Healthcare must embrace advance care planning

Now that it's clear that end-of-life care in the United States frequently fails patients, there are several indications that the healthcare industry and policymakers have finally started to take steps in a new direction, Thomas Harter, M.D., writes in a recent Health Affairs blog post.  

The Institute of Medicine's (IOM) "Dying in America" report published last year was a major wake-up call to providers, Harter writes, as it championed the merits of advance care planning (ACP) as well as the reasons why health systems are often ill-equipped to meet patients' end-of-life needs. Some of the hallmarks of successful ACP that the report highlights include counseling of patient and family; regular, personalized revision of a patient's care plan; frequent assessment of a patient's well-being; and referral to palliative or hospice care, FierceHealthcare has reported.

Shortly after the IOM report surfaced, the Centers for Medicare & Medicaid Services (CMS) issued a payment-policy rule that includes two new codes to "officially recognize" clinicians' and healthcare workers' efforts to engage in ACP with patients. Though the agency did not associate any explicit reimbursement with ACP, the codes likely will help CMS decide about reimbursement for the service in the future, according to Harter.

Both developments "mark an evolutionary turning point for advance care planning in the U.S.," Harter writes. He also points to a successful ACP program that the report highlighted--the "Respecting Choices" initiative the originated in La Crosse, Wisconsin--as a model that both health systems and states have started to emulate.

Research has found that the program, in which trained ACP facilitators work with adults in three distinct stages of health, can reduce the number of patients who receive treatment inconsistent with their wishes, according to Harter. To him, this "sends a strong message" to payers like CMS that proven ACP initiatives must be covered in order to cut costs and improve the quality of care.

In another recent Health Affairs piece, geriatrician Louise Aronson, M.D., echoes the call for better care for older patients based on a chance encounter with an elderly woman that led to Aronson's successful effort to improve the woman's situation. "Helping an older adult find a caregiver, delineating the caregiver's tasks, monitoring the caregiver's work with the older adult and ensuring the caregiver's own well-being are not traditional medical tasks," she writes. "They are, however, among the most important interventions to ensure the well-being and safety of frail older adults."

To learn more:
- here's the Health Affairs blog post
- read the Health Affairs article