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In 2009, exaggerated claims of “death panels” prevented Medicare from covering end-of-life discussions in ambulatory practice. Now, Medicare has proposed coverage of such discussions,1 and an increasing number of patients are presenting to the hospital with established goals of care and end-of-life wishes. Nearly half of Medicare patients now die in hospice care, up from less than a quarter in 2000.2 Quality measurement, however, has not kept up with the changing approach to end-of-life care. None of Medicare’s publicly reported mortality measures includes do-not-resuscitate (DNR) status in risk adjustment, largely because such data are not routinely reported by hospitals, but also in part because of an underlying assumption that the increased mortality risk of such patients can be accounted for by comorbidity adjustment.
Horwitz LI. Implications of Including Do-Not-Resuscitate Status in Hospital Mortality Measures. JAMA Intern Med. 2016;176(1):105–106. doi:10.1001/jamainternmed.2015.6845
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