- Medicare began reimbursing clinicians in January 2016 for delivering advance care planning services that identified patient end-of-life healthcare needs and preferences.
Reimbursement rates reached as high as $86 per half hour session, highlighting the importance of these engagement sessions in honoring patient choice and ensuring patient and family satisfaction in the face of critical illness.
“You can’t think about every single permutation about a given treatment option that may or may not be appropriate given your condition,” Anna Gosline, an advisor at the Massachusetts Coalition for Serious Illness Care, told PatientEngagementHIT.com.
“Instead of specifically talking about those procedures or treatments that you may or may not want, it’s about taking that broader step back and asking what’s important to you, what makes life worth living,” said Gosline, who is also a senior director of health policy and strategic initiatives at Blue Cross Blue Shield of Massachusetts.
Healthcare professionals should be engaging their patients in end-of-life care even before they experience a healthcare crisis or receive a chronic disease diagnosis, according to Gosline. Doing so removes some of the burden from the patient and her family who otherwise would not have known what to do during a serious health event.
Doctors should be driving these conversations, fusing their healthcare expertise with patients’ knowledge of themselves and their individual health preferences.
“We really want the healthcare system and providers to step up and have these conversations because a lot of times doctors can provide some great guidance and counsel,” Gosline noted.
Although end-of-life healthcare choices ultimately belong to the patient, doctors can offer valuable input.
However, these conversations aren’t happening at the rate they should be, Gosline acknowledged. A March 2016 survey from Cambia Health Foundation showed that only 29 percent of eligible Medicare providers were billing for advance care planning, showing that a majority of clinicians and patients are shying away from these conversations.
The survey, conducted in partnership with the John A. Hartford Foundation, also showed that only 14 percent of clinicians are engaging patients in healthcare planning. Approximately 30 percent of healthcare organizations have a protocol for healthcare planning or provide training or clinicians in this area.
“Sometimes patients question why they should think about care planning if they are healthy and not over 65,” Gosline explained. “But care planning is really about those situations where you don’t know what’s going to happen and making sure your loved ones aren’t faced with wondering what you would want and what you would do.”
For providers, barriers include a lack of care planning training and discomfort addressing the topic with patients.
“Providers feel like they don’t have the time and don’t have the training,” Gosline pointed out. “They’re worried about how care planning will be received by their patients. Patients might wonder if the doctor is saying something that they don’t know, or if their doctor is giving up on them.”
That’s why many care planning organizations across the country, including in Massachusetts, are opting for the term “healthcare planning” in place of “advance care planning.”
Clinicians should be guiding patients through healthcare planning throughout the entire healthcare process, said Ellen DiPaola, President and CEO of Honoring Choices Massachusetts. This both improves present health outcomes and eases the transition to end-of-life care.
“Everybody 18 and over has a right to direct their care and has a right to work with their care providers to get the best possible care through their lifetimes,” DiPaola said in a separate interview with PatientEngagementHIT.com.
“It’s not just this one time of life that we want to be doing this, but all throughout our life,” she continued. “The better care you take, the more care you have throughout your lifetime.”
Like Gosline said, patients have the right and the responsibility to decide what is important to them and the healthcare and lifestyle considerations that are valuable to them. But providers must engage patients in these conversations and ensure that these values are on the record and incorporated into care paths.
“Patients must talk to their doctor and talk about their goals for care,” DiPaola said. “Even if you’re perfectly healthy, this is a great time to start those conversations about what you want for care.”
However, like Gosline, DiPaola finds that healthcare planning is falling by the wayside. This is likely because clinicians and patients alike do not know how to approach the subject.
Patients don’t always recognize the value of healthcare planning when they are healthy, and clinicians fear upsetting a healthy patient by asking them to consider healthcare needs that may not appear urgent.
Many efforts for informing both clinicians and patients are underway for both Gosline and DiPaola.
At DiPaola’s organization, Honoring Choices Massachusetts, healthcare professionals are creating open-access materials to boost patient education in the area. With patients informed of their rights and responsibilities with regard to healthcare planning, they can drive conversations inside the doctor’s office.
At the Massachusetts Coalition for Serious Illness Care, Gosline and her team have recently launched the Write Your Script campaign, which introduces patient and providers to the idea of creating a healthcare plan.
The campaign materials help patients develop the skills to make their own healthcare decisions, and help patients and providers have more meaningful conversations about what both parties want for the patient’s health.
Familiarizing themselves with the process of healthcare decision-making and planning will likely have positive implications for patients, research shows.
A 2016 JAMA study found that healthcare planning improved quality of life scores for stem cell transplant patients. Patients experienced less depression, anxiety, and post-traumatic stress disorder symptoms.
Another study published in the Annals of Family Medicine showed that strong primary care and healthcare planning throughout a patient’s life reduces end-of-life spending. Patients who experienced strong planning and engagement throughout their lives yielded $65,160 in end-of-life costs, compared to $69,030 for patients with less engagement throughout their lives.
Engaging patients in healthcare planning will improve healthcare on several fronts. Healthcare planning will help clinicians adhere to patient preferences, ultimately improving satisfaction scores. Additionally, it will help drive patient activation and involvement in individual treatments.
Healthcare professionals can use healthcare planning to ultimately reduce costs and guide a smoother transition to end-of-life care by improving satisfaction and wellness throughout an individual’s life.