575,000 People Are Using This Medicare Benefit. Are You?

Q. My friend Kate’s 93-year-old mother, Sue, was recently in palliative care. Sue had her Advance Medical Directive in place and the doctor had access to them. The documents clearly conveyed that she didn’t want aggressive measures to prolong her life. Sue also signed a HIPAA Waiver allowing the doctor to share confidential medical information with her daughter Kate. When Sue got very sick about six months before her death, the doctor talked with Kate about Sue’s end-of-life wishes, and Kate was very surprised and didn’t agree with her mom’s wishes, but nothing could be done at that point. I know things could have been much easier if my friend had a conversation with her mother (and a doctor) in advance, before the traumatic event happened.

I would hate for the same thing to happen to me if the time comes for such actions to be taken with my mother or father. Instead of being blindsided, I would like to sit down with my parents and figure out what they would want, and then make sure all of our legal documents are in order. I think it would help if our physician were present, to help us make educated decisions and feel more at ease about them. But, doctor’s rates are really high, and I’m not sure if they offer such services, or are trained for such discussions. I heard something about Medicare covering this type of thing, but when I called our family’s doctor, she didn’t know about it. Can you tell me more about these discussions . . . are doctors trained to have them? Are they really covered by Medicare? Thanks!

A. Doctors are now talking to seniors and their loved ones about advance care planning on a regular basis. In fact, end-of-life consultations are now being paid for by Medicare, and being used by more than a half a million people.
Last year, the first year health care providers were allowed to bill for advance care planning discussions, nearly 575,000 Medicare beneficiaries took part in the conversations, according to Kaiser Health News. Nearly 23,000 providers submitted about $93 million in charges, including more than $43 million covered by Medicare.
This was much higher than expected. In fact, it was almost double the 300,000 people the American Medical Association projected would receive the service in the first year.

Advance Care Conversations with Physicians are a Good Thing for Seniors and Their Loved Ones

“I think it’s great that half a million people talked with their doctors last year. That’s a good thing,” said Paul Malley, president of Aging with Dignity, a Florida non-profit that promotes end-of-life discussions. “Physician practices are learning. My guess is that it will increase each year.”

Despite the numbers, advance care planning talks are not being used by most eligible Medicare providers and patients. Nationwide, slightly more than 1% of the more than 56 million Medicare beneficiaries enrolled at the end of 2016 received the benefit, according to calculations by health policy analysts at Duke University.

In addition, the cost is not completely free, the benefit pays about $86 for the first 30-minute office visit and about $75 for additional sessions. However, beneficiaries will have not have any cost sharing liability for advance care planning provided in conjunction with their annual wellness visits. In some cases, patients who have already considered their options may need only one advance care planning conversation with their physician. However, experts state that frequently beneficiaries may require a series of conversations with their physician or other health professionals to clearly understand and define their end-of-life wishes.

Why Isn’t Everyone Taking Advantage of the Advance Care Discussions?

According to a recent Kaiser Family Foundation survey, among all adults who said they had not had a discussion with their doctor or other health care provider about end-of-life care wishes, half said that they would want one. However, some physicians don’t know that this is a service and don’t know how to get paid for it. It’s been a struggle for CMS to get the word out to them.

Are Physicians Trained to Have Such Discussions?

A national poll from 2016 found that although 99% of the physicians feel end-of-life and advance care planning discussions are important, nearly half reported they do not know what to say and less than a third reported any prior training for these conversations. However, since then, communication skills experts are creating end-of-life conversation training opportunities and models to address these training gaps for medical learners from the student level to practicing physicians. Organizations such as Vitaltalk and the American Academy on Communication in Healthcare are supporting intensive in-person courses and expanding online resources for greater access. Those completing courses report having an increased sense of preparedness for end-of-life conversations.

The Conversation Is Only Part of Advance Care Planning

Advance care planning involves multiple steps designed to help individuals learn about the health care options that are available for end-of-life care; determine which types of care best fit their personal wishes; share their wishes with family, friends, and their physicians; and record those wishes in legal documents.

Talking about end-of-life issues is an emotional and difficult task for most of us, but it is an important first step to making sure your wishes are clear. I hope you have the opportunity to speak with your parents and their doctor about end-of-life care. However, regardless of whether your parents ever have this discussion with their doctor, it is vital that your parents develop incapacity planning documents, including Advance Medical Directives and HIPAA Waivers, to ensure their wishes are legally enforceable. A general financial power of attorney is also a critical part of incapacity planning. If your parents have not yet done incapacity planning, the best time to get started is now! Have them call us today to make an appointment for an initial consultation:

Fairfax Incapacity Planning Attorney: 703-691-1888
Fredericksburg Incapacity Planning Attorney: 540-479-143
Rockville Incapacity Planning Attorney: 301-519-8041
DC Incapacity Planning Attorney: 202-587-2797


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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.