Advance Care Planning Takes a Step Forward
Posted On: September 23rd, 2014
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
A proposal by the American Medical Association (AMA) would give patients more of a say in how they deal with chronic diseases, acute illnesses and where they want to spend their final days.
Responding to the proposed CMS Physician Fee Schedule for 2015, the AMA has proposed new CPT codes that cover advance care planning for patients. As those of us in the home care industry recognize, the discussion about whether palliative care or hospice care would be appropriate for a patient is fraught with emotions on both sides. Physicians may be reluctant to admit “defeat” by ending aggressive treatments. Patients may be unsure of their care options other than treatment or may be thinking more about their children or caregivers than themselves.
I’ve written previously about a study of Medicare records that shows twice as many elderly people died in hospice care than in a hospital or nursing home setting compared to a decade earlier. However, hospice remains the care of last resort, with more than 25% of admissions occurring within three days of death.
Controversy over end-of-life care decisions arose during debate on the Affordable Care Act as some opponents labeled them “death panels.” Ultimately, that portion of the act was removed. But in the intervening years, some private insurers have been offering physician reimbursement for advance care planning. The AMA’s proposal would bring the idea back to the mainstream.
The National Institute on Aging sums up the idea of advance care planning nicely and offers a good resource that may educate your patients on the concept. Here’s the NIA definition of advance care planning:
- Advance care planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know about your preferences, often by putting them into an advance directive. An advance directive is a legal document that goes into effect only if you are incapacitated and unable to speak for yourself. This could be the result of disease or severe injury—no matter how old you are. It helps others know what type of medical care you want. It also allows you to express your values and desires related to end-of-life care. You might think of an advance directive as a living document—one that you can adjust as your situation changes because of new information or a change in your health.
To be sure, discussing advance care planning or end-of-life care is difficult, whether you’re a patient, a caregiver, a physician or a home care worker. But using a hospice automation system that documents the existence of an advance directive helps ensure that organizations are able to respond to a patient’s final wishes.
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