- Associated Press - Wednesday, April 20, 2016

Medicare wants more doctors and patients to talk about the tough care decisions that must be made if a person becomes seriously ill or incapacitated.

The federal entity, which covers health care for people over age 65, has started reimbursing doctors for having face-to-face, advance care planning discussions about a patient’s treatment preferences should they become unable to speak for themselves.

Only 17 percent of adults say they have had these discussions with a health care provider, according to the nonprofit Kaiser Family Foundation. Here’s what you need to know.

- WILL EVERYONE HAVE COVERAGE NOW?

That can still depend on the insurer. If you don’t have Medicare, check before scheduling an appointment specifically for one of these discussions.

If there is no coverage, doctors may cut you a discount to have the talk. A half an hour of a doctor’s time could cost you $125 or more, depending on where you live. But don’t think a lack of coverage means you can’t talk to your doctor.

Doctors have been reimbursed for years for discussing treatment options with patients during the course of care or an office visit. Some have done it without reimbursement.

By offering reimbursement specifically for this discussion, the government aims to encourage more of these conversations to take place. This might make it easier for more people to have the conversation with their doctors if they are not facing a terminal illness.

- WHO SHOULD HAVE THIS TALK?

The range of patients isn’t limited to the elderly or people with a serious condition. These voluntary discussions can be crucial if someone later winds up critically injured from a car accident and unable to communicate.

Even healthy younger adults should think about an advance care plan, according to said Dr. Peter Hollmann, chief medical officer of University Medicine in Rhode Island.

“The odds of you needing it tomorrow are very, very small, but they’re not zero,” he said.

These discussions can last a half an hour or more and may require another visit.

-WHAT WILL THESE DISCUSSIONS INVOLVE?

There’s no set format for how they unfold. Hollmann says they should largely be directed by the patient.

The conversation may involve how you would want to be treated if you have a terminal illness. That could include exploring whether you would want a ventilator or CPR performed in certain situations. It also could include talking about nutrition and whether you want treatment that’s focused on comfort or prolonging your life.

Your doctor will probably want to discuss who you have chosen to act as your health care representative in case you become incapacitated and need someone to make decisions based on your wishes. Think carefully about the spouse, family member or close friend you select for this role and make sure they know your wishes.

- ARE THESE THE DISCUSSIONS THAT STIRRED CONERN THAT THEY WOULD LEAD TO FEDERAL ‘DEATH PANELS’?

Yes.

More than six years ago, a provision for Medicare to cover this sort of counseling, which includes discussing end-of-life care, touched off an uproar that threatened President Obama’s still-developing health care overhaul.

Former Alaska Republican Gov. Sarah Palin’s accusation that voluntary counseling could lead to government-sponsored “death panels” dictating the fate of frail elders was widely discredited. But the counseling still stirs concern among some right-to-life advocates that it could be used to nudge patients into forgoing life-saving treatment and cannot be adequately monitored for bias.

- WHAT SHOULD I DO AFTER TALKING TO MY PHYSICIAN?

Write an advance directive.

This documents in your own words instructions about future medical care. That means you won’t have to depend on your doctor being present in an emergency and having notes from your discussion.

Advance directives don’t expire, so patients don’t have to worry about writing one too soon. But people should periodically review them to make sure they still reflect their wishes, said John Mastrojohn III, executive vice president with the National Hospice and Palliative Care Organization.

“They basically remain in effect until you change it,” he said.

These are legal documents, and their form can vary by state. You won’t need a lawyer to complete one, but you may need a witness or notary to sign it.

Mastrojohn’s organization offers a website with links to copies of each state’s advance directive form: https://bit.ly/1cgFdvW.

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