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To the Editor: In their Perspectives on Care at the Close of Life article, Drs Harrington and Smith¹ discussed the role of chemotherapy at the end of life and made a few suggestions about how to reduce the cost of oncology care. It is also important to consider that delays in reimbursement and low reimbursement for counseling (relative to the time it takes) contribute to fewer physicians initiating more patient and family meetings to establish the goals of care. Medicare reimbursement for prolonged services with direct patient contact may be delayed up to 1 year or denied.

This certainly does not encourage busy physicians to have the kind of in-depth discussion that is required to clarify a plan of care. Such a discussion has the potential to result in cost savings through cessation of expensive therapy and moving patients out of the intensive care unit.

Financial Disclosures: None reported.

Stephen A. Hilty, MD
stephen.a.hilty.dms95@alum.dartmouth.org
San Luis Obispo, California

1. Harrington SE, Smith TJ. The role of chemotherapy at the end of life: "when is enough, enough?" JAMA. 2008;299(22):2667-2678. FREE FULL TEXT

JAMA. 2008;300(18):2119-2120.

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RELATED ARTICLE

The Role of Chemotherapy at the End of Life: "When Is Enough, Enough?"
Sarah Elizabeth Harrington and Thomas J. Smith
JAMA. 2008;299(22):2667-2678.
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Reimbursement for Patient and Family Meetings and the Costs of Care at the End of Life—Reply
Thomas J. Smith
JAMA. 2008;300(18):2120.
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