Hospital systems often see patients numerous times as they near the end of life. This period of time can involve a flurry of healthcare appointments, treatments and interventions. In their last six months of life, Medicare beneficiaries go to the doctor’s office an average of 29 times. In their last month of life:
These ER and ICU visits and procedures translate to Medicare spending for beneficiaries in the last year of life that is six times greater than the average. Every year Medicare spends 25-33% of its budget caring for Medicare beneficiaries who are near the end of life. Based on published research, we estimate this could have been as much as $225 billion in 2019.
A sizable percentage of this spending results from repetitive hospital readmissions in the final year of a patient’s life, as doctors and nurses make heroic efforts to extend their life. The Centers for Medicare & Medicaid Services (CMS) defines readmissions as when, within 30 days of a hospital stay, a patient is admitted once again.
These readmissions often come with a high financial and emotional cost and they are uniquely tragic, because the overwhelming majority of these patients, if given a choice, would choose not to be hospitalized or receive life-sustaining medical interventions.
It’s not uncommon, over the course of providing care to patients, for hospital staff members and nurses to find themselves scrambling to determine whether those patients have ACP documents or any record of their wishes. What do they value? Who have they designated to make medical treatment decisions on their behalf?
Being able to seamlessly locate and retrieve an ACP document whenever and wherever it is needed means healthcare workers are more easily able to:
All too often, ACP documents (if they even exist) are locked away in a file cabinet or a safety deposit box, or they are stored with other important documents in a closet or under a bed. Sometimes only paper versions exist. If a digitized paper form is available, it might not provide the quality of information needed by medical personnel.
Hospitals also face frequent uncertainty when attempting to discover which family or friends they should contact, how to contact them, or who is empowered to make decisions for a patient.
A 2007 review performed by Wilkinson, Wenger, and Shugarman found that amongst chronically ill nursing home residents — who rank among the most at-risk patients in the entire healthcare system — only 33% had any form of advance directive. This means that healthcare workers’ attempts to locate ACP documents are frequently fruitless.
COVID-19 further revealed the inadequacies and cost of a paper document-based advance directives approach.
Healthcare providers have a responsibility to provide their patients with better options. Yes, there may be a small, initial investment of time and resources required to properly implement a digital ACP process, but that action saves time later and decreases stress and uncertainty for everyone involved.
Digital ACP documents empower individuals to share their goals, preferences and priorities, including what medical treatments they want (and don’t want), up front. Digital ACP documents also state who is allowed to make medical treatment decisions if a patient can’t speak for themselves, reducing misunderstandings and improving communications between medical staff and the patient’s family and loved ones.
Leveraging technology to improve ACP improves outcomes and patient experience while reducing health-related costs for high-risk, high-needs patients. But what makes this approach more effective than traditional ACP processes? A digital process means:
ADVault’s digital ACP solutions help patients, as well as the doctors and nurses caring for them, create high-quality ACP documents and portable medical orders such as POLST forms. Everything is stored securely in the cloud and ADVault uses internationally recognized standards to exchange data with hospital systems’ EHRs. This means the process of locating and retrieving those documents fits easily within current clinical workflows, regardless of the point of care.
What does it look like when healthcare providers and their patients aren’t offered access to reliable and simple digital ACP options?
Unfortunately, this happens multiple times every day across the nation, meaning patients and their families suffer through unnecessary levels of confusion and trauma.
Leveraging technology to improve ACP benefits healthcare systems, healthcare professionals, patients and their families. It enables healthcare professionals to conduct structured, meaningful conversations with patients about their wishes and preferences regarding treatment goals and location of care. It increases the likelihood that healthcare providers and families understand and comply with patients’ preferences when they cannot speak for themselves. And it reduces moral distress among critical care doctors and nurses.
Digital ACP results in more compassionate and humane end-of-life experiences for both patients and their families, improves the morale of the medical personnel who care for them and reduces unnecessary and unwanted hospitalizations and the associated high-cost, low-value medical interventions that accompany them.