Planning for a patient’s end-of-life care is an uncomfortable but necessary conversation. Without it, a doctor won’t know if the person wants to be resuscitated, admitted to hospice, or undergo advanced treatments to prolong their life. You can also avoid expensive treatments and family fights that, in hindsight, were unnecessary.
Yet even with doctors now being compensated for having these conversations with their older patients, only a small portion of Medicare beneficiaries are receiving advice. According to Kaiser Health News, in 2016, the first year the government allowed health care providers to bill for advance planning discussions, nearly 575,000 Medicare beneficiaries talked to their doctor about it. That represents just over 1 percent of the 56 million Medicare beneficiaries in the US What’s more, nearly 23,000 doctors billed the government for these conversations to the tune of $93 million.
At first glance, an adoption rate of around 1 percent seems very low, but experts say the number should start to rise in the coming months. “There are a lot of barriers,” says Donald Taylor, a professor at the Sanford School of Public Policy at Duke University in Durham, North Carolina. “If he looks at the data, it’s shown increases that you might expect, but it’s still relatively low.”
Before 2016, if doctors wanted to have conversations with their patients about end-of-life care, they would have to carve out time on their own. oncologists, heart doctors and other specialists have always included advanced care planning discussions with their patients if treatments fail, but overworked family doctors and general practitioners just didn’t have time to have these conversations in a meaningful way.
Medicare compensates doctors for advanced planning talks
Recognizing that these planning conversations were not happening often enough, which in some cases led to expensive medical treatments that weren’t wanted, the federal government added compensation for advanced planning conversations to its fee schedule on January 1, 2016. The idea is that if doctors are compensated for these conversations, there will be more of them. “Sometimes these difficult conversations are time-consuming and doctors wouldn’t get paid extra,” says Judi Lund Person, vice president of regulation and compliance at the National Hospice and Palliative Care Organization, a trade association in Alexandria, Virginia. “Having the [insurance billing] code and having payments encourages doctors and other professionals to spend the time needed for these conversations.”
While conversations aren’t legally binding, having multiple conversations with patients can go a long way toward ensuring their wishes are followed and family members aren’t left arguing about what mom and dad wanted or didn’t want. It also empowers the patient, ensuring that her wishes are met. These discussions typically focus on whether or not a patient wants to be resuscitated. he or she wants to go to hospice, which treatments should doctors subject them to and which ones should they ignore. The number of conversations about end-of-life planning is expected to increase in the coming years, and many experts point to the 2016 results as an encouraging starting point. After all, he represents more than 500,000 people who haven’t had these conversations in a substantive way before, which Lund Person says is an “impressive” feat. It’s also higher than the 300,000 the American Medical Association had predicted would use this service in the first year.
Obstacles prevent a higher rate of adoption
Various barriers have also been erected that have prevented doctors from offering such discussions. Take billing systems for starters. According to Taylor, it took Duke University five to six months to have the ability to have its providers bill for the service, and it is a health system with the manpower and financial wherewithal to implement the new code. In addition, the compensation is relatively small — $86 for the first 30-minute visit and $75 for each follow-up conversation — contributing to the low adoption rate among some doctors, Taylor says. She points to a Duke survey that showed some doctors didn’t think the extra pay was worth it, while others said they would start offering it now that they’ll be compensated for their time. Then there is the communication barrier on the part of the federal government that prevents more advanced planning conversations from taking place. According to Taylor, Medicare did not issue a national coverage determination for the new compensation, which provides details on how and what can be billed. Without it, providers take longer to get up and running, he says. Not to mention, many don’t even know they’ll be compensated for discussions of end-of-life care planning.
More doctors are expected to give these talks
Despite the seemingly slow adoption of advanced care planning, all agree the rate will increase as Physicians feel more comfortable with these types of conversations and your billing systems can handle the upgrade. It is also expected to increase as more patients take control of their care in this era of self-directed health care. Signs are already emerging. dr Michael Munger, a family physician in Overland Park, Kansas, and president of the American Academy of Family Physicians, says he has surveyed all 100 primary care physicians in his health care system and found that in recent months more patients are receiving the service. “More doctors will start doing this, including myself, now that it’s structured,” says Munger. “Doctors are recognizing that this doesn’t have to be an afterthought. You can now set aside time to have this important discussion.”