Roughly 25 million Americans have been subjected to unwanted medical treatment at some point in their lives, and that means we have a healthcare system that is not listening to patients. We all say we believe in patient-centered health care, and now we have a bill in the U.S. Congress that would put our money where our mouths are. Literally.
Senators Mark Warner (D-VA) and Johnny Isakson (R-GA) introduced legislation this month that would make sure Medicare recipients and their doctors know how much or how little treatment those patients would want as they approach the end of life. The Care Planning Act of 2015 would specifically create a Medicare benefit for people facing grave illness to work with their doctor to define, articulate and document their personal goals for treatment. Doctors will be rewarded with reimbursement for helping patients make very important end-of-life decisions when there is time and space to do so thoughtfully, before a crisis and when the patient can advocate for herself.
Given my organization’s commitment to improving care and expanding choice at the end of life, we believe this legislation sets the right goals and is smart about how it achieves them.
The Care Planning Act will go a long way toward ensuring that once a Medicare recipient has determined and documented their treatment preferences, those preferences go with them. Ideally, everyone has an advance directive completed, but only a minority of us does, and they are often ignored, anyway. The Warner / Isakson legislation creates additional layers of insurance that the patient’s wishes WILL be honored, across a variety of settings. It brings in the patient’s family members, friends, religious figures and wider health care team to create a community of individuals who will understand and support the choices the patient makes. It even allows for training of people in the patient’s inner circle of family and caregivers in helping implement their plan when the time comes.
In short, this legislation recognizes that having our preferences documented is not enough. It is built around the understanding that people need a care plan they create in collaboration with loved ones and experts alike, and that the plan needs to be regularly revisited. The bill further recognizes that the providers a patient meets across a range of medical moments and settings all need to be focused on the patient’s plan, as do the patient’s advocates.
Importantly, Senator Warner’s and Isakson’s bill also takes accountability seriously. It will fund HHS to develop rigorous measures of success, where success means a patient’s documented care plan is completely followed by health care providers. Success also means that health care providers facilitate their patients in articulating and documenting their wishes, whether it’s a family doctor during an annual appointment or an ICU doctor after a patient is stabilized. Success means every provider a patient comes into contact with is focused on the patient’s goals for treatment, and getting those goals met.
One way this legislation ensures its goals will be achieved is by providing reimbursement for advance care planning consultations. It’s called a Planning Services benefit, and it is paid to health care providers under Medicare Part B. In our fee-for-service system, this is the best way to ensure Medicare beneficiaries have a real voice determining the amount of and type of care they receive.
Compassion & Choices is proud to support the Care Planning Act of 2015, alongside a growing list of organizations including the American Academy of Family Physicians and the American Geriatrics Society. It gets us closer to the patient-centered care everyone supports, and with its bipartisan sponsorship, there is every reason it should pass and give American health care consumers more power in our health care system
Daniel R. Wilson is National and Federal Programs director, Compassion & Choices.