Showing posts with label family practice. Show all posts
Showing posts with label family practice. Show all posts

Tuesday, January 11, 2011

Advanced Care Planning: One step forward, two steps back....

Author: Mehdi Rais, M.D.


It's only fitting that I redact yesterday's article about the new Medicare rules in advance care planning, as the Obama administration has officially chosen to remove the Medicare reimbursement regulation.  On January 1st, the regulation went into affect as part of the administrations eye on revamped preventative care measures.  Under the Medicare regulation, physicians would have been reimbursed annually for such voluntary discussions in regards to life sustaining treatments (living wills), surrogate decision makers (durable power of attorney), and palliative care.

The executive office expressed that the reason for the move was that,"the opportunity for the public to comment on it was too limited."

Naturally, the GOP will certainly call this a victory of sorts. Last summer, Sarah Palin (with the support of many party leaders) went as far to assert that such legislation would contribute towards the creation of "death panels."  These words led to a spirited debate as to the intent of advanced care planning.

The Obama administration stated today that this does nothing to stop the end-of-life discussion between patients and physicians.  Despite these words, the facts remain that 30% of seniors over 60 years old in the community do not have some form of advanced care planning.



About the author:

Dr. Mehdi Rais is a physician, medical lecturer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest and greatest trends in technology. Dr. Rais interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting in an effort to increase efficiencies while reducing discernable risk. He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.


Tuesday, January 4, 2011

2011: New Advanced Care Planning Incentives


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.