No one wants to be the bearer of bad news, especially when it involves the death of someone you’re caring for. After all, it’s ingrained in provider ethics to save lives and to “be dedicated to providing competent medical care, with compassion and respect for human dignity and rights” (American Medical Association (AMA) Principles of Medical Ethics). That’s why end-of-life care is a tough pill to swallow not just for the patient, but sometimes for providers, as well.
When many specialists are caring for the same patient, sometimes it’s unclear who should talk to patients about end-of-life care options. At times it’s so difficult, in fact, that The Atlantic posted an article, “Whose Job Is It to Talk to Patients About Death?” by Ricardo Nuila, MD, which discusses the end-of-life conversation struggles as a hospitalist, the doctor in charge of a dying patient’s care.
The article notes that a woman “described losing her 36-year-old husband to metastatic colon cancer. Even though she saw a multitude of doctors every day, when her young husband found himself struggling to breathe near the end, none of them dared to discuss the inevitable.” she said, “No one told us anything.”
Physicians now will have incentive to discuss end-of-life care when the time is appropriate, instead of avoiding or prolonging the conversation in hopes that another physician is handling it. A Centers for Medicare & Medicaid Services (CMS) press release announces a new proposed rule that:
… supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers. The proposal follows the American Medical Association’s recommendation to make advance care planning services a separately payable service under Medicare.
Medicare’s new reimbursement scheme will give doctors incentive to take ownership of the difficult conversations. According to The Atlantic, “Under the new Medicare proposal, scheduled to go into effect this fall, any qualified team member — a doctor, a nurse, an assistant — can bill for the time it takes to discuss all the different procedures and interventions that a patient … might face.”