Doctors in Tennessee have an opportunity – and an obligation to our patients – to lead the way on efforts that promote higher quality end-of-life healthcare.
The end-of-life segment of our healthcare system is an often misunderstood but rapidly emerging area of focus for insurance companies, healthcare providers, patients and families. We cannot continue to neglect the growing demand fueled by our aging population and prevalence of chronic disease.
We must find ways to avoid well-intentioned but inappropriate medical care at the end of life, which can lead to repeat hospital visits, unnecessary tests and medications, and other interventions that not only deliver no benefit to the patient ... but also contribute to our already exploding healthcare costs. We need to recognize when it is more appropriate to facilitate a transition from curative care to end-of-life services, such as palliative and hospice care to help with pain and symptom management.
And we can start by having a conversation.
Most physicians have difficulty finding time to engage in meaningful discussions with patients and still manage the growing financial pressures, administrative burden and regulatory demands that have complicated the practice of medicine.
Advance care planning is a way to re-ignite the critical patient-provider communication. It helps physicians give patients, families and caregivers the information they need to make informed healthcare decisions. It allows patients to clearly define their goals of care, treatment options and personal preferences directly with their physician. It empowers them to ask for and receive the care that best fits their values and clinical situations.
This straightforward yet sensitive communication is shown to not only improve patients’ quality of care in the final phase of life, but also directly contribute to cost reductions.
A study from the Institute for Social Research at the University of Michigan found that people who had a living will were much more likely to receive palliative care, much less likely to die in the hospital, and Medicare spent about $5,000 less on these patients compared to those who didn't have an advance directive.
Unfortunately, the Institute of Medicine estimates that only about 25 percent of the U.S. population has advance healthcare directives.
Extensive advocacy and education efforts from the Tennessee Medical Association and others within the healthcare industry aim to change that.
TMA joined a host of entities urging the Centers for Medicare & Medicaid Services to include reimbursement codes for advance planning in its current Medicare payment schedule. While CMS does not yet pay healthcare providers for such services, it has begun to recognize the associated value and track the codes to help determine whether it should reimburse in the future.
TMA is also one of many organizations supporting the Tennessee Department of eHealth Initiatives as it develops a statewide database for advance directives. The hope is that a central repository would encourage more patients to prepare and file their advance directives, and give providers one place to access the information when needed.
Using input from Tennessee providers, the Tennessee Department of Health recently enhanced its Advance Directive for Health Care form to include a commentary box for patients and/or caregivers to express their unique wishes regarding end-of-life care.
Through these and other initiatives, we may collectively begin to address this sensitive area of healthcare and deliver end of life care that meets each patient’s unique needs.
