National Healthcare Decisions Day

Floor Speech

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Mr. WARNER. Mr. President, I am pleased to recognize that today, April 16, 2015, is National Healthcare Decisions Day.

National Healthcare Decisions Day exists to inspire, educate and empower the public and providers about the importance of advance care planning. Started by a Richmond attorney as a local, grassroots initiative in Virginia, NHDD became an annual event in 2008 and today is recognized across all 50 States. Faith-based groups, doctors and nurses, hospitals, patients, and caregivers alike are engaged in these efforts.

It is critical that Virginians and all Americans--both patients and providers--engage in advance care planning, and that they have access to clear, consistent, and concise information on how to make these critical health care decisions. Today, on National Healthcare Decisions Day, it is important to discuss preferences and goals with family and friends--and this starts with filling out an advance directive. But advanced care planning is about much more than that, and in the last several years, there has been a growing awareness of the need to transform advanced care, both among providers and families.

First, broader transformations in health care, especially the movement towards paying for quality, not volume, of services offer opportunities to speed the adoption of effective advanced care programs. Our health care system does a great job paying for procedures: surgery, chemotherapy, hip replacements. It does a not so good job paying for health care providers to spend face-to-face time with patients, helping them to choose among many options with uncertain outcomes. Improvements to care planning would give individuals and their families the ability to make smarter decisions. It would provide additional information and support so they can make informed choices based upon those values and goals.

Meanwhile, across the country, people are innovating and creating new models of care to provide patients with the tools and support to make their own advanced care decisions. For example, in my own State of Virginia, a Richmond Academy of Medicine initiative called Honoring Choices Virginia promises to fill a critical hole. This innovative partnership involves the academy and three independent health care systems working to adopt nationally-recognized best practices, and adapting them to the needs of patients, families, doctors, and hospitals of the local community in Central Virginia. This commitment to patients and families in our region sets an example for the rest of the Commonwealth and the country.

It is similarly essential that we consider how Federal policies impact patients and their families during times of serious illness. For example, the vast majority of these patients receive care funded by Medicaid and Medicare, and many of them are elderly or disabled. Medicare, however, does not adequately reimburse physicians or other important members of the care planning team, such as nurses or social workers, for systems to support patients and their families. Likewise, faced with an uneven patchwork of advance directive laws across States, providers too often base their actions on the technicalities of forms or on fear of being sued. Such hurdles make it difficult for health care providers to focus on what the patient really wants.

In the 111th and 112th Congress, I introduced the Senior Navigation and Planning Act, to help people grapple with the challenges of caring for those with advanced illness. And in the 113th Congress, Senator Isakson and I introduced the Care Planning Act. The purpose of the Care Planning Act is to align the care people want with the level of care they get. It does not limit choices--it works to make sure people are made fully aware of the broad range of choices they have. I hope to reintroduce the Care Planning Act in the coming weeks.

I believe this effort is critical, not just from my time serving as a Governor and as a Senator, but also through the eyes of a loved one who struggled with these issues. My mother suffered from Alzheimer's disease for 10 years, and for 9 of those years, she couldn't speak. My father, sister and I found grappling with the challenges of caring for her difficult. The difficulty was greater because, when she was first diagnosed, my family didn't take the opportunity to talk in an honest and fully informed way with her and her health care providers about the full array of health care options available, or about what her priorities would be during the final years of her life.

It is not easy, and this is a subject that most people do their best to avoid.

But it is critical. National Healthcare Decisions Day reminds us of the importance of discussing ways to improve advanced care planning at all levels--Federal, State, local--and above all, amongst Americans and their loved ones.

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