Seeking Clarity in Uncertain Times: Embracing Advance Directive Planning (ADP)
Dennis B. Liotta, MD, MBA
Former Corporate Chief Medical Officer at Independent Living Systems, LLC
🌟Empowering People to Control Their Healthcare Future🌟
In a world of uncertainties, the future for ourselves and our loved ones remains an enigma unless we possess prophetic abilities or a crystal ball. Entrusting fate to chance is akin to wagering life savings on a game of chance in Las Vegas. The notion of what might happen to us or our family if we were unable to make decisions is a daunting prospect, leaving us pondering if anyone truly knows our present desires. Sadly, statistics reveal that merely one in three adults in the US has undertaken any form of advance directive planning (ADP), despite it being promoted as a vital means to communicate end-of-life care preferences for decades.
📜 What is ADP? An advance directive (AD) is a comprehensive document combining a healthcare power of attorney and living will, designed to offer guidance on medical decisions and end-of-life wishes in case of incapacitation or terminal illness.
💬 Why Advance Care Planning (ACP) Matters: ACP necessitates open discussions among patients, their families or designated decision-makers, and healthcare providers. This process takes into account the patient's cultural background and relationships, subsequently informing specific medical treatment decisions to be documented in an AD. The primary aim of ACP discussions is to ensure that patients receive care that aligns with their core values and goals.
💡 Empowering Personalized Healthcare: Despite various reasons cited in the literature to justify the lack of engagement in ACP, advance directives remain an indispensable component of delivering personalized healthcare, sparing individuals from guesswork and unwarranted financial burdens. Consequently, there has been a renewed emphasis and national priority to boost completion rates of advance directives.
🌼 Benefitting Elderly and Chronically Ill Individuals: Elderly and chronically ill individuals stand to benefit significantly from having these documents in place. For these populations, considering care goals becomes central to delivering person-centered care. An ACP typically documents a patient's care preferences, including choices regarding life-sustaining treatments, based on personal values and discussions with loved ones. ACPs empower patients to assert their desired care, especially if they are unable to communicate for themselves.
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💼 Collaborative Initiatives for Increased Participation: While neither federal nor state governments have mandated advance directive planning, a less authoritarian approach has emerged to increase participation. The Center for Medicare & Medicaid Innovation's BPCI (Bundled Payments for Care Improvement) Advanced Model incentivizes physicians and practitioners to deliver more efficient services, enhance care coordination, and prioritize high-quality care through the addition of ADP. Reimbursement comes in the form of two CPT billing codes and two CPT II tracking codes.
🗣 Breaking Barriers: People often shy away from uncomfortable topics or those seemingly distant in the future. However, with ADP, there is no "right" or "wrong" time to address it. Healthcare professionals understand that at the core of person-centered care lie values, meaningful conversations, and openness to planning. The inclusion of the ACP measure is crucial because any life-threatening condition or major medical procedure can serve as a trigger for discussions. Collaboration, questioning, and execution of AD documents should take place before they are needed, akin to purchasing insurance policies to safeguard against adverse life events.
💫 Embrace ADP: Securing a Future Aligned with Our Wishes and Values: ADP represents a process that assists adults, regardless of age or health stage, in understanding and sharing their values, life goals, and preferences regarding future medical care. The ultimate goal of ACP is to ensure that medical treatment aligns with an individual's unique values, aspirations, and desires. The timing and nature of ACP discussions may vary depending on the person's health status, and it should be integrated into routine care and revisited as needed when medical conditions change.
🗝️ Unlocking the Power of Conversations: It is high time for everyone to initiate a discussion about ADP. Get the conversation started to secure a future aligned with our wishes and values and those of our family and friends.