C-TAC intern Jacob Briscoe sat down with Dr. Susan Nelson from Ochsner Health to talk about Advance Care Planning and the ACPequity push this year. To learn more about C-TAC’s #ACPEquity efforts, see our updates here.
Advance care planning conversations are an important part of the care that Ochsner Health provides to people and especially for people who have serious illness. While CMS addressed payment for advance care planning conversations, CMS has it listed as a procedure, which requires copayment. And so, I think this bill will really change how we do that. It will put the advance care planning conversation on par with cancer screenings, and vaccinations as a really important proactive part of health care.
Advance care planning is a very individual conversation, although you can talk about it in generalities. However, there are some negative perceptions about advance care planning since it is hard to determine what an individual would want in the future. Because of this, separating advance care planning conversations into distinct conversations about current and future health care decisions and future life decisions based on what is important can help create a balance and ease the stigma surrounding it.
One of the problems with trying to measure how valuable advance care planning is, is that there is not a standard metric to measure patient outcomes yet. At Ochsner Health, we have been able to look at patients who have and have not had conversations and received care by our palliative medicine teams or not to create an age-matched cohort to measure the difference between patient outcomes. This is like a study that was done by Jennifer Temel at Harvard, which found that patients who received usual care with additional palliative interventions live longer than the patients who didn’t get those interventions. Our evaluation suggests that by providing goal directed and coordinated care, patients are able to live the best they can. This coordinated care is less expensive because we have eliminated some of the treatments that are not beneficial and are able to focus on what is important.
At Ochsner Health, we describe palliative care as an extra layer of support for people with serious illness. We focus on directed coordinated care, which includes pain and symptom management, navigating the healthcare system, and having conversations with patients to understand what their desires are so that we can provide the care that that is aligned these desires. Another point that is hammered home to our staff is that this is a shared decision between the patient, the patient’s family, and our staff. By updating the patients, it helps make their lives as good as possible for as long as possible. Additionally, coordinated care can save money as patients spend less time in inpatient hospital settings. At Ochsner Health, we have implemented a training program called Advanced Steps using the Respecting Choices curriculum with our fourth-year medical students that focuses on learning these important conversations skills early to help facilitate more competent care and a better physician-patient relationship to improve health outcomes.
What’s important is learning and having conversations with the patient and their family, to make sure that everybody understands what’s important to the patient, and then being able to act on it. Comprehensive palliative care is not necessarily covered in the community setting as a separate benefit so many patients must choose what is covered rather than what is best for them. This is where I think that the US healthcare system needs to get to. And there has been some success as the VA has piloted concurrent, palliative care along with hospice care. Looking to the VA as a source of information on how to improve and possibly implement it in the future will help lead to better advanced care planning and better patient satisfaction.
We thank Dr. Nelson for her time and thoughts and encourage everyone to view our C-TAC Policy Team present context on recent C-TAC legislative ACP efforts.
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