Reimbursing end-of-life discussions helps the individual and the care system

As a result of the Affordable Care Act, a new rule has been in effect since January, allowing Medicare to reimburse physicians and other health care professionals, including nurse practitioners, for holding advance care planning discussions with patients.

Why is this significant? Advance care planning educates individuals about their options for end-of-life care and allows them to choose which types of care align with their personal values and wishes. This ensures that their preferences are honored should they be unable to speak for themselves.

A chance to discuss and plan

Unfortunately, patients often do not know how to initiate this conversation with their doctors or what questions to ask. It is my hope, with the new ruling in place, that more conversations will occur throughout the course of a patient’s illness as goals of care are discussed.

The Institute of Medicine recently released the report, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life” that identified advance care planning as one of the key areas requiring attention.

A number of factors make the IOM study particularly timely, including the rapidly increasing number of older Americans with some combination of frailty, physical and cognitive disabilities, chronic illness and functional limitations.

Hospice of the Western Reserve has created a booklet called “Courage in Conversation: A Personal Guide” to help families begin these important conversations. It includes tips and helpful worksheets and all the legal forms for advance directives required by the state of Ohio.

Getting the word out

Thousands of these guides have been distributed in the community and to health care organizations, and many community groups and health care professionals have participated in our workshops and in-service sessions (free copies of the booklet can be downloaded by visiting our website).

Good advance planning for health care decisions is really about values, priorities, the meaning of one’s life and quality of life. People want to share their memories, pass on wisdom and keepsakes, connect with their families and make some last contributions to the world.

These moments are among life’s most important, for both the dying and for loved ones left behind. Sometimes, medicine forgets how vital such matters are to people as they approach life’s end.

Hospice of the Western Reserve plans to launch a major communitywide initiative later this year to bring this topic to the forefront with our health care and academic partners. For the thousands of professionals in our region who work in or with the health care sector, providing high-quality care for people nearing the end of life is a matter of enormous responsibility and urgency.

Having the necessary conversations to ensure patients’ wishes are honored is the first step to changing the system. Community engagement is the way to make it happen. Honoring patients’ wishes for their own end-of-life care holds the promise to not only enhance quality of life, but to contribute to a more sustainable and humane health care system.

William E. Finn is CEO of the Hospice of the Western Reserve provides palliative end-of-life care, caregiver support, and bereavement services throughout Northern Ohio.
William has served as CEO since February 2011 and has been in the field of hospice and palliative care for 28 years. Visit: or