Advance Directives: Let's Make a Law
If you don't have an advance directive, and the latest information I could find shows that less than 50% of even severely or terminally ill patients have one, you're effectively requiring your clinical caregivers to use every means available to prolong your life, even if such treatments are exactly what you do not want.
The only way to even hope that your wishes are followed is to complete one of these simple forms. Of course, that doesn't guarantee you won't be overtreated (advance directives helped make end-of-life decisions in less than half of the cases where a directive existed) but it helps.
Taming an "Insurmountable" Problem
Fine argues that healthcare leaders, lawmakers and policymakers tend to look at solutions that are intended to fix an insurmountable problem.
"We tend to look at insurmountable problems like fixing the healthcare system," he says. "That's insurmountable. But I wonder how healthcare would be viewed as a problem to be fixed if we just focused on patients who are 50 or above?"
Fine says he came to the conclusion that living wills would make a significant impact on healthcare affordability through Banner's participation in the Center for Medicare & Medicaid Services' Pioneer ACO program. While many organizations dropped out of the program after the first year, Banner did well and remained in the program for a second year.
Rather than focus interventions on the entire 50,000 Medicare beneficiaries in Banner's Pioneer ACO, leadership focused on what it saw as the problem population, the 5% of that population that used the most healthcare services.
"We were one of the ones who did pretty well," Fine says about Banner's Pioneer ACO results. "That could be dumb luck or focusing on the 5% of the population who are the greatest drivers of costs."
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