Hospice and 86 Bucks

blog-patient-doctor-communicationWhat is 30 minutes of your time worth?

For a physician meeting a patient covered by Medicare, that half-hour may be worth $86.00 in reimbursements.

Eighty-six bucks. For what?

Something remarkable is now available as a Medicare benefit. Based on guidelines approved in 2015, a person covered by Medicare can have a reimbursable conversation with their doctor about “advanced care planning,” which could include hospice. This became official in January 2016.

About seven years ago, this $86 physician-patient chat was lambasted as a “death panel,” with a faceless, faithless government discerning who’d die and who’d live. In August of 2009, former Alaska Governor Sarah Palin famously (or infamously) warned,

Seniors and the disabled “will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care.”

Seven years after the “death panel” headlines (or nonsense, depending on your view of Ms. Palin’s fears), what will the $86 get you?

I’ll answer that in a moment.

First, what could I buy for $86? Several darn good books to read or a new pair of tennis shoes (which, frankly, I need because mine are getting thin on the soles). Certainly it would cover a swell lunch with a friend. Hey, several friends! My wife and I could dine at one of our favorite “cheap” restaurants and still splurge for a Mud Pie Mojo at Coldstone Creamery. I could pay for next year’s season tickets to the Fresno State women’s basketball games.

I could keep adding “stuff” to this list because, with $86 in hand, I have lots of financial flexibility.

Second, what can you accomplish in a half-hour? Let’s not put a price on those ticks of the clock, but rather imagine . . . what could take place in the allotted moments?

You could have sex. Okay, I wrote that first to crudely grab your attention. It may be inappropriate, but it’s at least a possible use of time. Right?

While we were making a quick and easy dinner, I asked my wife to marry me in far less than 30 minutes. And, oh, with time left over, she said yes.

Once, when I was a young guy in above average shape, I could comfortably run four miles in 30 minutes. A world-class marathoner covers over seven miles in that same span of time.

Quickfire! Great food in 30 minutes...

Quickfire! Great food in 30 minutes…

On the reality cooking show “Top Chef.” the competing chefs do a Quickfire Challenge, starting from scratch and serving a (usually) scrumptious dish in 30 minutes.

The last 30 seconds of an NFL football game can consume 30 minutes!

Like spending $86, this list could keep expanding.

If a patient covered by Medicare seeks a discussion with her or his doctor about end-of-life options, that physician can now be reimbursed $86.

How radical.

How overdue.

How simple.

Medicare, whatever you feel about that government program, has traditionally been based on reimbursing doctors and/or health care institutions for doing “things.” Need an R-ray or an MRI? Need a flu shot? Need a drug for anxiety? Need a home health aide? Need physical therapy twice a week for six weeks? Need a medical test to determine if you need more medical tests? Need a wheelchair or bedside commode? All of those, and a massive amount of other things, from aspirin to heart surgery, will be listed as a reimbursable item.

But until January of 2016, your doctor could not get that $86 for a chat about “advanced care planning.”

Though I don’t feel a need to flaunt statistics, I’m confident many Medicare (and non-Medicare) patients have had conversations with their physicians about end-of-life issues like hospice. For a lot of people, that shiny new reimbursement doesn’t mean much. Concerned patients and families have always asked heartfelt questions about serious illnesses. Compassionate doctors have always taken time to listen and share feedback. Later, after whatever was discussed for however long it took, I would guess no bills were submitted and no reimbursements were made.

With or without billing $86, this isn’t splashing new paint on an old “death panel” debate...

This isn’t splashing new paint on an old “death panel” debate…

However the $86 represents a helpful step. Again, with nary a statistic to make me look smart or correct, I’m sure a few crucial conversations will happen because a patient or family member can now request a doctor’s appointment for . . . talking. If I’m the child of a stubborn father refusing to consider a wheelchair, maybe a doctor’s recommendation could change Dad’s mind about a reimbursable object. And for that same stubborn father—and let’s add that Dad is also the strong, silent type—suggesting a chat about health care options since it’s been paid for by his lifetime of work and taxes, may get the beloved old codger to enter the exam room. Isn’t that, literally, worth the effort for that reimbursable subject?

With or without billing $86, this isn’t splashing new paint on an old “death panel” debate, but about honest discussions regarding your quality of life. What I know is: in today’s climate of political divisiveness and social media blathering, it’s easy to create upsetting headlines. What I know is: when faced with a life-limiting illness, it’s tough to have a serious chat about a patient’s wishes.

Please . . . talk . . . listen . . . and learn about your options.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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  1. Interesting. Are there areas that a doctor is required to cover at this talk or is it up to the doctor to decide what information is given?

    • Thanks for the question!

      My understanding is this is at the discretion of the doctor to initiate. But there is also an “easy” obligation for the doctor to give answers initiated by the patient during a regular visit and/or schedule a specific appointment for this subject. The new twist is that however the subject is handled, the doctor can have her or his time reimbursed. To me, it’s one of those small, but BIG, steps to invite honest communication.

      You might want to check the Kaiser Family Foundation site and read their overview of what this allows/encourages.

  2. When Jim was ill, I remember hijacking one of his doctor appointments and discussing his care needs. Jim had just been put into rehab after another bout with pneumonia and we were very confused. It was great that the doctor could talk to me about his care and I’m sure eventually he billed Medicare because I never got an invoice. These conversations are essential for the patient as well as the caregiver.

    • Thanks, Suzi. I suspect others have had your experience: “hijacking one of his doctor appointments.” I hope that happens less and that conversations about end-of-life options happen more frequently and with an open-minded view to options.

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