Medicare Now Pays for End-of-Life Talks: the FACTS

You may not know it, but you help your clients do Advance Care Planning (ACP). ACP is medical jargon for discussing end-of-life health care wishes and creating advance directives (Health Care POAs, Living Wills, HIPAA Releases, etc.).

Starting in 2016, Medicare is now paying doctors when they have advance care planning conversations with their patients (your clients). This means that you are now in direct collaboration with your clients’ doctors. This has benefits for your clients — and for your practice.

Given the misinformation that swirled around the last time the federal government seriously attempted to reimburse this activity (i.e. the “death panel” label), I thought it would be useful to lay out the facts about this new Medicare policy, so you can be informed and help your clients make the most of this new benefit. You may want to proactively explain it as part of your client counseling, or use these ideas in your newsletter, blog, or an article in your local paper. Here you go – the facts are in bold, followed by my explanations, in italics:
FACTS/Explanation:

1. Medicare now pays doctors separately if they have an advance care planning conversation with a patient. This eliminates the prior disincentive for busy physicians with jam-packed schedules to have these important, but often lengthy, discussions with no extra compensation. Medicare pays physicians in half-hour increments for ACP.
2. ACP discussions are voluntary. A patient can bring up the subject, or a physician can do so in the course of giving appropriate care. The patient has the prerogative to accept or decline to engage in this conversation.
3. ACP discussions are for explaining and discussing advance directive documents, including standard forms. For your clients, who already have advance directives, their physicians are likely to (and should) ask for a copy. To make it easier for your clients to get their advance directives to their physicians, you might consider enrolling them in an advance directives registry, which provides the directives immediately upon request, 24/7. If you already do this, find out if that registry can send the directives directly to your client’s doctor (with client consent, of course). This service, which is offered by some registries (including DocuBank), is even more impressive and valuable to your area physicians in light of the new Medicare ACP payments. Utilizing a registry with such a service can be a great marketing tool –a real win-win-win for your firm, the doctor, and the client/patient that you share.
4. ACP is about discussing the patient’s wishes – WHATEVER THEY MAY BE.  An ACP conversation is about understanding the patient’s goals for their care. This could lead to a discussion about the patient wanting everything done to extend their life as long as possible in all medical situations. Or it could be about a patient wanting to be kept comfortable above all else in the case of a terminal illness. Or it could be a myriad of scenarios/choices in between, depending on the circumstances.
5. ACP is also about knowing whom the patient chooses as their surrogate decision-makers, and can also include discussion of organ donation or donating one’s body to medical science. Ensuring that your patients name their proxies is important because their wishes might not be consistent with your state’s statutory default decision-maker list if no agent is named.
6. It is appropriate for a physician to ask your client if they have an advance directive and/or have a conversation about health care wishes, even if your client is healthy. ACP can be conducted at a Medicare “Annual Wellness Visit.”  ACP discussions are recognized by the medical profession as a component of high quality care. (In fact, hospitals have been required for 25 years to ask patients if they have an advance directive (see Patient Self-Determination Act of 1990).
7. There is no co-pay for an ACP conversation during a patient’s Medicare Annual Wellness Visit. There may be a co-pay at other times, depending on the patient’s Medicare plan.
8. ACP conversations can occur with the doctor directly, or with a non-physician who is supervised by the doctor. Sometimes patients prefer to have these talks with a nurse practitioner, physician assistant, or other staff whom they feel are more compassionate or not as rushed.
9. Research shows that ACP – regardless of the specific care choices patients make —  increases patient and family satisfaction with their care and reduces the emotional burden and distress on caregivers. While this may seem like common sense, as you well know, many clients avoid these discussions with doctors and their own family (and with you). The evidence bears out that encouraging your clients to talk about their wishes is a tremendous gift that you can give to them and their loved ones.

If you’d like a version of this post in Q&A format that is already edited specifically for clients, contact me. Happy advance care planning!

Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), which ensures that the emergency information and healthcare directives of its 200,000+ enrollees are available 24/7/365 through the largest advance directives registry in the U.S., as well as access to an online safe for storage of digital assets and other vital documents. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A member of the Philadelphia Estate Planning Council, the International Society of Advance Care Planning and the Coalition to Transform Advanced Care, Randi is active in health education and public engagement related to advance care planning/advance directives. She serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative and as a board member of the Center for Advocacy for the Rights and Interests of the Elderly. Randi is an ongoing contributor to the Academy blog.

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