Experts: U.S. Should Reexamine Advance Care Planning
More attention should be placed on advanced care planning in care delivery models, witnesses told lawmakers at a roundtable event hosted by the Senate Special Committee on Aging.
Research shows that patients who have “frank and open” discussions about their end-of-life wishes receive care that is congruent with their preferences, said American Geriatrics Society CEO Jennie Chin Hansen, who moderated the roundtable Continuing the Conversation: The Role of Health Care Providers in Advance Care Planning.
“AGS strongly supports bipartisan legislation in Congress that would make confidential and voluntary advance care planning services more widely available to Medicare beneficiaries,” she said. “…We believe in the value of person-directed advance care planning and urge the administration and Congress to adopt policies that will incentivize all Americans to make their own informed healthcare choices.”
Aging with Dignity President Paul Malley discussed his organization’s main project, a living will called Five Wishes, which has more than 20 million copies in circulation and distributed by more than 35,000 partner organizations. The personalized document addresses health issues but also personal, emotional and spiritual matters.
“Most doctors and lawyers, concerned with providing immediate and quality care, want to know the name of the health care agent and the code status of the patient,” said Malley. “On the other hand, most individuals are primarily concerned with wanting to be comfortable, be with their family, to be cared for with dignity and to be at peace with their loved ones and God.”
Ascension Health Senior Vice President of Ethics, Discernment and Church Relations Dan O’Brien agreed, outlining the importance of spiritual wishes in advance care planning.
Aetna’s Randall Krakauer, who is the firm’s national medical director of Medicare, said programs focused on palliative and hospice care “can have a favorable impact on beneficiary satisfaction ad quality of care, but added that he believes current Medicare rules are a barrier to providing the best care to beneficiaries with advanced illness.
For example, beneficiaries must forego curative treatment before they can enter hospice and beneficiaries can only access hospice if they have a terminal diagnosis of six months or less to live, he said.
Bill Novelli, the cochairman of the Coalition to Transform Advanced Care, said about 25% of seniors lose their entire assets during the last five years of life because of the cost of advanced illness care. Additionally, Medicare beneficiaries with five or more chronic conditions represent the fastest-growing segment of the Medicare population.
President and CEO of Hope Healthcare Services Samira Beckwith said the nation’s healthcare system is excellent at managing acute episodic illness or injury “but there is great need to establish appropriate care systems for the number of aging boomers with advanced progressing illness.”
Beckwith lamented the “significant obstacles” to being able to provide care in the form of administrative and regulatory burdens that take time away from patient care and add no value.
“The effort to want standardized requirements across providers and patient populations utilizing a “one size fits all” approach does not work for end-of-life care,” she said, adding that there have been nine significant regulatory changes so far this year without coordination on implementation and policy changes and without consideration of impact on patients and families.
Carmella Bocchino, executive vice president with America’s Health Insurance Plans, added that improvements are needed in the clinical and operational definitions of advanced illness to make it more easily understood. Additionally, a lack of evidence about the effectiveness in care teams and strategies to promote patient and family engagement in advanced illness have constricted the scalability of this model, she said.