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July 1, 2013 The Honorable Mark Warner 475 Russell Senate Office Building Washington, DC 20510 Dear Senator Warner: I am writing to convey the support of the Roundtable on Critical Care Policy for the Care Planning Act of 2013. The not-for-profit Roundtable on Critical Care Policy provides a forum for the nation’s leaders in critical care and public health to advance a common federal policy agenda to improve the quality, delivery and efficiency of critical care in the United States. The work of the Roundtable is supported by participants from a broad cross-section of the critical care community, including clinicians, academia, public health advocates, industry, and many others from the broader health care community. Policy and structural improvements are needed to ensure that at the end of a patient’s life, he or she receives appropriate care and support. Aligning advanced care with the goals of patients and family members will improve individual patients’ care and population health. Specifically, upon a patient’s admission to the ICU, his or her wishes regarding life-sustaining therapies should be clearly documented, with these wishes expressed either by the patient or, when necessary, by the patient’s designated caregiver. We support efforts prior to ICU admission that will facilitate the efficient, reliable and effective communication of advanced directives and similar plans which enunciate and enable a patients’ desired course or level of treatment should they require critical care. As such, we applaud the provisions in your bill that would provide Medicare and Medicaid coverage for voluntary consultations about advanced care planning. We also strongly support the provisions that would encourage the development of quality measures and those provisions that would facilitate the development and promotion of best practices in communications about advanced illness between providers, individuals and family caregivers in different settings, including acute care hospitals. Finally, we commend the bill’s efforts to improve the public’s understanding of advanced care planning through grants to develop materials, a web site and a national education campaign to raise the public’s awareness of advanced care planning and advanced illness care. We support and value your leadership and look forward to working with you to secure passage of this important legislation in the 113th Congress. Sincerely,

Brad Poss, MD Chairman, Roundtable on Critical Care Policy Professor of Pediatrics, Division of Pediatric Critical Care, University of Utah School of Medicine; PICU Medical Director, Primary Children’s Medical Center