[Congressional Record Volume 155, Number 87 (Thursday, June 11, 2009)]
[Senate]
[Page S6558]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WARNER:
  S. 1251. A bill to amend title XVIII of the Social Security Act to 
provide for advanced illness care management services for Medicare 
beneficiaries, and for other purposes; to the Committee on Finance.
  Mr. WARNER. Mr. President, I rise today to introduce legislation to 
help seniors navigate through a complicated and often overwhelming 
health care delivery system. Because of the fragmented nature of our 
healthcare system, we often fail to provide patients, their families, 
and caregivers with the necessary tools, information, and support to 
age well and with dignity in the setting of their preference. I believe 
that if we provide patients with better information about advance care 
planning in non-crisis situations, they will make decisions for 
themselves and their families that result in better care and better 
quality of life.
  Our health care system is in need of sweeping reforms that will not 
only provide broader coverage but will also increase value and 
efficient access to quality care. As we provide meaningful reforms for 
the healthcare system, we should take the opportunity to refine and 
enhance those parts of the Medicare system that work well for seniors.
  Currently, Medicare beneficiaries with advanced illnesses have a good 
option in the Medicare hospice benefit to receive care, family support, 
and counseling during the last six months of life. For those who are 
ill or in need of advanced illness care, but are not eligible for the 
hospice benefit, there are very few options for counseling and services 
that would help them make informed choices about their care options. 
Often, they are left in the dark about their treatment alternatives and 
without the support they and their family members need to prepare and 
plan for the care they want and need. Frankly, it is unconscionable to 
leave it to families to resolve these extraordinarily difficult 
decisions, often in moments of crisis, without appropriate information, 
materials and supportive services. The Senior Navigation and Planning 
Act of 2009 will help seniors and their families navigate through an 
extremely complex system and will help them make informed medical 
decisions.
  My legislation would provide access to an advanced illness care 
management benefit, increase the awareness of advance care planning 
through a national education campaign and clearinghouse, reduce legal 
hurdles to the enforcement of advance directives, create incentives for 
hospitals and physicians to get accredited and certified in palliative 
care, increase compliance with medical orders and discharge 
instructions, educate entities including faith-based organizations on 
advance care planning issues, and increase integration and coordination 
between the Medicare and Medicaid programs. Collectively, these 
initiatives will create a more accessible environment for seniors to 
receive the care they need, when they need it, in the setting they 
prefer.
  Specifically, the advanced illness care management benefit would 
allow Medicare beneficiaries who have been diagnosed with a life 
expectancy of 18 months or less to have access to the guidance and 
expertise of a hospice team and receive services such as consultations 
on palliative care, advance care planning that is patient-centered, and 
counseling, respite, and care giving training for their family members. 
This new advanced illness care management benefit will provide seniors 
with the support they need to make informed decisions.
  This initiative builds upon the efforts of the hospice community and 
the private sector. For example, United Health Group has created an 
Advanced Illness model in their benefit design and offers this program 
to the seniors they serve in Medicare Advantage and Special Needs 
Plans. They have found by providing access to the hospice and 
palliative care teams earlier, patients experience an increase in the 
quality of their life and duplicative or futile care is reduced. Aetna 
and Kaiser Permanente have also implemented these types of programs 
with similar results.
  In addition to the impact a lack of advance care planning and access 
to supportive services has on a patient's quality of life, inadequate 
access to advance care planning services contributes to 27 percent of 
Medicare costs spent in the last year of life. Advanced illness, 
palliative, and hospice care have been shown to improve quality of care 
at a reduced cost. Specifically, studies demonstrate that if an 
additional 2 percent of hospitalized Medicare beneficiaries received 
palliative care, direct cost savings to the Medicare program would be 
$1.57 billion. Given health care costs are growing at an alarming rate 
and that seniors may not be getting the necessary information they need 
to make appropriate treatment decisions, we need to act now to provide 
them with access to advanced illness and advance care planning 
services.
  I believe that rather than deny or withhold healthcare services, 
overall health reform should include a thoughtful process that informs 
patients, their families, and caregivers on how to navigate and think 
through decisions about when and how long to pursue treatments at the 
end-of-life. By doing this, we will provide a culture in which all of 
us will have the ability to age well, with dignity, in the setting of 
our choosing.
  It is my hope that this legislation will be incorporated into the 
broader health care reform effort that is underway in the Finance and 
Health, Education, Labor, and Pensions Committees. I look forward to 
working with Chairmen Baucus and Kennedy to implement these meaningful 
reforms so seniors have access to the information and services they 
need to receive the care they deserve.
                                 ______