care in their home if they were terminally ill, yet data show that only about one-third of Medicare beneficiaries (age 65 and older) died at home
- roughly 25% of traditional Medicare spending for health care is for services provided to Medicare beneficiaries in their last year of life—a proportion that has remained steady for decades.
- Medicare spending averaged $33,500 per beneficiary– about 4 times higher than the average cost per capita for seniors who did not die during the year. Other research shows over the past several decades, roughly 25% of traditional Medicare spending for health care is for services provided to beneficiaries ages 65 and older in their last year of life
So in a nutshell, of the 2.5 million people who die every year, 75% are of Medicare age (over 65) and much of the care provided is expensive, unwanted and, if we are being honest with ourselves, not particularly effective in the way we generally measure these things (e.g., the patient got better). Of course some of this spend is for palliative care that makes those last days less painful and more comfortable. But on the other hand, general surveys suggest that many of these services are a waste if you believe that most people wouldn’t want to die in a hospital.
And because facts like these can’t be suppressed, suddenly there has been a massive resurgence of discussion about death and end of life. Clearly this was not brought about by Sarah Palin, though she does make many people think about death, or is that murder? Even she could not stem the tide of the consumer’s desire to have a better death and a more orderly and personal end of life. Because of the starkness of the facts, the aging of the population and, most especially, because of the passage of a new CMS rule putting into effect a new code in 2016 to reimburse doctors for conducting end of life planning discussions with doctors, the conversation is back on. Doctors and patients can now do the right thing and be properly rewarded for it.
The challenge is this: in a survey of physicians, 46% reported that they frequently or sometimes feel unsure of what to say to patients on this topic, and 29% report having had no formal training specifically on talking with patients and their families about end-of-life care. With about 72 million Americans reaching the age of 65 by 2030, that is a lot of very expensive and painful uncertainty for patients/consumers/human beings who want to die comfortably and with dignity.
By the way, in case you are wondering what people are dying from, see the chart below. I’m not going to get into the 3rd category here as I will save it for a future blog; let me just say I would be pretty pissed off if, while dying of a hospital-caused medical error, I got a bunch of medical treatment forced on me that I didn’t want when I could be home in my bed, surrounded by my vast collection of shoes.
So what are we doing about this challenge as a nation? With the floodgates open on this topic, venture capital firms and angel investors are now backing companies that are providing products and services to improve the end of life process in a way they never have before. Perhaps they are just relieved to be diverted from dying valuations to dying people, but investors are finding that death offers that big market we are always talking about. Companies like Vynca, CoPatient, and Aspire Health, among others, are all focused on changing a bitter end to a better end.
And now, with Palin safely tucked away, some of the nation’s biggest thinkers are getting in on the action. In just the last two weeks I have seen significant innovation challenges launched by IDEO and Sutter and another by the Aspen Institute. Each of these is seeking better methods, products, and approaches to easing end of life. The IDEO/Sutter challenge has this headline: “Let’s re-imagine how we prepare for, share and live through the final chapter.” Both of these challenges close on June 1, 2016, so if you have something to add to the conversation, get cracking before time runs out, so to speak.
FYI, if you are worried about a sustainable business model when selling to customers who will soon exit the spending part of the economy, the New York Times recently featured an article about products that make the being dead part, well, sustainable. Among the products featured were a biodegradable urn, which nourishes a tree (pick your favorite: Maple, Pine, Gingko!) and has, Silicon Valley-style, embedded sensors to monitor the tree’s health on an ongoing basis. How techno-perfect is this? Personalization and a handy dandy mobile app.
But my favorite product from the NYT article is the ninja-like Infinity Burial Suit that “incorporates mushrooms meant to break down a human corpse, cleanse it of toxins and distribute nutrients back into the soil.” You too can evolve to be that annoying patch of mushrooms on the lawn that the dog keeps trying to eat. Hurry because they have an “early adopter program” (oh, the irony) and be the first dead person on your block that works better as a soup than a human.
Healthcare is meant to be about making a better life, but giving each of us a better death is the natural end to that story. While some big names in Silicon Valley are taking the “let’s disrupt death approach,” others are “making the world a better place” a different way. It’s great that the conversation is happening.
Ps—another great resource on thinking about end of life is this: The One Slide Project from Engage with Grace
Blaine Warkentine says
Thank you Lisa. great post. would you mind alerting your readers to Caregoals.com. Thank you, Blaine
Lisa Suennen says
Thanks Blaine, should be posted in the comments now. Lisa
Lisa LaMagna says
– Fabulous head-on essay about the elephant in the room. Why do we all dance around the wasteful spending when we could be home surrounded by our loved ones (family, pets, shoes, the old MG in the garage that I’m going to fix up one day).
– I’d like to see more emphasis on taking control of our last days, with Advance Health Directives (eg. JoinCake.com). Ezekiel Emanuel has a point: we — as patients/consumers — need to take control, instead of counting on the healthcare system to do “what’s right” for *us*.
– You were outstanding as the Emcee at the AARP Innovations conference.
Lisa Suennen says