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Health Care Reform and Advance Care Planning

Author: Kathie Campbell | Published: 09/07/2009 | 47 Views | Short URL: http://www.inthepanhandle.com/local/n/3306

One of the most controversial issues in the news these days is the advance care planning provision in the House’s health care reform bill that allows for Medicare reimbursement for a physician to consult with a patient about his or her end-of-life care.  Honestly, I was thrilled when I heard about it. Finally, I thought to myself, we are finally moving toward a place where doctors will be incented to have those difficult discussions with patients so patients can have time to think about what they want and put their wishes in writing in advance directives. Millions of people will finally have access to good information (the informed part of informed consent) before a crisis occurs. Families will be given the gift of knowing what their loved ones want and will be able to respond accordingly without guilt or regret. And ultimately maybe more people will die dignified and comfortable deaths.

But much confusion and criticism resulted in the addition of this very important part of the health care plan. Critics stated that it would limit care or hasten death. They claimed that the intention was only to cut health care costs. They stated that the patient would lose their decision-making capability.
All the above criticisms are far from the truth about advance care planning and the intentions of this part of the bill.

Here are the facts:
The consultation (which could be paid for by Medicare once every five years) gives patients information that will help them make their own informed decisions about health 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 may be the patient’s own health care professional.
The consultation would be voluntary, it is not required. The Medicare beneficiary could choose to have a consult with their health care provider once every five years or when they face an important health care decision.

The hospice community has been especially interested and supportive of the advance care planning provision. One of the most frequent comments we hear from patients and family caregivers is, “Why didn’t we know about hospice sooner?” Hospice care is just one option that would be discussed in an advance care planning consultation.  But people could also learn about aggressive treatments such as CPR, artificial hydration and feeding, antibiotics, and respirators. Health care providers would have an opportunity to inform their patients about the medical outcomes of such treatments at the end of life and people could opt to have whatever treatments they want. What is different is that they would be able to have the information they needed, from a respected health care provider, to make the best decision for themselves before a crisis occurs. 

The 1991 Patient Self-determination Act already allows for advance care planning and stresses the importance of the patient’s wishes-so this is not necessarily new it would now be more readily available to Medicare patients.

Regardless of where health care reform ends up, West Virginians already have several options with regard to advance directives.
Traditional directives include the living will which allows you to state your desire to be allowed to die naturally if you are terminally ill or are in a persistent vegetative state and are not able to speak for yourself.  A living will is only used in these two circumstances. A person who wants heroics at the end-of-life would not have a Living Will.  The medical power of attorney enables you to appoint someone to be your medical decision maker if you are unable to make decisions for yourself.  These two documents are completed in advance of any medical problems.  A person may choose to have a living will or a medical power of attorney but most West Virginians have both.

There are other advance care planning options specifically for people who are of advanced age or seriously ill. The DNR or Do Not Resuscitate card is an orange card, signed by the patient and his or her doctor that tells medical personnel not to resuscitate if death occurs naturally. The POST or Physician Orders for Scope of Treatment form goes even further in that it enables the patient and his or her doctor to discuss and decide the kind of treatments the patient wants with regard to feeding tubes, resuscitation, hospitalization, etc. The DNR and POST forms are not normally used with people who are healthy.

While we cannot promise a physician consult, Hospice of the Panhandle staff are available to discuss the various advance directive documents with any interested person from the community. We maintain a complete stock of all the documents and also have a number of materials that we provide at no charge to the community. We are also available to give advance care planning presentations to any interested group, club, business or church. We even have notaries that are available every day, Monday through Friday, 8am-4:30pm. The public is welcomed and encouraged to use these services.

For more information about advance care planning, to obtain the necessary forms to complete an advance directive, to make an appointment to have documents notarized or to schedule a program just call the Hospice of the Panhandle marketing department at (304) 267-1870, Ext 214.