A year ago the heath care reform bill was signed into law by
President Obama. During the debate leading to the passage of this
sweeping legislation, there was much publicity about a provision
that would allow physicians to obtain reimbursement for voluntarily
having discussions with their Medicare eligible patients about
advance care planning (ACP). Overnight, ACP became a political
football and the focus of media frenzy.
Simply put, ACP consists of appointing someone to make specified
medical decisions in the event of one's mental incapacity. ACP
includes options for end-of-life care, which may include directives
to forgo aggressive life-sustaining treatment. ACP is seen as a
means to uphold one's autonomy by appointing a trusted person to
enact one's wishes if mentally disabled at a later date. A legal
document known as Power of Attorney for Health Care Suddenly is a
type of ACP tool. Research has shown that ACP discussions between
doctor and patient, especially about end-of-life care decisions,
help ensure that one gets the care one wants. Unfortunately, ACP
was mischaracterized as leading towards "government death panels"
and stirred a strange national debate. In short order, the entire
matter was dropped from legislation. It was simply too politically
and emotionally charged to move forward.
Then in January of this year, the Obama administration bypassed
the proposed ACP provision. Through a regulatory change, Medicare
would pay for physicians to voluntarily holding ACP discussions
with their patients. Again, the issue got much political heat so
the regulation was quickly dropped with one exception. Medicare
will pay physicians for having ACP discussions only at the first
visit when someone becomes eligible for Medicare.
Does this mean the end of ACP? No, in fact, ACP has been part of
American life for the past few decades and is getting more
attention as the number of older Americans with chronic health
conditions, such as dementia, is increasing rapidly. In addition,
the federal Patient Self-Determination Act requires that all
Medicare-participating healthcare facilities inquire about and
provide information to patients about ACP. Regardless of one's
political affiliation, most people can agree that everyone should
have a strong voice in making one's own health care decisions. And
those decisions can cover a number of areas including organ
donation, cardiopulmonary resuscitation (CPR), and exactly what
should happen if you could no longer make medical decisions.
All of us need to be having conversations about ACP now instead
of when later facing an illness. These conversations should be
taking place around a kitchen table with our families and other
trusted advisors. Attorneys can also be consulted for advice. Legal
forms are readily available to express one's wishes in writing. And
most health care professionals will be happy to guide you through
the process, with or without Medicare reimbursement.
Resources: For more information about an ACP tool known as The
Five Wishes, go to http://www.agingwithdignity.org. The Illinois
Statutory Short Form Power of Attorney for Health Care is available
at http://www.idph.state.il.us/public/books/PwrOf.PDF.
An organization devoted to promoting ACP through an annual National
Healthcare Decisions Day (April 16th) can be reached at www.nhdd.org.
Daniel Kuhn, LCSW is Community Educator for Rainbow
Hospice and Palliative Care, based in Park Ridge.