As predicted, the American Medical Association issued recommendations for Medicare to cover end-of-life discussions with patients, a change that could prompt physicians to initiate these conversations more often, according to an article from the New York Times.
With reimbursement, "I'd do one of these [conversations] a day," Joseph Hinterberger, M.D., a family physician in Dundee, New York, told the newspaper. Currently, he and many other physicians spend hours in unreimbursed time explaining to patients and family members the various care options should the patient become unresponsive.
Once the political controversy over so-called "death panels" subsided, some private insurers, at the urging of physicians began paying for end-of-life talks, according to the article. For example, Blue Cross Blue Shield of Michigan began paying an average of $35 per conversation, face to face or by phone, conducted by doctors, nurses and social workers. Meanwhile, Excellus Blue Cross Blue Shield of New York not only helps train healthcare providers to navigate these difficult conversations, but pays doctors $150 for a one-hour conversation to complete an advance directive form and $350 for two hours. Many elderly patients, however, carry only Medicare.
Further, some experts say that reimbursing just one end-of-life planning session is not enough. "This notion that somehow a single conversation and the completion of a document is really an important intervention to the outcome of care is, I think, a legal illusion," said Diane E. Meier, M.D., director of the Center to Advance Palliative Care. "It has to be a series of recurring conversations over years."
Finally, while it's unclear whether advanced-care planning reduces healthcare cost, evidence suggests other benefits. A study published in the Journal of Clinical Oncology found that cancer patients who discussed their end-of-life preferences with their doctors more often had their wishes carried out.