Sponsored by Assemblyman Herb Conaway Jr. (D-Burlington), a new bill before the New Jersey state legislature would establish a Practitioner Orders for Life-Sustaining Treatment (or POLST) Form Registry in the state of New Jersey. The bill would give residents the option to voluntarily register their end-of-life health care wishes through the Motor Vehicle Commission (MVC) in a similar fashion one would elect to become an organ donor.
Payers, health care providers and policymakers increasingly have been recognizing the importance of advance care planning in ensuring patients receive goal-concordant care, as well as potential cost savings, as patients indicate they would prefer lower acuity care at the end of life, such as hospice. Efforts to improve and expand palliative care and hospice awareness have ramped up in recent years, with New Jersey among a number of states enacting legislation to expand those services.
Raising public awareness and interest in hospice and palliative care has been an ongoing initiative for the state of New Jersey, with new laws such as S-3118, passed early this year, to promote community-wide advance care planning discussions.
“Interest in palliative care and promoting use of advance directives have been growing in New Jersey for many years for many reasons,” said Donald Pendley, director of hospice and palliative care for the Home Care & Hospice Association of New Jersey (HCNJ), in an email to Hospice News. “First is the desire to make the final stage of life as comfortable and pain free as possible for patients.”
If signed into law, the bill would call for the MVC to create a process for residents to document their advance care planning wishes using the state’s (POLST) forms. The bill calls for the MVC to create a registry database of these forms that could be accessed statewide by emergency responders and medical providers, including hospice and palliative care settings.
According to a report from the New Jersey Governor’s Advisory Council on End-of-Life Care, the need for improvement is urgent to better define and expand utilization of hospice and palliative care statewide.
“New Jersey’s utilization of hospice has been low,” Pendley told Hospice News. “This initiative to place people’s care directives on their driver’s licenses is one more step in efforts to clarify people’s health care preferences.”
Establishing effective communication channels and clearly defining patient priorities and goals of care are strategies further highlighted in the report and reflected as the state continues growing initiatives in raising advance care planning awareness.
Another concern involved in the bill’s considerations is the cost-saving possibilities for the state’s overall Medicare expenditures.
“New Jersey has long topped the list for per-capita expense on health care in the last years and months of life,” Pendley said. The state’s urgent need to incorporate more advance care planning directives sooner into the scope of hospice and palliative care was exemplified in a report by the U.S. Centers for Medicare and Medicaid Services (CMS) stating, “Medicare expenditures per beneficiary were highest in New Jersey in 2014.”
Discussions on the bill have taken place at a hearing of the state’s Assembly Health Committee, but further consideration is needed before the committee takes a vote. While the coronavirus crisis has contributed to the state’s adjustment of this legislature’s priority, so has concern among committee members in urging caution around the government’s accessibility to resident’s health care directives, as Pendley shared with Hospice News.
“Everyone in New Jersey’s health care community hopes that we’ll find a way to centralize people’s end-of-life care wishes,” said Pendley. “Several entities are working on that beyond this bill. Most especially is the need to give health care providers quick and easy access to people’s care wishes in the event that they cannot express them by themselves.”