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Advance Directives: Let's Make a Law

Philip Betbeze, for HealthLeaders Media, April 11, 2014

As we all know, we have a collective healthcare cost problem in this country that provides plenty of fodder for our stories and plenty of challenges for the leaders who run healthcare organizations.

Fine brought up his idea with me a few weeks ago during an interview for an otherwise unrelated story on healthcare prices. A cancer survivor himself, Fine knows from running Banner Health that many of the problems with cost in healthcare happen in the last year of life. In 2006, 25.1% of Medicare expenditures went to patients for care in the last year of life, a number that has not changed significantly since at least 1978.  

With advance directives required as a condition of participating in Medicare or even Medicaid, it's likely that many patients and their families would refuse some of this care, and thus, those decisions should have a pronounced effect on healthcare spending.

And for those of you who see "death panels" in this argument, don't even go there.

The beauty of an advance directive is that it lets you, the patient, through your agent, determine how far to go to prolong your life. Nobody else is making those decisions. You can fill out an advance directive that asks caregivers to use all tools available even if there is little to no hope of recovery. That's still your right, you're just being forced to make those choices while you are still able. Because when you aren't able, those choices default to using all those expensive tools.

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3 comments on "Advance Directives: Let's Make a Law"


YeahRight (5/8/2014 at 3:30 PM)
I will never have a public advance directive. I will have a private letter to the person(s) I choose to represent me when I am unable. I will do this because I saw first hand the abuse that came when a hospital thought they had decision making powers. If my father had had an advance directive they would have killed him. Hell, they tried to anyway, with me as his medical power of attorney protesting all the way. Had they had a "legal" document to back them they would have proceeded against my will to stop treatment of a man who, once released from their dubious "care" went on to live another decade.

Alene Nitzky (4/14/2014 at 10:53 AM)
It's nice to see media attention to healthcare leaders acting on behalf of the public's well-being, taking the bull by the horns, and not solely for their own personal gain, and just worried about their voiced opinions affecting patient satisfaction scores. I have often wondered if organizations like the ACHE ever discuss the moral and ethical obligations of health care leaders to the public they serve, and the people who do the hard work in their organizations. We need to work toward a more humane health care system, for all: patients, families, health care workers, and the public.

donaldstumpp (4/11/2014 at 2:58 PM)
To your point Phil about even just getting started on the healthcare problem with the Medicare or even over 50 population, maybe the first step if for Medicare Advantage plans to lead the way. 25% of Medicare patients choose them and since it is a choice, maybe MA plans could make this part of their enrollment. If 1 in 4 of the Medicare population is doing this, maybe the stigma begins to go away and there's more voluntary adoption.