It’s about time. That ‘taboo’ topic to discuss is now covered by Medicare. I’m talking about the often dreaded end-of-life discussion. It can clear a room, silence a dinner conversation, or drive fear into people’s hearts in the blink of an eye. Yet, it’s vital to understanding a patient’s wishes, provide the best care, and make sure the patient fully understands their choices.
As a nurse for many years, I’ve participated in this type of conversation more times than I can count. I’m not going to lie—they’re hard, but very rewarding, too. Sadly, I’ve seen patients denied the conversation, because too often their providers have denied the need for the discussion, or didn’t feel comfortable having it, as it was not in their scope of practice; not enough time, and lack of payment for the time needed for the conversation—let’s face it—these conversations do take time.
For example—primary care providers have often pushed the conversation off on the specialist providers, and vice versa. How is that fair to the patient if nobody has the willingness to have this heart-to-heart conversation? Another rationale I’ve heard is the lack of time and lack of payment—these two go hand-in-hand. Understandably, time is money in a practice—providers are under tremendous pressure to bring in revenue and see a lot of patients, too.
How has any of this been fair to the patient, however? By a conversation not taking place about end-of-life options, how is the patient adequately informed? What about informed consent? Too often the discussion is not taking place until an emergency happens and the patient is on life support.
This year, we should be seeing an increase in patient-provider discussions regarding end-of-life options, thankfully, because Medicare now allows providers to bill for this service. According to the Centers for Medicare and Medicaid Services, Advance Care Planning (ACP) is available as part of an annual wellness visit (check-up), other office visits or home visits, or during a hospitalization. Examples of providers permitted to bill for an ACP discussion are physicians, physician assistants, and nurse practitioners.
Now, you may be asking, “How are they going to discuss this in a typical 15-minute appointment slot?” Thankfully, Medicare has thought about this, too, allowing 30-minutes for the initial discussion, with the option of additional 30-minute increments.
Practically speaking, what does this mean for the patient? Well, it’s optional—not mandatory, so patients need not fear they will be ‘cornered’ and forced to have a discussion about this. Instead, though, patients should know that this is a paid service by Medicare, and they are entitled to having the conversation, if they want. The excuses of not enough time, and needing to only see patients for billable issues no longer applies.
Of course, one’s comfort level doesn’t change with this—the addition of Advance Care Planning to Medicare doesn’t immediately flip the switch of comfort among providers. But, it should allow providers the reassurance that their time is money in their practices, and they will be paid for providing this valuable service.
I’m sure that each of us can think of at least one person who could benefit from Advance Care Planning, right? Love them enough to encourage the conversation to start. Love them enough to help them formulate a list of questions, concerns—even a bucket list, to bring with them to their appointment.
Here are some additional resources which you may find helpful: