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Why Some Providers Struggle with Advanced Care Planning Talks

99% of providers agree that advanced care planning is vital for patient care, and yet only 14 percent have actually billed Medicare for these services.

By Sara Heath

Although an overwhelming majority of healthcare providers agree that advanced care planning is critical for adequate and ethical patient care, only a small number of them are actually engaging patients in these kinds of conversations.

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In a new report commissioned by the John A. Hartford Foundation, the California Health Care Foundation, and Cambria Health Foundation, researchers found that 99 percent of healthcare providers agree that advanced care planning conversations are important.

Another 95 percent of providers support the Centers for Medicare & Medicaid Services’ reimbursement model for advanced care planning services, and 75 percent agree that this model encourages them to engage in these kinds of conversations with patients.

Yet only 14 percent of providers surveyed have actually billed Medicare for advanced care planning services.

The researchers identified two overarching reasons for this. First, several hospital policy barriers keep providers from fully engaging in advanced care planning conversations with their patients.

READ MORE: Patient-Provider Communication Strategy May Boost Education

Only three in ten providers say their practice has a formal protocol that helps them determine patients’ end-of-life care wishes, and only 29 percent of providers report having underwent any sort of training for discussing advanced care planning with patients.

Hospital technology also gets in the way of providers’ ability to identify patients’ end-of-life care wishes. A significant number of providers report that their EHRs keep them for digitally noting their patients’ preferences.

Forty percent of providers say their hospital’s EHR system has no place to note whether or not a patient has informed a provider of their end-of-life care wishes. Of the 60 percent of providers who indicate their EHR does note advanced care planning notes, 31 percent say they cannot access that part of the record.

Of course, hospital policy is not the only factor keeping providers from engaging in advanced care planning conversations with their patients. Many providers report having difficulty addressing the subject with their patients.

Just under half of providers say that they are uncomfortable with addressing the topic with their patients because they are unsure of what to say.

READ MORE: What Patient Complaints Say About the Patient Experience

Several providers say that they struggle with identifying the proper time to broach the subject with their patients. Forty-eight percent of providers didn’t want their patients to think that they were giving up on them, and 46 percent didn’t want their patients to give up hope.

That all said, providers were nearly unanimous in explaining why advanced care planning is an important aspect of patient care, with 92 percent wanting to respect patient’s values and wishes. Another 87 percent wanted to avoid unnecessary and unwanted hospitalizations at the end of life, and 81 percent wanted to improve patient and family care satisfaction.

According to Peggy Maguire, Cambria Health Foundation’s president and board chair, it’s critical that providers ensure that patients are satisfied with their advanced care planning conversations.

"Reimbursing doctors to have these conversations is only part of the equation. It's equally important that consumers are empowered by these conversations and feel their wishes are expressed and respected," Maguire said. "We're grateful for the opportunity to work with physicians to create better experiences for people facing serious illness and their families."

The survey shows that although difficult, these conversations benefit the patient, and are satisfying to providers. Providers report that they feel good about considering their patients’ needs and wishes following advanced care planning conversations.

READ MORE: 3 Best Practices to Improve the Healthcare Patient Experience

"As a primary care physician, I've had end-of-life conversations with patients for more than two decades," said Sandra R. Hernández, MD, president and CEO of the California Health Care Foundation.

"As health care delivery becomes more patient-centric, this improvement in communication can relieve significant pain and suffering for patients and their families. These conversations, though not easy, benefit from taking into account the patient and physician's knowledge, attitudes, and beliefs about end-of-life care options."

Several branches of the healthcare industry are working to boost the level of advanced care planning conversations. As mentioned above, CMS began reimbursing practices for advanced care planning services on January 1.

Earlier this week, health technology professionals also acknowledged their roles in boosting advanced care planning. In Michigan, the Greater Lakes Health Connect (GLHC) will partner with other HIEs to make advanced care planning information available in their data repository. This will help patients receive the end-of-life care they desire regardless of physician they visit.

“Housing advanced care plans within the GLHC registry helps safeguard patient’s wishes and assures that the patient receives high-quality healthcare even when they cannot make their own choices,” said Doug Dietzman, GLHC’s executive director. “It guarantees that patient preferences remain at the center of the healthcare decision-making process.”

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