New year, new rules. Medicare has broadened its coverage of preventive services. As of January 1st, the new legislation allows for reimbursement of annual wellness visits that include advanced care planning. Also dubbed as end-of-life counseling, this legislation reimburses physicians to open the dialogue with Medicare patients about issues such as life sustaining treatments (living wills), surrogate decision makers (durable power of attorney), and palliative care.
Many believe this could not come at a better time. A recent New England Journal of Medicine study stated that only 70% of community living elderly have advanced directives. The study went on to suggest that more than 25% of adults greater than 60 years old may need surrogate decision making before death.
Several reasons can account for this low adoption of advanced care planning from both the patient's and the physician's side. On the patient end, he or she may have certain cultural views on death that prevent such discussion, a fear of death itself (thanatophobia), or any number of other emotional psychological or social hindrances that prevent for such planning.
On the physician's end, monetary reimbursement for the care provider's time can be viewed as one of the main inhibitors towards opening this dialogue. Much like any other medical plan, physicians must tailor their approach in evaluating each individual patient’s needs (medical, financial, emotional, etc.) and delivering substantive advanced care options. Such planning takes time.
Armed with this added reimbursable incentive, physicians can bridge the gap towards a more informed patient population in regards to palliative care, living wills, durable power of attorney, and other end of life provisions.
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