A Matter of Life and Death: Advance Care Planning

February 3, 2017 Madeleine Biondolillo

Consider this: If you are in a serious accident or have an illness that leaves you unable to talk about your wishes, who will speak for you? When it comes to important personal decisions regarding medical care for serious illness and eventual end-of-life care preferences, one conversation can make all the difference.

Advance care planning (ACP) is the process that enables individuals to make plans about their future healthcare. Typically, advance care planning includes:

  • Accessing information on the life-sustaining treatments that are available;
  • Deciding which treatments you want should you be diagnosed with a life-limiting illness;
  • Sharing your personal values and preferences with your loved ones;
  • Ensuring your wishes are documented in your health record; and
  • Writing legal instructions (advanced directive) on treatments you would/would not want to receive.

Advance care planning has not yet become a common practice, yet most people feel it should be. In fact, while 90 percent of people say that talking with loved ones about end-of-life care is important, only 27 percent have actually done so. And while most people—up to 80 percent—feel that sharing treatment wishes (should they become incapacitated) with their doctor is vital, only 7 percent report having had the conversation. Patients who have ACPs in place when they are needed report greater satisfaction with their healthcare and have been shown to have lower costs of care.

There are excellent resources on advance care planning available both to patients/families and clinical care. One focused on ambulatory practices and other sites of care is the Institute for Healthcare Improvement’s program, “The Conversation Project.” At the QUEST National Meeting in December 2016, best-selling author Dr. Angelo Volandes also led a very popular presentation of his work with the non-profit ACP Decisions, which helps patients visualize the actual care decisions to be addressed.

Fortunately, there is strong support for physicians, patients and family members to engage in end-of-life planning conversations. As of January 2016, the Centers for Medicare & Medicaid Services (CMS) pays for voluntary advance care planning under the Medicare Physician Fee Schedule (MPFS) and the Hospital Outpatient Prospective Payment System (OPPS). This has created appropriate incentives to promote spending time on these experience-enhancing discussions.

Additionally, under CMS’ new Merit-based Incentive Payment System (MIPS), doctors and other clinicians must report on a certain number of quality measures successfully, and ACP leading to a plan of care for complex medical conditions can be an effective component of MIPS success. Most importantly, ACP enables Medicare beneficiaries to make important decisions that give them control over the type of care they receive and when they receive it, ultimately increasing patient satisfaction scores and overall physician performance metrics.

Making the investment in advance care planning is beneficial, and will certainly pay off for physicians when reimbursement season rolls around. Even more importantly, the quality of care for many patients is sure to improve as a result.

Interested in learning more about MIPS performance improvement services or the QUEST 2020 collaborative? Visit our website for more information.

Author information

Madeleine Biondolillo

Madeleine Biondolillo

Dr. Madeleine Biondolillo is vice president, Quality and Safety at Premier, where she is responsible for growth of strategic quality and population health initiatives to support members in value-based healthcare delivery improvement. When she's not working, her hobbies are running half-marathons and volunteering in organizations that support victims of domestic violence.

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