The Pew Charitable Trusts and the Gordon and Betty Moore Foundation, with support from Discern Health, wrote a letter March 14 to Health and Human Services Secretary Tom Price and Seema Verma, the newly confirmed administrator of the Centers for Medicare & Medicaid Services, outlining a number of steps that Medicare could take to ensure that patients and their families receive high-quality care near the end of life. The recommendations, which were informed by an expert panel convened by the two organizations, call on Medicare to:
- Implement two quality measures that assess whether Medicare beneficiaries in hospitals have completed advance care plans.
- Capture the experiences of patients who have died or who cannot speak for themselves through regular surveys of their family members.
- Collect data on the care of seriously ill patients in a standard way across all health care facilities.
- Create new measurement tools to assess whether a patient’s care was consistent with his or her preferences.
- Develop and implement new meaningful quality measures in alternative payment models—that is, ways to pay for Medicare services beyond traditional fee-for-service—to ensure that patients receive care that matches their goals, preferences, and values.
Implementation of these recommendations would address shortcomings in the care people receive near the end of their lives. For example, a recent report by the Centers for Disease Control and Prevention found that although the majority of Americans say they prefer to die at home, nearly 75 percent die in other settings, such as hospital intensive care units or nursing homes. Medicare—in addition to clinicians, health systems, and payers—could use the strategies outlined to address this and other gaps in care.
Alongside the letter, Pew, the Moore Foundation, and Discern released a report detailing the process for developing the recommendations described in the letter.