C-TAC’s Senior Regulatory Advisor, Marian Grant, co-authored a recently published review of federal advance care planning (ACP) policy entitled “Federal Advance Care Planning Policy Primer – Key Aspects, Barriers, and Opportunities.” This content was also presented at the 2023 AAHPM and HPNA Annual Assembly in Montreal.
Written with three of last year’s Health and Aging Policy Fellows, (Sarguni Singh, LaCinda Jones, and Debbie Freeland) the review notes that ACP is a nuanced process where patients identify their goals and consider their preferences for medical care over time. It also addressed the ACP evidence issue by noting that recent systematic reviews have shown mixed findings about the association of ACP with the provision of goal-concordant care, completion of advance directives, and health care utilization.
Despite a lack of consistent proven benefit, patients and clinicians value ACP and policy makers at the state and federal level, have been moving ACP policies forward. All fifty states have policies regarding advance directives, and federal policy has had important implications on promoting awareness of ACP and its corresponding legal documents such as advance directives. However, challenges to effectively incentivize and facilitate the delivery of high-quality ACP exist.
The paper provides an overview of key federal policy aspects and barriers that affect ACP use including limitations of Medicare ACP billing codes, disparities in telemedicine access, difficulties with interoperability of advance directives, and underutilization of ACP as a mandatory measure in federal programs. It also highlights key opportunities to improve federal ACP policy, something that C-TAC consistently advocates for.
Because ACP is an essential part of high-quality care and is deeply embedded in state and federal policies, it is imperative that people are knowledgeable about these issues so they may more effectively engage in ACP policy.
