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Advance Directives: Let's Make a Law

Philip Betbeze, for HealthLeaders Media, April 11, 2014

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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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.