Baldwin Part of Bipartisan Effort to Improve Planning Options for Patients with Advanced Illness

WASHINGTON, D.C. – U.S. Senator Tammy Baldwin, a member of the Health, Education, Labor, and Pensions (HELP) Committee, and a bipartisan coalition led by Senators Mark R. Warner (D-VA) and Johnny Isakson (R-GA), introduced legislation today designed to give people with serious illness the freedom to make more informed choices about their care, and the power to have those choices honored.

The Care Planning Act of 2015 creates a Medicare benefit for patient-centered care planning for people with serious illness. It will reimburse a team of healthcare professionals for providing a voluntary, structured discussion about the patient’s goals, illness, and treatment options. Under this legislation, a written plan would reflect the informed choices made by patients in consultation with their health care team, faith leaders, family members and friends. The Care Planning Act also provides resources for public and professional education materials about care planning. Senators Susan Collins (R-ME), Amy Klobuchar (D-MN), and Shelley Moore Capito (R-WV) are also original co-sponsors.

“Wisconsin has been a leader in promoting comprehensive and patient-focused advanced care planning services and I’m proud to join this effort to ensure all Americans have the opportunity to better manage their care,” Senator Baldwin said. “The Care Planning Act puts more control in the hands of patients, and empowers doctors to put patients first in order to improve health care quality for all of our families.”

“We know that advance care planning makes a huge difference in patients’ lives, and through Honoring Choices Wisconsin we know that this can and should become the standard of care. As a neurologist I see the consequences every day. The Wisconsin Medical Society enthusiastically supports U.S. Senator Tammy Baldwin’s Care Planning Act legislation,” said Donn Dexter, MD, Chief Medical Officer, Wisconsin Medical Society.

"We want to thank Senator Baldwin and her colleagues the United States Senate for addressing such an important topic in healthcare.  This bi-partisan legislation mirrors our model over the last 20 years: patients receive the care they want and deserve, providers have clarity for treatment and families gain peace-of-mind that their loved one’s wishes were honored," said Jeff Thompson, MD, CEO of Gundersen Health System.

A quarter-century ago, La Crosse’s Gundersen Health System launched a team-based program called “Respecting Choices,” designed to promote conversations about advanced care planning. Gundersen’s comprehensive Respecting Choices program is now used in many communities across the country and even internationally. More than a quarter of all Medicare spending is attributable to the 5 percent of beneficiaries in the last year of their lives. Patients between 55 and 65 are invited to select a decision-maker and complete an advance care directive. Patients in the middle stages of chronic or progressive disease are offered information about what the road ahead looks like – including the decisions that they may one day encounter. And patients who are likely in the final months of their lives are given the ability to determine the goals of their care. This program is purely optional.  Patients retain total control over their care. But most patients understand that having these conversations gives them more control, and they choose to take advantage.

The Dartmouth Atlas reports that Gundersen patients spend an average of 13.5 days in a hospital during the last two years of their lives – compared with 23.6 days among the general population.  And the total cost of that care is just over $18,000 – compared with more than $25,000 nationally.

According to a recent article published by Vox, “by 1995, 85 percent of La Crosse residents had an advance planning document on their record. In 2008, it hit 90 percent.”

As a member of the U.S. House of Representatives, Senator Baldwin offered a bipartisan amendment to the Affordable Care Act to fund public awareness campaigns about end-of-life planning and in addition, cosponsored an amendment from Representative Earl Blumenauer of Oregon that would have allowed physicians to be reimbursed under Medicare for having these conversations with patients. 

The Care Planning Act:

• Establishes Medicare reimbursement for healthcare professionals to provide a voluntary and structured discussion about the goals and treatment options for individuals with serious illness, resulting in a documented care plan that reflects the informed choices made by patients in consultation with members of their health care team, faith leaders, family members and friends.
• Tests new models for more intensive services for those with advanced illness, and provides funding to support the development of a public information campaign to encourage effective care planning. It also provides grants to develop materials and maintain a web site with information about advanced care planning, portable treatment orders, palliative care, hospice, and planning services, and directs the U.S. Dept. of Health & Human Services (HHS) to include information about advanced care planning in the official Medicare & You handbook.
• Puts structures in place to focus providers on evidence of patient preferences, such as directives from other states or past discussions about treatment goals, and requires documentation of plans made prior to discharge from health facilities to assure that care plans travel with patients after discharge.
• Directs the HHS to develop quality metrics that will measure synchronicity among the individual’s stated goals, values, and preferences with documented care plans, the treatment that is delivered, and the outcome of treatment.
• Explicitly prohibits the use of funds in violation of the Assisted Suicide Funding Restriction Act of 1997, and further requires that all services be free from discrimination based on advanced age, disability status, or the presence of advanced illness.

In addition to Gundersen Health System and the Wisconsin Medical Society, the legislation has been endorsed by more than 40 national and local health care and elder advocacy organizations, including: the AARP, Alliance for Aging Research, Alzheimer's Association, Alzheimer's Foundation, AMDA – The Society for Post-Acute and Long-Term Care Medicine, American Association for Long Term Care Nursing, American Geriatrics Society, American Health Care Association, American Heart Association, Augusta Health, Cambia Health Solutions and the Cambia Foundation, Capital Caring, Caregiver Action Network, Center for Elder Care and Advanced Illness, Altarum Institute, Coalition to Transform Advanced Care, Connected Health Resources, Dementia Action Alliance, Emory University Woodruff Health Sciences Center, Good Samaritan Hospice, Home Healthcare Hospice and Community Services, Latino Alzheimer's & Memory Disorders Alliance (LAMDA), Latinos Against Alzheimer's, National Academy of Elder Law Attorneys, National Association for Home Care & Hospice, National Association of Activity Professionals, National Association of Directors of Nursing Administration/Long Term Care, Inc., National Committee to Preserve Social Security and Medicare, National Consumer Voice for Quality Long-Term Care, National Council on Aging, National Hispanic Council on Aging (NHCOA), National Hospice and Palliative Care Organization, National Partnership for Hospice Innovation, National Transitions of Care Coalition, Parkinson's Action Network, Second Wind Dreams, SeniorSherpa, League of United Latin American Citizens (LULAC), Union for Reform Judaism, United Methodist Church – General Board of Church and Society, University of Virginia Health System, USAgainst Alzheimer’s, Visiting Nurse Associations of America, and Women’s Institute for a Secure Retirement (WISER).