Hi, and welcome to my blog! I'm Susan E. Mazer -- a knowledge expert and thought leader on how the environment of care impacts the patient experience. Topics I write about include safety, satisfaction, hospital noise, nursing, care at the bedside, and much more.
November 13, 2015
Last month, the Center for Medicare and Medicaid (CMS) issued a final rule updating payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule.
It included a separate payment and a payment rate for clinicians to conduct advance care planning conversations with patients who are seriously ill. In other words, Medicare will now pay doctors to talk with patients about end-of-life care planning.
Now, it’s not clear as to where these conversations with patients need to take place, but we can assume that they will happen either in a physician’s office or in the hospital. Still, the “where” is not defined in a way that facilitates a meaningful dialogue about very difficult issues.
Most hospitals have private consultation rooms with a table and maybe a couple of chairs. But is this really place for intimate conversations about life and death?
How can we create spaces that facilitate candid, personal, and challenging conversations? That help patients, families, and physicians authentically share their greatest fears and deepest desires regarding death and dying?
We know what won’t help: noise and interruptions caused by talk television, other people’s laughter and banter, cell phones, and pagers. This is the short list.
What might help: A comfortable, home-like environment that puts each person in the conversation in place where they are able to participate, or at least hear one another. This place should have:
What matters is the physicality of those who are in this discussion. That they can be with each other and the clinician. If at all possible, this should not be a clinical setting where the patient plays second to the physician.
The C.A.R.E. Channel is often used as a back drop for these kind of intimate conversations. It creates an environment of intention and respect. And, because the music is instrumental and non-commercial, those in the room will not be distracted by it.
Designing the environment for conversations about end-of-life decisions is just as important as having the actual discussion. It will help patients and families better comprehend and retain what the physician is saying. And, help them make the best decision.
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