I'm sorry about your friend.Originally Posted by Gerry Clinchy
Under current Medicare law, when your friend or other Medicare patient is admitted to the hospital, they must be asked about their preferences for treatment in the event that they are no longer able to direct their care. The unanswered question is where do patients find out what choices they have, which necessarily includes having someone explain that in terms that the patient can understand.
To do that well costs more than the 6-12 minutes paid for by standard visit rates under Medicare and private insurance plans. For the physician to be paid more, there must be a specific reimbursable service that they provided and that may be billed. That was the reason for including this item in HR 3200. The specific language actually began its life as a proposed amendment to Medicare authored by a Georgia Republican.
You raise the question of whether or not this counseling should be done by the physician. That's a fair question. I think the answer is that it is a service that should be provided at the moment and in the context where it is most relevant for the patient. If a physician is providing a general physical exam, or delivering bad news, or discussing an impending hpospitalization with a patient, the timing and context are likely to be right. The physician may provide the information directly or the physician may have a nurse or counselor in his office provide the information. However, without reimbursement, it is unlikely that the service will receive the time it deserves. I don't think anyone is prepared to have Medicare establish a special reimbursement program to pay an attorney to help with this, although it would be an interesting service.
The reality is that the legalities are not that complex (other than the fact that they are different in every state), but part of what is included must be specific instructions for each type of medical service, whether that be medications and other treatment procedures, pain killers, IV nutrition, or even IV hydration. My father's instructions, which he thought about extensively, explicitly prohibited any IV hydration if his condition were deemed by his designated representative (me) to be terminal. That was his way of guaranteeing that he would not linger for long. In the end, that was not what killed him since he actually awakened lbriefly the evening before his death and in his 15 minutes of lucidity ate some eggs and drank some juice. However, throughout his final days he was receiving extensive morphine to eliminate all pain and no IV's were attached to him at any time other than for the administration of morphine.
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