ADVANCE CARE PLANNING
Due to the increased life expectancy, the rate of chronic and terminal illnesses and technological advancement, patients are putting more priority on the Quality of Life (QOF). From various studies conducted in the past, it is evident that End-of-Life (EOF) care that starts with Advance Care Planning (ACP) ensures a better quality of life for the patient. Other than the better quality of life EOF care saves cost for the patient and his/her family which ultimately increases satisfaction. Many obstacles stand in the way of EOL care. Eliminating them starts with making reforms on policies to promote ACP. Nurses and other practitioners in the field play a critical role in becoming instrumental in advocating for these reforms to the Medicare payment rule for the Advance Care Planning. The practitioners play their part by honoring moral, professional and ethical obligations.
The EOL at present is costly to the patients and their families, the levels of satisfaction are low therefore the need for policy change in the Medical care to promote the quality of life for the EOL. The article, therefore, looks at the Medicare payment to put to light the need for reforms that will enable ACP for adequate EOL care. The article expounds on the potential benefits of expanded payment for ACP under the Medicare policy initiated in January 2016. The paper also explains the impact the change in payment rule has on nursing practices.
The article begins by giving a background of chronic diseases in the United States, Advance Care Planning, End-of-life and quality of life. Under Chronic illness in the US, the articles provide statistical information on life expectancy in 2001 and comparing it to that of 2013. The rate of expectancy increase by 2.06% over the period of 12 years due to advanced technology that prolonged life for those suffering from illnesses like heart disease and cancer. The article observes that the Medicare spending has reduced since 2010 and that the bigger percentage of it is spent on managing chronic illnesses. It, therefore, suggests that if a good number of hospitals in the US used Palliative Care (PC), the system would save a lot of money. One of the impacts the fact that people would opt for alternative and cheap means for the EOL like avoid readmissions and choose to die at home rather than hospital beds.
The article further discusses the components of Advance Care Planning which include the provision of information to the patient and the family on the options available for their treatment, supporting the family like deciding on what treatment to choose. Support also includes assistance in giving directives where the patient provides then ahead of time in writing. Should there come a time where this patient is not able to communicate, the family and the caregivers would know what to do with the directives written ahead of time. The article notes that the Medicare does not cater for the PC which is one of the obstacles that face ACP.
Under End-of-life and Quality of life, the article highlights findings from a study that indicates that, if EOL is initiated early enough, it is possible to improve the QOF for the patient and his/her family. The article further discusses Medicare payment for ACP where it notes that there was no justification for professional training of ACP since it was not paid for initially. The changes in the billing have some implications on the people responsible. One of which is to include didactic and clinical courses.
The article concludes by stressing on the benefits of ACP being taken care of by the Medicare. The change of policy not only enables self-determination but also improves the QOL for the patient and the family. It will also benefit practitioners as they will receive payment for this.
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