Making end-of-life conversations common practice remains uphill battle

By Matt Kuhrt

Medicare's approval of reimbursement for end-of-life discussions with patients may provide some incentive for doctors uncomfortable with starting these sorts of conversations, but additional guidance and training will still be necessary, according to a story published in USA Today.

Advance care planning codes cover time spent both in discussion with patients and filling out related legal forms, such as Living Wills, according to previous reporting in FiercePracticeManagement. The codes cover an initial half-hour session, as well as an add-on code for each subsequent 30 minutes. The Centers for Medicare & Medicaid Services confirmed to Medical Economics that it considers the unit of time complete after 15 minutes have elapsed.

Kevin Newfield, M.D., told USA Today he's skeptical that the current reimbursement rates will move many doctors to start a conversation about which they may already feel uncomfortable. Moreover, he said, "doctors make money by keeping people alive."

For their part, members of the medical education community see greater margin in providing training and support as the industry works to encourage advance care planning. The University of California, San Francisco now trains its medical students on initiating and conducting advance care planning, according to the newspaper. The school also provides programs for residents, nurses and other physicians.

Among the doctors who spoke to USA Today, hard experience in treating patients who require palliative care emerged as the most compelling incentive. Scott Dunn, M.D., a family physician from Idaho, described his regrets about a patient for whom a conversation might have saved the cost of keeping him alive in intensive care, as well as needless suffering.

While Dunn indicated the combination of his experience and Medicare reimbursement might cause him to have more end-of-life discussions with his patients, he still doesn't see them becoming a routine part of his practice, because, as he told the paper, "Medicare pays us more to do other stuff."

To learn more:
- see the USA Today story
- read the article in Medical Economics