Empowering Medicare Beneficiaries with Clear End-of-Life Care Preferences
Understanding the Significance of AHCD
AHCDs play a crucial role in ensuring that an individual's healthcare wishes are respected in medical emergencies or at the end of life. They typically include identifying a healthcare proxy and a living will, which details the treatments an individual wants to receive. Other complementary documents also help communicate treatment wishes. With the aging population, addressing end-of-life care challenges becomes increasingly urgent. Research shows that patients with ACPs are less likely to receive unwanted treatments and are more likely to receive comfort-focused care.Historically, federal policies like the Patient Self-Determination Act have emphasized the importance of patient decision-making rights. However, despite these efforts and the availability of CMS provider reimbursement codes, there are still many barriers to completing AHCDs. Medicare beneficiaries often face cultural, religious, financial, and mental health reasons for avoiding these conversations. Additionally, the cost of completing an AHCD and the lack of uniformity in AHCDs across states pose challenges.
The Medicare Advance Healthcare Directive Enrollment Initiative
CMS should launch the Medicare Advance Healthcare Directive Enrollment (MAHDE) Initiative to support all Medicare beneficiaries aged 65 and older. This initiative focuses on four interventions.Streamline the Process
During open enrollment through Medicare.gov or an alternative CMS-approved secure ACP digital platform, beneficiaries can complete an electronic AHCD and renew it annually at no extra cost. User-friendly tools and resources are provided to guide beneficiaries through the process. Some states are also integrating electronic ACP completion into healthcare enrollment processes.An annual electronic renewal process allows beneficiaries to review and update their selections. It also provides educational opportunities around end-of-life care. The electronic enhancements ensure that AHCDs are legally compliant and accessible across different states and health systems.
Remove Barriers to Access
CMS should remove the deductible and 20% coinsurance for voluntary ACP services with a physician or other qualified health professional. This would encourage more beneficiaries to complete their AHCDs. Additionally, continued health provider education and partnerships with organizations like The Conversation Project and Evolent can support ACP discussions.Internal studies have shown that these enhancements can lead to significant savings in the final months of life and potential Medicare spending reductions.
Ensure Electronic Accessibility
CMS should integrate the Medicare.gov AHCD storage system or an alternative CMS-approved secure ACP digital platform with existing electronic health records (EHRs). This would prevent AHCDs from being misplaced and make them easily accessible across different healthcare systems.External add-ons can be used to connect EHRs with AHCD storage systems, ensuring that Medicare beneficiaries' end-of-life care preferences are consistently honored.
Provide Financial Incentives
CMS should offer financial incentives like tax credits, reduced copayments, and prescription rebates for completing an AHCD. With Medicare's increasing costs, these incentives can provide financial relief to beneficiaries and encourage them to complete their AHCDs.Medicare Supplemental Insurance can also help cover some of these costs, but additional financial support is needed to make AHCD completion more accessible.
Encourage Expansion of the NCQA's ACP HEDIS Measure
The MAHDE Initiative should be coupled with the expansion of the HEDIS measure to include all Medicare Advantage beneficiaries aged 65 and older. This would embed ACP into standard patient care and incentivize health plans to prioritize ACP.By taking these steps, CMS can empower patients to engage in ACP and reduce medical costs nationwide. Starting with the Medicare population aged 65 and older can pave the way for expanding ACP efforts to other high-need groups and the general population.
Conclusion:When patients and their families are clear on their goals of care, it is much easier for medical staff to navigate crises. The MAHDE Initiative is a feasible way to support ACP and redesign the healthcare system. By educating patients and families about their options and providing the necessary tools and incentives, we can create a more patient-centered healthcare environment.