Why Medicare Patients Are More Likely to Have End-of-Life Talks With Their Doctors

Planning for care at the end of a patient's life is an uncomfortable yet necessary conversation.

Having end-of-life conversations can be empowering for patients and ensures that his or her wishes are met.

Without it, a doctor won’t know if the person wants to be resuscitated, placed in hospice or subjected to advanced treatments to prolong his or her life. It can also avoid costly treatments and family fights that, in hindsight, were unnecessary.​​

Yet, even with physicians now being compensated for having these discussions with their aging patients, only a small portion of Medicare beneficiaries are receiving the counseling. According to Kaiser Health News, in 2016, the first year the government allowed health care providers to bill for advanced planning talks, close to 575,000 Medicare beneficiaries engaged with their doctor on the topic. That accounts for a little more than 1 percent of the 56 million Medicare beneficiaries in the U.S. What’s more, nearly 23,000 doctors billed the government for these conversations amounting to $93 million.

At first blush, an adoption rate of around 1 percent seems very low, but experts say the number should start to increase in the months ahead. “There are a lot of barriers,” says Donald Taylor, a professor in the Sanford School of Public Policy at Duke University in Durham, North Carolina. “If you look at the data it has shown increases that you might expect, but it's still relatively low.”

Medicare Compensates Doctors for Advanced Planning Talks

Before 2016, if doctors wanted to have discussions with their patients about end-of-life care, they would have to carve out time on their own dime. Oncologists, heart doctors and other specialists have always included advanced care planning discussions with their patients if treatments fail, but overworked family physicians and general practitioners simply didn't have the time to have these conversations in a meaningful manner.

Recognizing these planning conversations weren’t happening frequently enough, leading in some cases to costly medical treatments that weren’t wanted, the federal government added compensation for advanced planning conversations into its fee schedule on Jan. 1, 2016. The thinking is that if doctors are compensated for these conversations more of them will happen. “Sometimes having these hard conversations are time-consuming and doctors wouldn’t get paid extra,” says Judi Lund Person, vice president of regulatory and compliance for the National Hospice and Palliative Care Organization, a trade association in Alexandria, Virginia. “Having the [insurance billing] code and having payments encourages physicians and other practitioners to spend the time necessary for these conversations.”

While the talks aren’t legally binding, having several conversations with patients can go a long way in making sure their wishes are carried out and family members aren’t left bickering about what mom and dad may or may not have wanted. It also empowers the patient, ensuring his or her wishes are met. These discussions typically focus on whether a patient wants to be resuscitated, whether or not he or she wants to go into hospice, what treatments doctors should subject them to and what they should ignore.

Having this conversation with their physician may also help patients with their insurance and final expense planning. Once the discussion has been raised is a good time to sit down with your agent and make sure your plans are fully in place. Contact us at RCB & Associates for assitance.

The number of end-of-life planning talks is expected to see an uptick in coming years, with many experts pointing to 2016 results as an encouraging starting point. After all, it represents more than 500,000 people who didn’t have these conversations in a substantive way before, which Lund Person says is an “impressive” feat. It's also higher than the 300,000 the American Medical Association had predicted would use this service in the first year.

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