U.S. Senators Chris Coons (D-Del.) and Tom Coburn (R-Okla.) have introduced legislation to encourage Medicare beneficiaries to create advance directives -- legal documents that allow patients to articulate their preferences for their medical care should they suffer from a debilitating illness or condition. The Medicare Choices Empowerment and Protection Act would offer a small, one-time financial incentive to encourage Medicare beneficiaries to provide clear guidance to their medical providers and family members should they become incapable of speaking for themselves.
"Every American deserves the opportunity to make their own decisions about their medical care," Senator Coons said. "Too many Americans leave their end-of-life care to chance or to the preferences of distraught family members. This bill will encourage more Americans to proactively make choices about their medical care, reducing confusion and empowering individuals to spend their final days and hours on their own terms. I am proud to work with Dr. Coburn on this bipartisan legislation and intend to work with all of my colleagues to see it become law."
"Advance directives are a valuable, voluntary tool that offers patients the ability to protect patients' future health care preferences or to specify someone to act on their behalf," Dr. Coburn said. "This bill would encourage their adoption by Medicare beneficiaries and is intended to start a discussion about how best to move this policy forward. We welcome constructive comments from stakeholders to improve this plan and to better encourage the voluntary adoption of advance directives by Medicare beneficiaries that can be accessible in real-time by their physicians and hospitals."
According to a 2006 study by the Pew Research Center, 70 percent of Americans have thought about their end-of-life health care preferences, but only one-third have completed an advance directive. Under the Medicare Choices Empowerment and Protection Act, Medicare beneficiaries would be able to voluntarily create and register an advance directive with the Centers for Medicare & Medicaid Services (CMS) at any time. Advance directives would be created through and maintained by outside organizations certified by CMS, and could be modified or terminated at any time by the beneficiary. An advance directive would include any written statement that outlines the kind of treatment and care a beneficiary wants or does not want under certain conditions, and can include identification of a health care proxy. Beneficiaries would also receive a small, one-time incentive for registering an advance directive.
"The Medical Society of Delaware appreciates the efforts of United States Senator Chris Coons to introduce the Medicare Choices Empowerment and Protection Act -- S. 2240," said Dr. Nancy Fan, president of the Medical Society of Delaware. "The Medical Society has always taken a position in support of advance directives and that such directives should be shared with family, and friends, and most of all -- with their physicians. With the considerable technological advances in health care today, and to come in the future, it is essential that patients communicate with their physicians regarding their individual expectations of end-of-life care. Such discussions and documentation can provide great clarity when patients and their loved ones are confronted with difficult treatment decisions. We applaud Senator Coons for bringing this legislation to the forefront and look forward to working with him on this critically important subject."
To address concerns about confidentiality, the Medicare Choices Empowerment and Protection Act requires both CMS and outside groups maintaining advance directives to hold the highest standards for privacy and security protection as well as system functionality. CMS would only keep track of the certified organization through which a beneficiary has created an advance directive and would not keep a database of these documents. The bill does not interfere with any state laws governing advance directives.
"Quality advance care planning is a critical element in comprehensive advanced illness care, and we applaud the efforts of Sens. Coons and Coburn in taking the initiative to engage Americans in this critical dialogue," said Tom Koutsoumpas, co-chair of the Coalition to Transform Advanced Care. "Advanced illness is an issue that will touch the lives of every single one of us, and it is vital that all Americans and their families are as prepared as possible when facing health care decisions during the most difficult of times."
The American College of Emergency Physicians and MyDirectives.com, which independently registers Americans' advance directives, have endorsed the legislation. Senator Richard Blumenthal (D-Conn.) is also a cosponsor of the bill.
National Healthcare Decisions Day, held this year on Wednesday, April 16, is an initiative to raise awareness among the public and health care providers about the importance of advance care planning.
As of 2012, more than 157,000 Delawareans -- approximately 17 percent of the state's population -- were Medicare beneficiaries.