Medicare Wants You to Talk to Your Doctor About Medical and End Of Life Wishes

Medicare is hoping to encourage more patients to talk to their doctors about end of life preferences and wishes for medical care by now paying physicians to have these critical conversations during office visits. In an effort to incentivize more physicians to have open conversations with their patients about medical and end of life wishes, Medicare will now pay doctors to talk about healthcare directives during office visits. The logic behind the decision, according to Medicare, is simple; studies show that patients are more satisfied and receive better quality care when Advance Healthcare Directives that lay out a patient’s wishes for care are available and legally in place.

A recent survey of emergency room physicians by Geneia confirms this idea, finding that:

 Most emergency medicine physicians (93 percent) are less frustrated in cases where

an advance directive is easily accessible.

 Eighty-five percent of emergency medicine physicians agree, “When a patient says

they have an advance directive, it helps me deliver better quality of patient care.”

 Nearly nine in 10 emergency medicine physicians believe family members are more

satisfied with the medical care when patients’ wishes are known and communicated

in an advance directive.

 More than half (54 percent) of emergency medicine physicians describe their reaction

to learning a patient has an accessible advance directive in place as “relief.”

The other factor, according to Medicare, is purely financial. End – of – life care is complicated and expensive.

Many people at the end of their life go on to endure treatment that they would likely not agree to, if given the choice. By documenting a person’s true end – of – life wishes and setting out clear boundaries for when life – saving measures such as feeding tubes or ventilators are to stop, Medicare hopes to cut back on non – beneficial medical interventions in advanced illness.

It’s important to remember that Advanced Healthcare Directives are actually legal documents and physicians are unable to give legal advice; but having conversations about medical and long – term care with a doctor is a great place to start in exploring end – of – life options and making your wishes known. For example, if you are dealing with a specific illness (such as cancer), your doctor would be able to lay out the normal course of treatment that you could expect over the following months and years. If there is something you do not agree with, or do not want, this is a great time to begin drawing boundaries around your care with your doctor.

The issue of incapacity is another topic to bring up in the doctor’s office. In addition to legally naming someone in a Healthcare Directive who can make decisions if you are unable to speak for yourself, your doctor may also want you to complete a HIPAA form to keep on file listing this person as well. This will help direct your doctor as to who he or she should (or should not) communicate with if something happens to you.

Additional medical and end – of – life wishes to explore with your doctor include:

 Whom do you trust to make medical decisions on your behalf?

 How do you feel about feeding tubes, life support and other artificial life saving


 What about organ donation?

 Is there any type of medical care you would NEVER want?

 If you were permanently disabled or incapacitated, what things would contribute or

take away from your quality of life?

 What are your thoughts on nursing home vs. in – home health care?

Under the new Medicare provisions, physicians will get paid in 30 minute increments for discussing these topics with their patients. But, to ensure all the bases covered, be sure to take the final step to have Healthcare Directives and Powers of Attorneys created with the help of an attorney so you’ll have the peace of mind knowing that the issues discussed with your doctor are properly documented and will be legally honored later.

David Wingate is an elder law attorney at the Elder Law Office of David Wingate, LLC. The elder law office services clients with powers of attorneys, living wills, Wills, Trusts, Medicaid and asset protection. The Elder Law office has locations in Frederick and Montgomery Counties, Maryland.


From Veterans Information Services, Inc.,

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