January 4, 2018

Advance Care Planning vs. Patient-Provider Communication

Remember back in January of 2016, when Medicare approved a benefit to discuss Advance Care Planning?  It was a big deal. I know that because I was one of many who talked (endlessly, it seemed) about what a big deal it was. Our high expectations came from knowing that when people discuss in advance their wishes for care at the end of life, they are more likely to get the treatment they prefer, receive less futile medical care and--guess what--we save a ton of health care dollars.

Well, the results are in. During the first year, more than 570,000 Medicare patients used the benefit, which sounds pretty darn impressive. Here's the deal: That's only about one percent of all the people who could have. But, hey, it's twice the number of patients that the American Medical Association predicted would take advantage of the new benefit.

Now, here's some truly good news: A study at the University of Washington found that when doctors focus on patient-centered care for Intensive Care Unit patients by discussing treatment options and the use of palliative care, the costs per patient go down about 25 percent. Read: having real patient-provider conversations in the midst of a life-limiting health care crisis--along with the conscious practice of shared decision making--has a positive impact on patient care, as well as expenditures. 

Could we have been wrong for the past forty years about the role of Advance Care Planning? Perhaps . . .