Goodman suggested this is because far too often the decisions of what care services to invest in are driven more by reimbursement than by what's best for the patient. That because, he speculates, Medicare pays a lot less for hospice care than it does for curative care.
These palliative programs are such that "many institutions are concerned that these are going to be cost centers that will lose money," Goodman said.
"Considering that the payment for palliative care and hospice care is much less than it is for more aggressive care, including chemotherapy and procedures and such, so these places feel often that the reimbursement system isn't in their favor," he said.
But hospitals need to be part of community-based efforts to build that capacity, he added.
He added that it's also true that for some doctors, not offering something in those last few days is tantamount to giving up hope, which isn't in their culture. "That's language that's caused a lot of harm in cancer care," he said.
I know this from first hand experience, but that's a tale for another time.
The cancer report's numerous tables beg these questions about the wide variability in end-of-life care.
Why are 63.6% of cancer patients in Elgin, IL seeing 10 or more physicians during their last six months of life, when in Idaho Falls it's only 14.3%.