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Thursday, September 12, 2024

The End of Advanced Care Planning?

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 The Illinois Statutory Short Form Power of Attorney for Health Care is available at An organization devoted to promoting ACP through an annual National Healthcare Decisions Day (April 16th) can be reached at

Daniel Kuhn, LCSW is Community Educator for Rainbow Hospice and Palliative Care, based in Park Ridge.

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