[Congressional Record (Bound Edition), Volume 163 (2017), Part 6]
[Extensions of Remarks]
[Page 8851]
[From the U.S. Government Publishing Office, www.gpo.gov]




      INTRODUCTION OF PATIENT CHOICE AND QUALITY CARE ACT OF 2017

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                          HON. EARL BLUMENAUER

                               of oregon

                    in the house of representatives

                        Wednesday, June 7, 2017

  Mr. BLUMENAUER. Mr. Speaker, from sweeping changes to how care is 
delivered, to the rise of personalized medicine, patients today have 
more treatment options when facing advanced illness than ever before. 
With these medical advances, the line between life and death can 
sometimes be blurred, which has changed the way we must talk about how 
we want to live and die.
  Despite these enormous changes, confronting an advanced illness or 
the end of life remains one of the most difficult and challenging 
situations any family faces.
  There is substantial evidence that suggests the care individuals want 
to receive at the end of life is not necessarily the type of care they 
do receive. Patients, in fact, often receive aggressive treatment that 
not only substantially shortens their length of life, but its quality. 
At other times, patients find the health care system instead 
undervalues the quality of their life, withholding treatments they 
would otherwise want to receive.
  Issues surrounding the end of life and advanced illness management 
become even more important when looking at the rapidly aging population 
in the United States. In 2014, Americans ages 65 and older made up 15 
percent of the total population; by 2060 that share is projected to 
grow to 24 percent.
  A recent survey conducted by The Economist and the Kaiser Family 
Foundation found that the majority of U.S. adults say the government is 
not prepared to deal with the aging population. The same survey found 
that a large majority of Americans believe both that patients and their 
families should have a greater say in which treatment options they 
receive, and that most Americans don't believe they have enough control 
over their medical decisions at the end of life. This must change.
  Individuals should have every opportunity to actively participate in 
making decisions about their health care throughout their lives and 
should receive care consistent with their values, goals, and informed 
preferences. Patients should feel empowered to make informed choices 
about the health care they want and to have those care decisions 
honored by their providers and family.
  During passage of Affordable Care Act, I saw an opportunity to apply 
lessons learned in Oregon with its landmark comprehensive palliative 
care programs, which give patients more of a say about the medical 
treatment they want at the end of life. I worked to ensure that 
Congress included a payment for doctors to talk to patients and 
families about advance care planning in the Affordable Care Act. 
Unfortunately, this provision wasn't included in the final legislation 
due to a breakdown of the legislative process.
  After years of advocacy, the Centers for Medicare and Medicaid 
Services designed a benefit allowing doctors to receive reimbursement 
for voluntary advance care planning conversations with their patients. 
For the first time, Medicare will pay for these critical doctor-patient 
discussions in the same way it pays for any other medical service.
  Yet our work to improve end-of-life care is far from over, and it is 
for these reasons that I am introducing the bipartisan, bicameral 
Patient Choice and Quality Care Act of 2017. This legislation will 
strengthen advanced illness care by establishing a new model of care 
delivery that to better manage advanced illness, improve quality of 
care, and enhance training, resources, and tools for providers, 
patients, and their families.
  Ideally, health care should work in sync with social, psychological, 
and spiritual support as the end of life approaches. Care near the end 
of life must be patient-centered and family-oriented. This legislation 
is supported by patient advocates, physicians, nurses, and the faith 
community, who understand how improving care delivery for advanced 
illness fundamentally improves quality of care and quality of life. To 
that end, I ask my colleagues to join me and support this important 
legislation.

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