Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Blogs
    • AI
    • Deals
    • Layoff Tracker
    • HIMSS 2023
  • Opinion
    • Breaking Bias
    • Commentaries
    • Letters
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - AI and Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Sponsored Video Series - One on One
    • Sponsored Video Series - Checking In with Dan Peres
  • Data & Insights
    • Data & Insights Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Government
September 13, 2017 12:00 AM

Healthcare groups, lawmakers push Medicare to promote advance directives

Rachel Z. Arndt
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    Although the CMS reimburses clinicians for advance care planning during Medicare patients' yearly wellness visits, the agency has yet to encourage patients to set up these plans. It shows: Two-thirds of American adults do not have advance directives to guide their healthcare if they become unable to communicate.

    The CMS currently advocates a low-tech, hands-off approach to advance care directives, advising people via its website to keep copies of the directives "where you can easily find them"; give copies to healthcare providers, proxies, and family and friends; and to carry a note "in your wallet" saying you have an advance directive.

    But even if a person has an advance directive, it may be hard to use.

    "The current dynamic is somebody might have a form that's on their refrigerator, and if an EMT happens to see it and grab it, then great," said Sharon Pearce, vice president of policy for the National Hospice and Palliative Care Organization. "What's worse than not having a directive at all is having it and it not being followed" if no one sees it.

    Some lawmakers and organizations are looking for new ways to encourage people to create advance directives and know about them in the first place.

    "Far too many patients aren't having these conversations and aren't documenting their end-of-life care wishes," Pearce said.

    The CMS for its part added two new codes to its physician fee schedule so physicians, physician assistants and nurse practitioners are reimbursed for having discussions about advance care planning with patients.

    Sens. Bill Cassidy (R-La.), John Barrasso (R-Wyo.) and Michael Bennet (D-Colo.) want the CMS to do more. Their legislation, the Medicare Choices Empowerment and Protection Act that was reintroduced in July, would have the CMS pay Medicare beneficiaries $75 for writing and registering digital advance directives. Accredited vendors certified by the CMS would maintain the directives online where beneficiaries' doctors can access them, and the CMS would have on file which organization hosts which beneficiaries' information.

    The legislation's push for digital versions of the directives makes sense, given the move toward complete electronic health record adoption and patient safety concerns, Pearce said.

    While most directives are downloadable, coming from both government and private companies, many are not actually stored online. All states provide advance care directives (and maintain their own laws regarding them), but only a handful administer their own registries for the directives, and most of these registries allow filing only via mail. Private options for maintaining digital copies of directives include companies like ADVault, which contracts with private insurers, providers and others to offer a directive that's legal in all states.

    Still, there is no national registry and no government-issue, standardized directive form—nor would this bill establish either.

    "There is very good intention in the proposal, but as with many things, the devil is in the details," said Kelly McCutcheon Adams, senior director at the Institute for Healthcare Improvement. "How would this work? How would the national Medicare system handle this state by state, where different documents count as being advance directives?"

    Some organizations hope the Office of the National Coordinator for Health Information Technology, the CMS and the National Institute of Standards and Technology will set standards for advance directives. The agencies should " develop regulation, mandate the use of standards on directives, and train the workforce involved in data capture, management, and the release of information," said Anna Orlova, senior director of standards at the American Health Information Management Association. "These organizations need a push not so much from Congress but from professional associations."

    The American Hospital Association, hospitals themselves, the American Bar Association and others offer advice and toolkits for creating advance care directives. One organization, the Conversation Project, is entirely dedicated to advance directives. The project, in partnership with the Institute for Healthcare Improvement, encourages people to have end-of-life-planning conversations long before they're in the hospital.

    "It doesn't matter if the widget is electronic or paper," said Harriet Warshaw, executive director of the Conversation Project, "you still have to have that conversation."

    The CMS could encourage the conversation, by including tools for advance directives in a Medicare welcome kit, according to Warshaw.

    "If something could be put right into that, that would be extraordinary," she said.

    The agency might also make documentation of a healthcare proxy (a type of advance directive) in each patient's EHR a quality standard, Warshaw said. "Just how you're tracking an allergy medication, you should be able to track what people want at the end of their lives."

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    congress prescription drugs
    PBMs, Big Pharma face off in House hearing
    Biden COVID copy_i_i.jpg
    Biden administration asks employers to help more workers who lose Medicaid
    Most Popular
    1
    Centene to lay off 2,000 workers
    2
    How health systems are battling price-gouging allegations
    3
    Senate advances bill to temporarily aid hospitals, health centers
    4
    Elevance, Blue Cross Louisiana halt $2.5B proposed deal
    5
    Tower Health to sell urgent care centers, close others
    Sponsored Content
    Modern Healthcare Alert: Sign up for this breaking news email to be kept in the loop as urgent healthcare business news unfolds.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Help Center
    • Advertise with Us
    • Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Blogs
      • AI
      • Deals
      • Layoff Tracker
      • HIMSS 2023
    • Opinion
      • Breaking Bias
      • Commentaries
      • Letters
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - AI and Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Sponsored Video Series - One on One
      • Sponsored Video Series - Checking In with Dan Peres
    • Data & Insights
      • Data & Insights Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing