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Medicare to Reimburse Doctors for End-of-Life Discussions

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    The Centers for Medicare and Medicaid will now reimburse physicians who have end-of-life discussions with their patients and their families. This new rule is voluntary and a Medicare beneficiary must be the one who chooses to pursue the discussion.

    Physicians have been asking for this rule change because they are finding that many of their patients don't have the proper advanced directives in place before they become unable to make decisions for themselves, which causes an undue burden on the patient and family alike. Now Medicare patients will be able to have an end of life discussion with their doctor while they are still healthy and will be able to have a plan in place whenever they do become unable to make decisions for themselves.

    If you are unsure whether you need to begin this discussion with your doctor then "The Conversation Project" has your back. They have come up with a list of ten questions to ask yourself or discuss with your family. The answers to these questions may help you figure out the time you'll need to begin developing advanced directives with your doctor with regards to your end-of-life decisions.

    1) When you think about the last phase of your life, what’s most important to you? How would you like this phase to be?

    2) Do you have any particular concerns about your health? About the last phase of your life?

    3) What affairs do you need to get in order, or talk to your loved ones about?(Personal finances, property, relationships)

    4) Who do you want (or not want) to be involved in your care? Who would you like to make decisions on your behalf if you’re not able to? (This person is your health care proxy.)

    5) Would you prefer to be actively involved in decisions about your care? Or would you rather have your doctors do what they think is best?

    6) Are there any disagreements or family tensions that you’re concerned about?

    7) Are there important milestones you’d like to be there for, if possible? (The birth of your grandchild, your 80th birthday.)

    8) Where do you want (or not want) to receive care? (Home, nursing facility, hospital)

    9) Are there kinds of treatment you would want (or not want)? (Resuscitation if your heart stops, breathing machine, feeding tube)

    10) When would it be okay to shift from a focus on curative care to a focus on comfort care alone?

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    This is definitely a move in the right direction. But I have to bring up that it is a little ridiculous that doctors were pushing for an incentive to have a conversation with their patients that they should already be having. It should be a built in, fundamental part of the doctor/patient relationship. I really dislike doctor's aversion to talking to their patients for more than 30 seconds. The system is built to allow doctors to avoid the patients on a one-on-one basis as much as possible. It's really not fair to feel like you are putting your doctor out just simply by trying to engage them with a few follow-up questions.
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    J.K.Logic Wrote: This is definitely a move in the right direction. But I have to bring up that it is a little ridiculous that doctors were pushing for an incentive to have a conversation with their patients that they should already be having. It should be a built in, fundamental part of the doctor/patient relationship. I really dislike doctor's aversion to talking to their patients for more than 30 seconds. The system is built to allow doctors to avoid the patients on a one-on-one basis as much as possible. It's really not fair to feel like you are putting your doctor out just simply by trying to engage them with a few follow-up questions.

    It is all changing. I remember a time where doctors visits were longer, and it wasn't because of waiting on the doctor to come in the door either, it was usually because doctors took more time to have a discussion with their patients. I'm glad this is becoming a thing, especially in a time where we are seeing more and more doctors attempting to draw their patients into a "Club" that they pay monthly for. These "Clubs" are work-arounds for doctors who are loosing out on the insurance battle.