90% in LaCrosse sign advanced directives

As the result of two decades of community-wide work, the LaCrosse medical community on the western edge of Wisconsin, led by Gunderson Lutheran Health, has achieved the 90% mark for end-of-life patients who have signed advanced directives.


That remarkable accomplishment saves distress and cost at many levels:


  • Medical providers don’t have to guess or chase down family members to figure out whether to use heroic or palliative treatments. The patient has already made his or her wishes known in writing.
  • Patients’ wishes for how they want to be treated are respected, even if they can’t communicate.
  • Families don’t need to debate about what their loved one would want for treatment.
  • Total medial costs of care for Gunderson patients for the last two years of life average $18,159, far below costs at comparable medical centers. The highest total was $65,660 in New York.
  • Gunderson’s comprehensive advanced planning process saves $3000 to $6000 per patient per year.


It required a lot of hard work and visionary leadership to take LaCrosse from the U.S. average of 15% of end-of-life patients with directives to 90%.

An example of the rigor of the approach is the automatic embedding of the directive intro the patient’s electronic medical record. That means all providers up and down the chain of care have access to the document and know the patient’s wishes.

Another is the insistence on a family meeting, with the patient at the center of the process, to shape treatment decisions.

Of note, The Center for Medicare and Medicaid Services (CMS) has been apprised of the LaCrosse success story. But the slow-moving agency has yet to adopt the model on a broader scale with its Medicare population.

There has been some static along the way from “right to life” proponents. But their logic is tortured. Moral mandates from ideologues should never be allowed to trump the rights of individual Americans to their choice of treatment.

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  • Bill Kraus

    The next piece of low hanging fruit on the medical cost tree seems to be action that stops the escalation of chronic medical problems to the expensive acutebstage. Anything going on in Wisconsin that deals with that.

    • Anonymous

      Absolutely. On-site primary care is a stampede. Company docs do proactive versus reactive care.

  • Kathy Klein

    This is such a simple yet effective way to avoid family conflict during a highly emotional time. Anyone looking for a very comprehensive and free form which will talk you though all of the major decisions that comprise a detailed advanced directive should contact Community Memorial Hospital in Menomonee Falls. It will guide you through family, medical and spiritual aspects to designing your end of life experience. Think about all of the time, energy and thought we put into planning for the birth of our children. Shouldn’t we put at least that much time into all the considerations that form our last few months or days? The CMH form is a fantastic prototype, at least it was the last time I reviewed a copy about a year ago,