When Medicare Pays for End-of-Life Consultation

July 10, 2015

This week, there was a profound policy change by the Centers for Medicare & Medicaid Services (CMS) that would allow reimbursements for end-of-life consultations between patients and their physicians. This is a welcome change from the “death panel” talks that stopped all forward movement on a critical issue of importance to all of us.

The next question is what exactly is there to talk about? How will a physician know how to do this? Which courses in medical school cover the challenges of counseling a patient (and family) about making choices about life and death?

Hospice and palliative care practitioners talk and empathize with patients while they face life and death. They live and breathe compassion and advocate for the best outcomes, even if death is inevitable.

When we move from a singular goal of curing, to the broader goal of living well, the discussion dramatically changes. It requires in-depth conversations and sharing of what matters and a yielding of the traditional role of the physician to a role not yet developed.

Science does not care about beliefs, hopes, or personal goals. The nature of evidence-based practice is specific to separating perception from fact (to the degree it exists). However, supporting a subjective and intimate understanding between patients, and those who care for them, about what they want demands the kind of empathy, compassion, and sensitive listening that long ago left the public discourse on healthcare.

So, the question is how do we stand up to this task? How do we practice authentic caring and valuation of what the patient wants? How do we provide the details related to the other side of options available, such as the risk of broken ribs or a collapsed lung from cardiopulmonary resuscitation (CPR), or the choice between burdensome and beneficial treatment? Now, we have been given both permission and a directive to discuss life and death choices candidly and in depth, openly and graphically.

So much to think about. It all changed yesterday. Talking about end-of-life choices is a rich and challenging re-entry into our own humanity.

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