Improving end-of-life care

The purpose of this report is to examine our attitudes towards end-of-life care and assess the systems of reimbursement and quality measurement that support and sustain it. This report is divided into two primary sections: the first, Culture, explores the culture of end-of-life care, from its historical roots and development to its slow integration into modern medicine. The second, Infrastructure, focuses on the Medicare Hospice Benefit and quality measurement under the Affordable Care Act. Under healthcare reform, reimbursement is now more than ever tied to quality and as such the two systems operate in close concert. Their influence on the provision and assessment of end-of-life care is significant, and this report analyzes flaws in each that undermine their potential to truly advance quality, person-centered care. This report ends with recommendations for improvement for both reimbursement and quality measurement, with the sincere hope that by strengthening the structures that support end-of-life care, we will better support patients and their families.