Herein lies some confusion for me. Like you, Jeff, I see no evil in counselling patients on their options & the results of those options. And sometimes that relates to terminal illness, sometimes not.That is why I liked the fact that the House bill provided reimbursement to physicians to provide that type of counseling. Currently they may provide such advice, but Medicare will not pay for the service.
The experience roadkill describes seems like part and parcel of the responsibility of being a doctor. The doctor dx's the disease; explains the disease; explains the treatment alternatives and the possible results of each alternative. In the case of a terminal illness, this also would often includes length of possible remission, etc.
I'm not entirely sure why one would pay an additional fee for doctors doing this part of their job. This intends no offense to the doctors on this board.
When the discussion goes beyond the purely medical alternatives (in terminal illness), then that should be provided by an attorney and accountant, as that would be their specialty.
This makes me wonder whether someone anticipates that doctors and PAs will no longer have the time per patient to provide this information, due to the patient load?
Or is it because fees will be negotiated to the point that this is a vehicle for providing an additional payment through the health omnibus legislation to offset other downard fee negotiation? Due to the rather "vague" nature of this service, would it not be open to abuse? Could each doctor involved in a case check off the "end-of-life counselling" box & the fee get paid multiple times for the same patient?
Unfortunately, we wouldn't know the answers to my last few questions until the administrative bureaucrats craft the actual rules.
As I've suggested before, couldn't this type of service be provided for through other existing agencies? Here in PA each of our counties has an "Agency on Aging" for assisting elderly on many items. This service could easily fall into that area. And it could be, perhaps, more effectively handled by such agencies before the highly emotional time of imminent death.
Yesterday I lost a dear friend to cancer. She was undergoing treatment for diabetes and a bloodclot in her leg. She was taken to the hospital ostensibly for that, & they discovered she had extensive cancer. She refused chemotherapy which, she was told, would extend her life only by a few months. She had watched several friends die who had chosen chemotherapy, and she had already decided what her choice would be.