Opinion: Compensate providers for engaging in end-of-life conversations with patients

When asked, most people say they want to spend their final days comfortable, in their own homes surrounded by family and friends, wrote Sen. Bill Frist, MD, in an opinion piece on Forbes.

Yet, as a heart surgeon, Dr. Frist said he witnessed patients undergo aggressive, late-stage medical interventions that only prolonged the inevitable and left patients hooked up to machines in hospitals, rather than opting for the type of end-of-life care most of them would likely prefer.

"Americans are living longer than ever, and children are increasingly helping aging parents and grandparents manage multiple chronic conditions," Dr. Frist wrote. "This new reality has more and more people thinking about new models of end of life care, and has sparked a national conversation about how we can all live well, until the very end."

Dr. Frist wrote that as a component of the soon-to-be-released proposed 2016 Medicare Physician Fee Schedule, the Obama administration will be able to choose to compensate providers for offering voluntary counseling services to patients and families about end-of-life care options.

"…I strongly urge it to do so, it is an important first step," Dr. Frist wrote. "But our opportunities for change don't stop there."

CMS is testing several comprehensive programs for the seriously ill, according to Dr. Frist, such as the Independence at Home Demonstration, which provides chronically ill Medicare beneficiaries with primary care services at home. Another initiative funded by CMS, Sutter Health's Advanced Illness Management program, has implemented a medical home model that provides patients with home visits from registered nurses, telehealth support and provider coordination through the patient's primary physician. Many of these programs boast successful results such as improved care, lower readmissions and significantly reduced costs.

"Healthcare providers are in a unique position to grant patients and families peace by helping them understand care options and ensuring that their goals and preferences are honored," Dr. Frist wrote. "These are the types of patient-centered programs we need to expand nationwide, and Medicare reimbursement for end-of-life conversations will be a great start."

More articles on patient care:

Emotional harm: The overlooked patient harm
25 lessons from a patient survey of adverse medical events
CMS data collection rules may detract from infection control 


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