Following a government career as mayor, congressman and lieutenant governor, Stan Lundine served as the founding executive director of the Chautauqua County Health Network from 1995 until 2007.
During the last several weeks, health care has received an unprecedented amount of media coverage. Despite allegations that pending health reform legislation would create panels to decide which patients were worthy of living, the facts are clear—and they clearly disprove these misrepresentations.
The portion of the larger health reform legislation in question would allow Medicare to compensate doctors for discussing with their patients the most difficult care choices— those that happen at the end of life. It would actually empower individuals to make the best decisions for themselves and their families, and better ensure that their wishes will be followed.
This is advance-care planning and it has been a key component of the work of the Chautauqua County Health Network (CCHN) for more than five years. CCHN is an organization comprised of the four hospitals in Chautauqua County, their governing boards and medical staff, and is dedicated to strengthening the local health and wellness delivery system. The organization has been working to increase and strengthen cooperation among local providers to ensure that residents have access to quality medical services and that their end-of-life choice are known and respected. This includes conducting community-wide and targeted campaigns to promote the completion of advance directives and maintaining a secure, web-based repositoryfor these documents to be accessed by health care providers and emergency responders at all times.
In doing this work, CCHN has first-hand knowledge that the types of conversations referenced in the health reform legislation are already taking place in many local health care provider practices as part of the continuum of primary care. It only makes sense that reimbursement is made available for the valuable time dedicated to it during these very busy appointments. The legislation contains no requirement to attend regular sessions with a provider or any provision encouraging euthanasia. Just as advance care planning efforts throughout NYS have been doing for years, this simply opens a wider door to compassionate and supportive conversations by trained professionals.
It is a fact that treatment at the end-of-life remains our most expensive episode of health care consumption, with an average of 70 percent of all spending on a person’s healthcare occurring in the last 18 months of life. Physicians with whom I have worked for many years tell me that their patients are often fearful of losing control of their care once they become ill. They fear getting swept along in a system designed for specialized treatment rather than personal choice and quality of life.
These patients want to know that their goals, values, and hopes will be the primary considerations when health care decisions need to be made. None of the proposals Congress is considering propose that care be withheld or rationed except to accommodate a patient’s wishes. It is time to provide modest reimbursement to complete work that has long been deemed important.
Physicians often ask patients who they would trust to help make health care decisions on their behalf if they were unable to speak for themselves. Often this triggers important thought processes and conversations around a patient’s care management decisions and personal care goals. Many people appoint one or more of their children, or their spouse, but some prefer to spare their family this burden of responsibility and appoint a friend or other representative.
This aspect of health care reform legislation does not determine what decisions will be made; it simply reimburses doctors for the time and attention they provide for the patient to articulate their wishes and provide clear direction for how they should be followed. All Americans should have all of the care they need but only the care they want.