Doctors may start to get reimbursed for end-of-life care discussions with patients. Tuesday, the Center for Medicare and Medicaid Services proposed a rule change that would encourage physicians to start having these conversations with patients.
The rule would allow doctors to start billing Medicare for continuing talks with patients about how they want to be cared for when they are dying.
“There are two rules in medicine," he Dr. David Beyda, a bioethicist at the University Of Arizona College Of Medicine. "Rule No. 1 is people die and rule No. 2 is you can’t change rule number one. So let’s deal with it and let’s talk about it. And let’s address the issue with how we talk with patients, not to patients.”
A 2008 AARP pollfound about half of adults over 60 have completed an advance directive. Beyda said this is partly because doctors don’t talk about end-of-life planning as much as recommended.
Physicians cite time constraints and a lack of training as reasons for not having the conversations. Dr. David Butler, medical director of Hospice of the Valley, said this rule means Medicare is finally recognizing these discussions are an important part of ongoing care.
“This is not just a check-box exercise of a form," Butler said. "This is a discussion and making sure that everyone close to them understands what their wishes are. If that’s not explicit the default in our system is to treat until the end.”
The proposal is available for public comment for two months before the final rule is published. Medicare plans to start implementing the changes next year.
