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    Why end-of-life care planning is a necessary service



    Conversation Is Important

    “Everyone would agree: these conversations are very important, and for the government to pay for them is a huge step forward,” says Tim Short, MD, a palliative care physician at the University of Virginia Health System in Charlottesville. “But it’s not enough to pay for them; we need to make sure that practitioners know what they’re doing—which may require training.”

    Short says these conversations are happening more often these days but they don’t always translate in meaningful ways to impact how care is delivered.

    “I live and breathe these conversations every day in my work, so I was surprised to find that we don’t have really good double-blind data on the outcomes and effectiveness of advance care planning.”


    The Technical Fine Print

    The fee for a doctor’s care planning visit, based on time spent, can run about $85 for an encounter lasting between 16 and 30 minutes. The government doesn’t spell out additional requirements for the visit, Acevedo says.

    “Medicare is pretty clear that this is a voluntary discussion for the patient, the documentation should reflect that the patient consented to have the discussion,” she says. 

    The notes should address who was present and what kinds of treatment decisions were made or advance directive documents discussed. “And, of course, since these are time-based codes, the number of minutes spent in the discussion must be documented,” Acevedo adds. But it is not required that a completed advance directive results from the visit. 


    The Patient Needs a Say

    Advance care planning, done to help prevent the provision of care that would not be wanted by the patient, requires a discussion with that patient, says Joseph Rotella, MD, chief medical officer of the American Academy of Hospice and Palliative Medicine and a physician in Louisville, Kentucky. 

    “The people we care for want to have a say in their care. Many families have had the experience of a loved one who was on life support, where the family has to make painful decisions. The only thing that can make it easier is if they know what the patient would have wanted,” he says.

    “I don’t believe doctors want to give futile, harmful care to their patients, but the default position in our medical culture is to do everything,” Rotella adds. “We all find it challenging to talk about the end of life. But when we lean in and think about it and take some control over our preferences and have these conversations, we realize that we do have choices. It can be empowering.” 

    Larry Beresford
    Larry Beresford is a contributing author for Medical Economics.


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