Just a quick nota bene that the current edition of Generations — the journal for the American Society on Aging (ASA) — is posted on ASA’s blog courtesy of funding from Compassion & Choices (the present incarnation of the old Hemlock Society) and the Robert Wood Johnson Foundation.

One of the articles is by AARP veteran and Coalition to Transform Advanced Care (C-TAC) co-founder Bill Novelli (“Advanced Illness Care: We Can Do Better“).

Novelli and his friends at C-TAC still haven’t gotten over the fact that they met resistance (which was bipartisan, by the way) when in 2009-2010 their friends in Congress and the White House tried to sneak through legislation and regulation requiring end-of-life planning.  Novelli can’t stand open and honest debate; it is “toxic”:

During the passage of health reform a few years ago, political controversies surrounding the language and messaging of advance care planning led to misguided notions regarding government panels and end-of-life care decisions. This turned the debate into one that was toxic, strikingly partisan, and devoid of rational, open discussion.

And Novelli repeats the standard (unsettling) refrain that all these sick old people are costing us money:

In 2010, more than a third of Medicare beneficiaries experienced four or more chronic conditions. Those with four to five conditions cost $12,174 in per capita spending, and those with six or more chronic conditions averaged nearly $32,658 in per capita spending (Centers for Medicare & Medicaid Services [CMS], 2012).

C-TAC recommends more hospice, more advance care planning, and more research to provide the “metrics” they need to more accurately redefine “quality”:

CMS can work closely with well-established private-sector entities, such as the National Quality Forum, to develop consensus on key quality metrics to be adopted by Medicare to assess the quality of care delivered at the end of life (including measures that include quality, cost, access, and patient and family satisfaction).

. . . The systemized collection and reporting of quality measures are essential to building the evidence base for effective interventions . .  and driving effective payment and delivery reform. The passage of the Improving Medicare Post-Acute Care Transformation Act (IMPACT Act) in October 2014  . . . will allow Medicare to compare quality performance across settings, improve discharge planning, and use this data to guide and inform future payment and delivery reform efforts.