Hot topic: Advanced Care Planning Consultations in healthcare reform

The America's Affordable Health Choices Act of 2009 (H.R. 3200) and specifically Section 1233 (pages 424-434) of the House Ways and Means Committee version of health care reform contains a new Medicare provision to allow coverage for an "Advance Care Planning Consultation." It offers Medicare beneficiaries an opportunity to engage in an informed and focused conversation with their health care practitioner about advance care planning options.
 
However, this provision has created confusion about its true intention and the value of advanced care planning. Myths about death panels, mandatory patient/physician discussions and fear of limited care for the elderly have consumers and healthcare professionals up in arms. The provision simply ensures that physicians will be reimbursed for their time for to discuss end-of-life issues with patients if the patient so desires.
 
Research shows that these end-of-life discussions are valuable.

In an October 2008 study published in the Journal of the American Medical Association (Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment), researchers concluded that end-of-life discussions are associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care is associated with worse patient quality of life and worse bereavement adjustment.
Another study in the March 2009 issue of Archives in Internal Medicine (Health Care Costs in the Last Week of Life: Associations With End-of-Life Conversations) reported that patients with advanced cancer who said they had end-of-life conversations with their physician had significantly lower health care costs in their final week of life. Higher costs were associated with worse quality of death.
 
The National Hospice and Palliative Care Organization (NHPCO) has published the following talking points based on their analysis of Section 1233.

The consultation provision gives patients information that will help them make their own informed decisions about their care:
- It covers the broad spectrum of care and options when facing a life-limiting illness.  

- The consultation is with a physician, physician assistant or nurse practitioner--and in many cases may be the same health care professional the Medicare beneficiary has been seeing for years.

- Research has shown that patient discussions with their physicians results in a higher quality of life for patients and family caregivers.

This consultation would be voluntary, it is not required:
- It would be reimbursable under Medicare, just like other Medicare consultations.

- Beneficiaries could elect to have the consultation once every 5 years or when they face an important health situation.

Discussing advance care planning before a Medicare beneficiary finds him or herself in a medical crisis will help ensure the patient gets the care that he or she wants.
- One of the most frequent comments hospice providers hear from family caregivers is, "Why didn't we know about this sooner?" Hospice is just one option that would be discussed in an advance care planning consultation,  but this would ensure patients and family caregivers knew about it earlier.

The provision has bi-partisan support in Congress.
- Additionally, the 1991 Patient Self-determination Act already allows for advance care planning and stresses the importance of the patient's wishes--so this isn't necessarily new, it would now be more readily available to Medicare beneficiaries.
What the advance care planning consultation is NOT about...

• It's not about limiting care;
• It's not about hastening death;
• It's not about having choices made for the patient; and
• It's not about saving money.

This provision exists to ensure Americans have the tools to make their wishes known and to assist health care providers in honoring these wishes.