The John A. Hartford Foundation conducted a national survey of primary care and specialist physicians, asking them about end-of-life care and conversations about advanced care planning with their patients. (The link is at the bottom of this post.)
A total of 53% of physicians indicated that “Every day or almost every day” they see elderly patients who they would not be surprised if they died within a year. Additionally, 89% of respondents felt that having conversations about advanced care planning was “very” or “extremely important”, but only 14% had billed Medicare for an advanced care conversation with their patients.
Where’s the disconnect? Only 29% of the surveyed physicians have had training for talking with families about end-of-life care, and the same percent indicated that their practice has a formal system for assessing their patients’ end-of-life goals/wishes. It is possible that some physicians have had informal conversations with their patients and just not billed for it, but roughly 40% indicated that there is no place in their EHR system to document whether their patients have an advanced care plan, anyway.
To be fair, this is an area where the patient (and their family) needs to be proactive in initiating these conversations, and it shouldn’t be solely the responsibility of the physician. While it is important to provide physicians with the training for how to have these conversations, patients also need to be educated on the importance of advanced care planning. Trying to make major decisions regarding end-of-life care are often left up to loved ones, and it can be extremely difficult to know what’s best when you’re in the moment. Aside from the cost of this type of care (which can be substantial), there are emotional and psychological costs when family members are faced with these tough decisions. This is an example of how the “quality of care” can be driven by the patient as much as by the provider.
Here is the link to the survey results: http://www.jhartfound.org/news-events/news/advance-care-planning-poll