Correspondence

Health Insurance and Palliative Care

N Engl J Med 1998; 339:203July 16, 1998

Article

To the Editor:

The frustration of Dr. Knoll (March 12 issue)1 with the rejection by health insurance companies of reimbursement for acute hospitalization for palliative care is avoidable. Had his patients been placed in a hospice, their inpatient treatment would have been fully covered through hospice benefits. Hospice benefits cover home care as well as acute care for palliative treatment of symptoms — meeting a “prudent layperson” standard as well as offering a seamless continuum of care for the dying.

Gregory J. Miller, M.D.
Intermountain Health Care Hospice, Ogden, UT 84403

1 References

1. 1

   Knoll AM. Health insurance and palliative care. N Engl J Med 1998;338:767-767
   Full Text | Web of Science | Medline

Author/Editor Response

Dr. Knoll replies:

To the Editor: I completely agree with Dr. Miller. As a hospitalist, I was introduced to these patients in the emergency department while they were in a state of crisis, and both were discharged according to a hospice-based philosophy: one went home with hospice care, and one was sent back to a nursing home. Their need for hospice care could have been anticipated, thus avoiding the problem for which they presented for emergency care. We should discuss end-of-life issues with our patients and their families in a timely fashion and make referrals to hospices before emergencies develop.

Andrew M. Knoll, M.D.
Syracuse, NY 13207