WASHINGTON—The U.S. needs to revamp its approach to end-of-life care and conversations about dying to save costs and improve patient care, according to a sweeping report released Wednesday by an influential health committee.
End-of-life conversations with medical providers should be covered by insurers and Medicare, said the report by the Institute of Medicine, an independent organization and the research branch of the National Academy of Sciences.
One impetus behind the study was concerns raised in 2009 about "death panels," a term that sprung up during political debates about what became the Affordable Care Act.
"Right now, there is too much fear and apprehension, and the discussions don't happen," said Phillip Pizzo, co-chair of the panel and former dean of the Stanford University School of Medicine.
"What we call for is that there be an opportunity for discussions with clinicians throughout the life cycle and not just one time," he continued. "It's part of the process of living."
The report by the nonpartisan committee is especially important these days as baby boomers age. The more than 70 million Americans born from 1946 to 1964 are starting to age into Medicare, which is available to Americans when they turn 65.
The program also covers the disabled.
People nearing the end of their lives experience high rates of preventable hospitalizations and often struggle with a fragmented system that may not be aware of their preferences regarding late-stage care, the report said.
Widespread adoption of timely palliative care, which focuses on pain relief, appears low, even though such treatment is linked to better quality of life and longevity.
Improving end-of-life care should tie financial incentives to advance-care planning and frequent clinician-patient conversations, the report said.
Medicare incentives in place today may have the opposite effect, the report says, by encouraging late enrollment in hospice facilities and more transitions among care settings.
"We have a fragmented, disjointed approach that results in people not getting what they want," said David Walker, who served as U.S. comptroller general and was co-chair of the panel that worked on the report.
Some of the recommendations may require policy changes, he said.
Patients currently can't generally be referred to a hospice until they are expected to die, which is within six months, which means many get this type of care too late. People in hospices also may not have access to certain curative treatments.
A 2009 version of the health law required that Medicare begin paying physicians for counseling patients on end-of-life planning, such as setting up a living will or obtaining hospice care.
Such policies, however, became erroneously labeled as calling for "death panels."
The furor resulted in those policies being omitted from the final 2010 health law, and later attempts by the Obama administration to reimburse for such care got shelved.
This year, the American Medical Association provided the Centers for Medicare and Medicaid Services with proposed service codes so the program could pay physicians for having advance-care planning sessions with patients. That may lead the government to adopt a payment policy that would reimburse for those services.
Some private insurers already are beginning to reimburse physicians and clinicians for having end-of-life conversations, Mr. Walker said, a sign that such discussions improve patient care and also help save money.
Discussions about dying and medical care should occur during major life transitions, such as obtaining a driver's license, getting married and enrolling in Medicare, said those who worked on the IOM report.
The document, which is more than 500 pages, also suggests all health-care professionals be required to have training in holding such conversations.
"The important point that may be hard for the public to believe is that their doctors and nurses have had no training in how to have conversations on what matter most to patients," said Diane Meier, director at the Center to Advance Palliative Care and a professor at Icahn School of Medicine Mount Sinai in New York, who also worked on the report.
The National Hospice and Palliative Care Organization said it supported some of the conclusions, including paying physicians for end-of-life conversations and earlier use of hospices.
"Our current system is broken in some ways in dealing with end-of-life care," spokeswoman Anita Brikman said.
Advance planning is especially important because the majority of patients nearing the end of life will receive acute hospital care from physicians who don't know them, the report said. Planning is vital to ensure that patients obtain care that fits their goals and preferences, the report said.
Younger, poorer, minority and less-educated individuals tend not to have end-of-life conversations, the report noted.
Write to Stephanie Armour at stephanie.armour@wsj.com