We're not talking death panels!
Last year, new Medicare guidelines were proposed that would allow doctors to get reimbursed for holding voluntary end-of-life consultations with patients during annual medical checkups. It would have given specific directions to doctors on what they should tell patients, including discussion of palliative care, hospice and other services. And it would have been a separately billable item.
In early December less specific language watered down advance-care planning to nothing more than having a discussion about advance directives (living wills) that would tell doctors what to do if the patient is too ill to make medical decisions.
Now the regulation will delete references to end-of-life planning as part of the annual physical examination. They can still have a discussion if they wish. It is just not as impactful.
Huh?
The Obama administration cited procedural reasons for changing the rule but with a new Congress trying to throw out health care reform (unlikely by the way), this regulation was seen as a distraction.
Administration officials told The New York Times "This should not affect beneficiaries' ability to have these voluntary conversations with their doctors."
So I have a few questions for you -
- Why wait until the annual physical to bring this up?
- Why can't others have that discussion with a loved one?
My answer on the first is that you shouldn't wait to have these important discussions.
The second question is more complicated. End of life care is not just about clinical care. It is also not about rationing. It is not about death panels.
It is about the quality of life for people as they age.
Well-meaning doctors and hospitals often treat patients aggressively, keeping them hooked up to machines and prolonging life at all costs, including the quality of that life. Some physicians understand the benefit of palliative care and hospice care but many more need to be educated about it. And frankly, under today's reimbursement system, the more you order the more you get paid. That is not to suggest that is what happens but it has to be in the back of the mind.
As the front line providers of care, particularly those of you in the home care and hospice space, I would hope that you educate your clients and particularly their caregivers about end of life care.
And it could start right with the families themselves.
I believe it is your role to educate. And you might start with questions from Alexandra Drane's and her Engage With Grace: The One Slide Project. She poses five questions that you can answer for yourself online and use to help caregivers get the conversation started with their loved ones.
In the meantime the politics over this has ticked me and others off too. So I thought it appropriate to start introducing some information about advocacy issues that you can use to become educated about issues and to do something about them.
Learn more ~ or join the conversation!
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