DEEP DESIRE TO REDUCE HEALTH CARE SPENDING USING ADVANCE CARE PLANNING CAN MEAN PREMATURE DEATH

Gundersen Lutheran Health System, a physician-led, not-for-profit integrated delivery system serving more than 550,000 people in Wisconsin, Iowa, and Minnesota, implemented a program promoting advance care planning. According to an analysis done by the Commonwealth Fund, Medicare spends $8,000 less per patients treated at Gundersen Lutheran than the national average—and roughly $10,000 less at Gundersen Lutheran during the last six months of life than at other area hospitals. The analysis specifically attributed these lower costs to the completion of advance directives associated with the health system’s promotion of advance care planning. [1]

How does Gunderson save this money?

A group of national and local disability rights groups had pointed words regarding Gundersen Health Care System Respecting Choices advance care planning documents entitled “Tube Feeding:  What You Should Know” and “Help With Breathing:  What You Should Know.”  In a letter to Bernard Hammes, Ph.D., the Director of Medical Humanities and Respecting Choices, the groups wrote,

However, using frequently identical language, both documents reflect a strong bias against using these medical devices for any purpose other than short-term recovery.  The documents describe long-term use of these devices as fraught with discomfort and unpleasant side effects, and actively discourage individuals from even trying them despite the certainty that they will die as a result....Many of the undersigned individuals are among the tens of thousands of people with disabilities who use these medical technologies on a long-term basis and are therefore able to enjoy meaningful, productive and fulfilling lives.

The groups asked Gunderson to make specific changes including,

·       Stop marketing and distributing “Tube Feeding:  What You Should Know” and “Help With Breathing:  What You Should Know.” 

·       Send a formal notice to all known purchasers and users of these documents directing that they no longer be used due to their misleading nature and offering to refund any related payments received for their purchase.

The full letter can be found here.

Information on how even more advance care planning materials already in widespread use are suffused with vivid, emotional, and distorted presentations designed to persuade individuals to forego life-preserving medical treatment can be found here.

What is worse, this summer, the Obama Administration has proposed a regulation using its executive power to pay doctors to conduct advance care planning conversations with seniors, to take effect January 1, 2016.But Rep. Steve King (R-IA) has introduced a bill, H.R. 3251, to prevent the Administration from implementing that funding.

 You may ask Your Representative to Co-Sponsor H.R. 3251 against Biased “Advance Care Planning” Under Medicare by clicking here

[1] S. Klein & D. McCarthy, “McCarthy D. Gundersen Lutheran health system: Performance improvement through partnership Case study: Organized health care delivery system 2009,” http:// www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2009/Aug/1307_McCarthy_ Gundersen_Lutheran_case_study_v2.pdf.

“FALSE PREMISE” OF OVERTREATMENT IS PARTLY TO BLAME IN OBAMA ADMINISTRATION PUSH TO REIMBURSE DOCS FOR ADVANCE CARE PLANNING

What is driving the current major nation-wide push, both in the private and public spheres, to promote “Advance Care Planning”?  One major disability rights group points to a very important reason, the “false premise” that there is widespread overtreatment.

In her presentation to the 3rd International Society of Advance Care Planning and End of Life Care Conference, Diane Coleman, JD, CEO of disability rights group Not Dead Yet pointed to a major flaw in the thinking of those promoting advance care planning,  

I call the Disability Perspective a Quest for Balance because advance care planning has developed under the false premise that the primary or only problem is overtreatment of dying people. A balanced approach would also address the problem of undertreatment of people who may or may not be terminally ill. I want to emphasize that while the disability community may be most sensitive to this problem, it affects everyone who may find themselves on the patient end of the health care system.

Ms. Coleman highlighted one shocking example of Terrie, 19 year old who was in an accident and was initially on a ventilator.  

“While I was lying in the hospital bed . . ., the doctors would come in and ask my mom if she was ready to pull the plug on me. ‘Why would I want to do that?’ she would ask? The doctors answered, ‘What kind of life will she have— she won’t. She won’t be able to dance, walk, work, have a social life, or be independent.'...Terrie’s parents argued with the doctor, who “responded that any good mother would pull the plug instead of seeing their baby suffer. . . .”

According to accounts,

[Terrie] had a rough time medically for about five months, but eventually, she said “I was spending hours a day off the ventilator and the doctors were still asking if I wanted to live the rest of my life with this condition. If I chose no, they would keep me off the ventilator and I would die. I could get injected with Morphine so I couldn’t feel it.”...”

When she returned a year later, with a power chair like mine and no ventilator, the doctors’ “jaws dropped to the floor and their eyes began to fill with tears.” Their reaction suggests that the doctors always meant well and thought they had been doing the right thing.” 

The full story can be found here.

Information on how advance care planning materials already in widespread use are suffused with vivid, emotional, and distorted presentations designed to persuade individuals to forego life-preserving medical treatment can be found here.

What is worse, this summer, the Obama Administration has proposed a regulation using its executive power to pay doctors to conduct advance care planning conversations with seniors, to take effect January 1, 2016.But Rep. Steve King (R-IA) has introduced a bill, H.R. 3251, to prevent the Administration from implementing that funding.

 You may ask Your Representative to Co-Sponsor H.R. 3251 against Biased “Advance Care Planning” Under Medicare by clicking here

“FEAR OF LIVING WITH A DISABILITY” PUSHES REJECTION OF TREATMENT IN ADVANCE CARE PLANNING

There is currently a major nation-wide push, both in the private and public spheres, to promote “Advance Care Planning”. There is strong reason for concern that, motivated by cost concerns, promotion of advance directives and advance care planning frequently deviates from a neutral effort to elicit and implement patients’ genuine wishes in the direction of influencing them, subtly or not too subtly, to reject life-preserving treatment.

One recent example can be found in New York State “Conversation Ready” Project materials uses the heavy-handed description,  “Are there circumstances that you would consider worse than death? (Long-term need of a breathing machine or feeding tube, not being able to recognize your loved ones)” 

The shocking thing is that materials leave out basic information including the fact that many studies show that it is difficult for doctors to predict whether these interventions will be either short-term or permanent. What about those who would want these interventions for a short-term? There is no separate question posed in that manner. What about the thousands of people living full and long with the use of assisted feeding, breathing machines, and so forth? Where are their stories?

A recent letter from the disability rights groups Not Dead Yet and the Center for Disability Rights opposing the “Conversation Ready” Project protested its negative framing of life with disabilities:

 Understandably, individuals do not want to lose their abilities due to an accident, illness, or age. Yet disability is a natural part of the human experience and it is unacceptable that a government program will encourage people to choose death over disability... Though this site also refers to individuals coping with advanced and untreatable diseases, The Conversation Project makes it clear that the fear of living with a disability is what drives the seemingly innocuous decision-making process designed to steer people away from receiving care. 

More info on how advance care planning materials already in widespread use are suffused with vivid, emotional, and distorted presentations designed to persuade individuals to forego life-preserving medical treatment can be found here.

 This problem will not be limited to New York State. This summer, the Obama Administration has proposed a regulation using its executive power to pay doctors to conduct advance care planning conversations with seniors, to take effect January 1, 2016.But Rep. Steve King (R-IA) has introduced a bill, H.R. 3251, to prevent the Administration from implementing that funding.

 You may ask Your Representative to Co-Sponsor H.R. 3251 against Biased “Advance Care Planning” Under Medicare by clicking here

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