Partnership for Advanced Care Planning: Preparing for the Final Transition
Julia Upton, Ph.D, Distinguished Professor of Theology, St. John's University (NY)
In order to incentivize preventive care for the aging population in 2011 under the Affordable Care Act the Centers for Medicare and Medicaid Services (CMS) instituted reimbursement for the Annual Wellness Visit (AWV). Unlike an annual physical, the AWV is a yearly office visit that focuses on preventive care. During the AWV a member of the medical team reviews a patient’s history and risk factors for diseases, ensures that the patient’s medication list is up to date, and provides personalized health advice and counseling. An optional component of the AWV is Advance Care Planning (ACP).
ACP would provide essential communication between patients, families/caregivers and health care providers, giving the opportunity to review patients’ goals, values and beliefs. If relevant this would include a discussion of current diagnosis, prognosis and treatment options and may include completion of an Advance Directive (AD), Health Care Proxy (HCP) and the state’s version of Physicians Orders for Life Sustaining Treatment (POLST).
Nationwide implementation for the AWV remains low—just 17.7% of eligible beneficiaries in 2015 with marked socioeconomic disparities. With ACP as an optional component of the AWV, there is surely scant evidence of such important conversations happening across the nation today.
Atul Gawande’s recent book Being Mortal: Medicine and What Matters in the End informs this paper. Conversations about patients’ goals, values and beliefs need to begin long before the crisis arrives, and perhaps physicians are not the best people to lead those conversations. With practical, pastoral examples, this paper proposes that partnerships be established between medical practices and spiritual leaders in the community, forming interdisciplinary teams to better serve the aging population. The holistic WHO definition of health as “a state of complete physical, mental and social well-being and not just the absence of disease or infirmity” embraces the spiritual dimension of human life without naming it specifically.
In order to incentivize preventive care for the aging population in 2011 under the Affordable Care Act the Centers for Medicare and Medicaid Services (CMS) instituted reimbursement for the Annual Wellness Visit (AWV). Unlike an annual physical, the AWV is a yearly office visit that focuses on preventive care. During the AWV a member of the medical team reviews a patient’s history and risk factors for diseases, ensures that the patient’s medication list is up to date, and provides personalized health advice and counseling. An optional component of the AWV is Advance Care Planning (ACP).
ACP would provide essential communication between patients, families/caregivers and health care providers, giving the opportunity to review patients’ goals, values and beliefs. If relevant this would include a discussion of current diagnosis, prognosis and treatment options and may include completion of an Advance Directive (AD), Health Care Proxy (HCP) and the state’s version of Physicians Orders for Life Sustaining Treatment (POLST).
Nationwide implementation for the AWV remains low—just 17.7% of eligible beneficiaries in 2015 with marked socioeconomic disparities. With ACP as an optional component of the AWV, there is surely scant evidence of such important conversations happening across the nation today.
Atul Gawande’s recent book Being Mortal: Medicine and What Matters in the End informs this paper. Conversations about patients’ goals, values and beliefs need to begin long before the crisis arrives, and perhaps physicians are not the best people to lead those conversations. With practical, pastoral examples, this paper proposes that partnerships be established between medical practices and spiritual leaders in the community, forming interdisciplinary teams to better serve the aging population. The holistic WHO definition of health as “a state of complete physical, mental and social well-being and not just the absence of disease or infirmity” embraces the spiritual dimension of human life without naming it specifically.