Press Releases

CAPC Statement on Health Reform and Advanced Directives

New York, NY (August 10, 2009) — Recent scare tactics and gross misrepresentations of the facts concerning the provision in the House bill pertaining to advance directives are cruel and potentially harmful to patients and families.

The facts surrounding the bill are clear.

The provision in question is intended to offer Medicare beneficiaries an opportunity to engage in an informed and focused conversation with their health care provider about advance care planning options. This consultation, like other consultations within the Medicare system, would be voluntary and would be reimbursable under Medicare when provided no more than once every five years, or whenever a patient undergoes a qualifying event, such as a life threatening or terminal diagnosis, chronic disease diagnosis; or admission to a long term care facility, a skilled nursing facility, or a hospice program.

The consultation is not mandatory. No one is required to undergo the consultation.

Dr. Diane Meier, director of the Center to Advance Palliative Care, has issued the following statement concerning the misrepresentations and misunderstandings of advance directives and their place in the bills currently being hashed out in Congress:

“As a geriatrician and primary care physician, I take care of many senior citizens. My patients are uniformly fearful of being overtaken and harmed by the health care system and their greatest concern is that they will lose control over their lives and their options once caught up in it. They have read about hospital infection rates and medical errors and they have watched and worried as friends and loved ones with serious and chronic illnesses try to negotiate the fragmented and confusing health care system.

“My patients want to know that their goals, values and hopes will be the primary considerations when healthcare decisions need to be made. They are frustrated by how little time most of their doctors can devote to talking with them and how rushed and time pressured these encounters have become.

“The reason for these time pressures is two fold. Physicians do not always have the time to devote to intenisive patient/family counseling. Doctors are paid well for doing things to patients – X rays, chemotherapy, procedures, surgery – but are paid almost nothing for talking with patients (so called cognitive services).

“The House bill is a small effort to restore a balance. It recognizes that conversations between doctors and patients about the patients' illness, the patients' goals, the treatment alternatives and their pros and cons are time consuming and require skill and expertise. It also attempts to compensate clinicians for taking the time out of an extremely time pressured day to have them.

“These conversations are needed throughout the typically multi-year course of a chronic illness (such as cancer or emphysema) and are not limited to the "end" of life. We don't know who is actually at the end of life until only a few weeks before death. The House bill is an effort to rein in the financial pressures driving health care decisions (do more things to patients and make more money) and are a small step towards restoring power and control to the objects of all this effort and expense – the patient.”

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The Center to Advance Palliative Care (CAPC) provides health care professionals with the tools, training, and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings. Located at Mount Sinai School of Medicine, CAPC is a national organization dedicated to increasing the availability of quality palliative care services for people facing serious illness.

Contact: Lisa Morgan, LDM Strategies, 212-924-6182 or

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