The Affordable Care Act of 2010 is one of the most impressive changes to our healthcare system since the introduction of Medicare in 1965. But Sarah Palin’s “death panel” hysteria forced President Obama to remove a crucial piece of his original proposal, rendering it less effective, some might say anemic. Section 1233, which called to compensate physicians for providing counseling to patients about living wills, advance directives, and end-of-life care options, never saw the light of day.

But on July 7th, the Center for Medicare and Medicaid Services (CMS) — which is the largest insurer of patients at the end of life, covering 80% of those who die every year—announced that it was considering compensating physicians for having end of life conversations with their patients beginning in 2016.

To me, this proposal is a no-brainer. Six years too late in the making, this is a clear win-win for everybody in our society, patients especially.

I am an Intensive Care Unit physician and I live, work, and breathe to save patients’ lives. Helping a body recover from critical illness is a privilege few can claim. It is a reason to get up in the morning.

But spend a day with me and you’ll see that many of the patients I care for will never benefit from the intensive therapies I heap upon them. I could recount story after story of gruesome cardiopulmonary resuscitations which never had a chance of working, breathing tubes pumping breath after breath of air into patients who will never breathe on their own, and feeding tubes sewn into stomachs delivering artificial nutrition to those who will never enjoy another meal.

Why would I do this, you might ask? As an ICU doctor, if there is any doubt as to what the patient might choose, I err on the side of prolonging life at all costs. And there is almost always doubt, because most patients, even those with life-limiting illness, have never discussed their preferences for treatment with their doctors. And the frenzied world of the ICU is a very difficult place to do that.

Especially if doctors are not getting paid for it.

In the highly prevalent Fee-For-Service payment model of healthcare, doctors submit an itemized invoice for services rendered. Each billable activity is represented by a Current Procedural Terminology (CPT) code on the invoice. Each CPT code has a Relative Value Unit (RVU) assigned to it, and many hospitals report, sometimes publicly, each physicians RVU score on a periodic basis. And so in the Fee-For-Service world, a physician’s value is largely determined by their billings(…) Read Full Article Here

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