Readmission News: Advance Care Planning

August 04, 2016

Readmission News publisheda byline in their June issue by our CEO, Dan Hogan, about the importance of, and how to facilitateadvance care planning. Check it out below.

Last month we celebrated Older Americans Month, highlighting the contributions of older adults and bringing awareness tothe many issues that they face. People are living an average of eight years longer than what their parents andgrandparents could expect, thanks to the combination of great medical advances and our intensified national focus onhealth and fitness. And that is adding a whole other chapter to our lives – second and third careers, more time for family andoverall improved quality of life.

But even as our extended lifetimes allow us to do more, we still must plan for end of life. As Ben Franklin famously said, “Inthis world nothing can be said to be certain, except death and taxes.” We plan for our taxes every year – whether we want toor not – and it’s important to put the same attention toward planning our final days.

Advance Care Planning

Death is not an easy thing to talk about. We don’t want to think of ourselves – or our loved ones – as mortal. However, it’s aconversation that we must all get comfortable having.

Right now, the majority of people in America aren’t dying the way that they want – almost entirely due to a lack of planning.80 percent of Americans would prefer to die at home, if possible, according to the Stanford School of Medicine. The studygoes on to say that, despite that fact, 60 percent of Americans die in acute care hospitals, 20 percent in nursing homes andonly 20 percent at home.

Not only do these statistics represent an unfortunate reality for patients andtheir families, the trend is also costing billions of dollars to the healthcaresystem. Even more frustrating, findings from a study in the Annals of InternalMedicine showed that increased spending does not result in better healthoutcomes or satisfaction with care.That makes it crucial for older Americans, their families and their doctors tohave conversations concerning advance care planning and end-of-life
decisions. And, hospice considerations should be part of that conversation –especially since hospice allows patients to live longer, have greater comfortand stay at home, according to the National Hospice and Palliative CareOrganization’s 2010 study.

Too often, patients who are nearing the end of the life are in the wrong care setting. The above-mentioned Stanford studynoted that only a minority of dying patients gets to use hospice care, and even those patients are referred to hospice in just thelast three-four weeks of life—that’s too late. Advance care directives should address this.

The good news is that these end-of-life conversations are being increasingly encouraged within health care. In fact, as of thisyear, Medicare’s advance care planning policy covers up to $86 for an office-based counseling session.


The majority of people – 89 percent – look to doctors to discuss end-of-life care issues. Where else would a patient go withquestions like that? It’s a clinician’s responsibility to make sure his patients – and their family members and/or friends – areaware of their care options and can make educated choices so they can live their final days on their own terms.

To effectively engage in an end-of-life conversation, clinicians need to understand who needs the conversation and when.Typically, doctors and nurses who are singularly focused on treatments and cures are at a loss to recognize when thatapproach may not be the right one. This is the clinical version of Abraham Maslow’s assertion from his 1966 book thePsychology of Science. He wrote “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if itwere a nail.” That’s where predictive analytics comes in.Mathematical decision support is a new and important tool for care.

At Medalogix, for example, our solutions analyze patient data to predict future outcomes. Our end-of-life analytics solution,Bridge, can predict which patients could most benefit from hospice care. This equips clinicians with the ability to identifypatients that need to have these critical, time-sensitive discussions earlier than if they were not using these analytics, allowingthe patients and families more time and information to make the best end-of-life care decisions for themselves.

When Should the Discussion Begin

It may be uncomfortable, but it’s important to understand end-of-life preferences before the patient is entering his or her finaldays. For post-acute clinicians, it’s recommended to start those advance care planning conversations when:

• A patient is admitted to your facility.

• A patient shows consistent decline instead of improvement during his or her home health episode.

• A patient verbalizes he or she is tired of being hospitalized with a chronic illness.

• A patient appears in Medalogix’s analytics-based hospice benefit risk stratification.

How Should the Discussion Go?

The initial discussion should be an opening to further conversations. Most people needtime to digest what is being said, have explanations repeated and an interval to reflectand discuss with those closest to them. By addressing the options – including whathospice care is– you as a clinician are enabling the best patient care. Of course, thepatient gets the final choice, and whatever it is should be respected. It should just be aninformed choice. Otherwise, he or she loses the freedom to choose how best to live his or her final days.

The Institute of Medicine’s (IOM) report, “Dying in America,” recommends that all clinicians across disciplines and specialtieswho care for people with advanced serious illness should be competent in basic palliative care, including communication skills.

Though all caregivers do their best, it’s still not always easy. It can be helpful to have an established method to identifypatients who could benefit from the conversation, which is why Medalogix encourages caregivers to leverage analytics to helpidentify patients in need of more or different care.

Older Americans have a right to live the ends of their lives with dignity and comfort. It’s up to caregivers and healthcarespecialists to get comfortable with having difficult conversations, so that every patient has considered and made advance caredecisions while they are still able to do so.

Dan Hogan is founder and CEO of Nashville, Tennessee-based Medalogix, a health care technology company that provides analyticsand workflows to home health providers.

*Photo Credit:Nashville Business Journal

*Originallypublished inReadmission News.

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