Medicare recently announced that it would implement paying physicians for taking the time to have advance care planning conversations with their patients beginning in January 2016. This could have happened in 2009 but certain politicos and pundits warped the intention of this into “death panels” which knocked these important conversations off the table. Now that Medicare will reimburse physicians to have these conversations, I can’t help but wonder about the metrics and outcomes measurements that will also be implemented to track the occurrences of these conversations, as well as their efficacy.
It seems like a step in the right direction to reimburse physicians for the time they spend in these conversations with their patients. These conversations can provide important information for doctors, nurses, social workers, etc. about what their patients want as far as treatment, pain and symptom management, and end of life care. However, the majority of “care” that patients receive may not be provided by their doctor (oncologist, cardiologist, primary care doctor) or the nurses, social workers and psychologists who work inside the healthcare facility.
Medicare’s decision to reimburse physicians for their time may encourage more physicians to take the time to talk with their patients in more depth than time has so far allowed. Physicians and other healthcare providers certainly have a role in discussing risk vs. benefit of treatments, rates of survival, efficacy of drugs, places to receive care, etc. This reimbursement will probably not entice physicians already reluctant to talk about “care vs. cure”. It will not instill the comfort and confidence needed to have these kinds of conversations with patients in some physicians who have not found that comfort and confidence already in their approach.
A conversation in a healthcare setting is only a beginning of much needed consistent and continuing conversations to help a patient and his/her family through chronic illness management and decisions. Physician-led conversations will likely not be as frequent (or appropriate) in the midst of a medical crisis, accident or trauma. Conversations must occur long before these situations happen. There must be more to these conversations than medical considerations.
I continue to believe that the most important aspect of care conversations is the information shared among family and friends who will be the in-home caregivers providing the majority of care. Family and friends who will serve in the role of surrogate decision-maker when the patient is no longer able to make decisions or needs known will reap the benefit of these conversations. There are rare instances where financial reimbursement is available for the time family and friends will spend in caring for a loved one. But when care choices are discussed and prepared for, those experiences can be priceless.
Caring Choices knows that asking questions about values and beliefs can start deep, loving conversations. We created Elephant in the Room™ to help individuals and families begin these important conversations. Start with these three questions from Elephant in the Room™ and see where your conversations lead:
- What gives your life purpose or meaning?
- Where do you want to be cared for at the end of your life?
- If you were suddenly unable to communicate, would your family know what kinds of care you want (or don’t want)?
© 2015 Caring Choices