TROY — Under a new Medicare ruling, patients and families will be able to have discussions regarding end-of-life wishes that will be paid for by Medicare.
Effective Jan. 1, 2016, physicians will be able to bill for two 30-minute sessions to Part B for end-of-life counseling. Medicare would pay $86 for the first 30 minutes of advance care planning in a doctor’s office and $80 for the service in a hospital. In each setting, Medicare will pay up to $75 for 30 additional minutes of consultation. The standard amounts can be adjusted for differences in costs in different parts of the country.
During these conversations, patients will be able to talk about whether and how they would want to be kept alive if they became too sick to speak for themselves. Doctors can advise patients on options for end-of-life care, which might include advance directives to forgo aggressive life-sustaining treatment.
Heather Bolton, executive director of Hospice of Miami County, said Hospice was in favor of the ruling. She said the physicians needed to be reimbursed for the end-of-life counseling sessions and that patients needed to have the conversations to ensure their final wishes have been met.
“These conversations are difficult and can become very complicated,” she said. “We agree that physicians should be reimbursed for this kind of thing, for meeting with the family and we also think that the patients deserve to have that kind of stuff.”
Development coordinator for Hospice of Miami County Susan Walker Hemm said the conversation is not reserved for patients who are elderly or already facing an illness.
“This conversation can happen any place in time for physicians and family members who want to have those conversations when somebody is well and rationally thinking of what they would like or not like as opposed to being faced with it here and now,” she said.
The discussions would include wills and power of attorney, as well as provide family the opportunity to hear their loved one’s wishes.
“We see currently a decrease in length of stay with Hospice care,” Bolton said. “It’s always been a struggle with late referrals. Physicians have been trained to fix people and heal people, and having these conversations puts everyone on a level playing ground, of having those conversations of ‘what do you want when this time comes?’”
Bolton shared the example of Dr. Pauline Chen, who is a transplant surgeon by trade and recently gave a presentation. Bolton said Chen had some interesting clinical career moments in her life that changed how she viewed end-of-life.
“Do you continue to seek really aggressive treatment? Do you continue to push for that next chemo dose or radiation? Do you really want to go through that transplant if the end result is not going to buy them any more time or quality of life?” she said. “I think that because physicians will be reimbursed that will open that door for conversation.”
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