Here They Talk About Death

How choosing their end-of-life care helped residents of La Crosse reduce their healthcare costs
Bud Hammes

Bud Hammes, medical ethicist for the Gundersen Health System

While healthcare costs are among the top concerns for an average American, the small city of La Crosse, Wisconsin spends less on the end-of-life care than any other place in the country. Saving money was not the main goal for Bud Hammes, a medical ethicist for the Gundersen Health System. Bud was the one who sat down with a grieving family to discuss what to do for a loved one who’s in a coma or hooked up to machines. “The moral distress that these families were suffering was palpable,” Bud reveals in an interview with NPR, “You could feel it in the room.” Most patients were ill for a long time, and yet, their end-of-life options had not been discussed, so in addition to grief, these families had to face some very difficult ethical issues that could have been resolved long ago.

La Crosse

Downtown La Crosse

Hammes wanted to make a change. He trained nurses to offer their patients advanced directive forms to fill out. Tough questions were asked, and people often chose not to undergo treatments with debilitating side effects only to prolong their lives by a few months. Stopping these treatments reduced the costs and soon, Jeff Thompson, the CEO of Gundersen Health System, discovered that when patients chose their end-of-life care, they often chose a less costly course of action. In La Crosse, the last two years of life cost significantly less, about $18,000, when compared to a national average of $26,000.

“The moral distress that these families were suffering was palpable,” — Bud Hammes

Today, thanks to Bud Hammes and the nurses of Gundersen, 96 percent of La Crosse residents have some type of an advanced directive in a nation where only 30 percent of adults have such a document. The population of La Crosse is so comfortable talking about death, it’s unusual for someone not to be prepared for his or her end of life.

Advance care directives


Even though the reduction in La Crosse’s health care costs came as a welcome sideline, it got the attention of other communities that now want to copy the program. Hammes believes that since the Affordable Care Act encourages new ideas on how to decrease health care spending, this is the perfect time for the La Crosse advanced directive plan to enter the national and even international spotlight.

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