What changed this time around? “The apprehension and concern has slowly ebbed as public support got stronger,” Mr. Blumenauer said. “And some of the people making the most outrageous charges have gone on to make outrageous charges about other things.” Public support does appear strong. The federal Centers for Medicare and Medicaid Services received hundreds of comments this fall on its proposed rule, a spokesman told me; the great majority felt the agency should pay doctors to confer with patients about the end of life.
… In a survey of 1,200 adults in September, more than 80 percent said Medicare should cover doctor-patient discussions of end-of-life treatment. A similar majority thought private insurers should, too. The poll also demonstrated how rarely these conversations take place. Fewer than one in five respondents reported actually having had such a discussion with a health care provider, including only about a third of those over age 75 and about a third of those with a debilitating disability or chronic medical condition.
Any emergency room physician or intensive care unit social worker can tell harrowing tales of frantically trying to locate a relative, a neighbor, a document — any clue to what an incapacitated older adult wants when she can’t speak for herself. Medicare reimbursement, alas, will not magically solve that problem. A lot has to happen first.
Somehow patients must learn that they can have extended discussions about life and death decisions with a doctor if they want to. … Somehow, too, doctors must learn how to broach and explore very tender subjects. The prospect makes them hesitant and anxious, said Dr. Diane Meier, who leads the Center to Advance Palliative Care at Mount Sinai Hospital in New York. “The great majority of providers allowed to use these new codes have had no training in effective communication about what’s most important to people with a serious illness,” Dr. Meier said. “People are not born knowing how to have these conversations any more than they’re born knowing how to do an appendectomy.”
It’s about time. Next steps will be to get doctors the training that they need, and find ways to efficiently and effectively store and access Advance Medical Directives so that they are available if, and when, they are needed!