JustCare

Tag: Advance care planning

  • More people benefiting from Medicare coverage of advance care planning

    More people benefiting from Medicare coverage of advance care planning

    A new report in Health Affairs reveals that substantially more people with Medicare are benefiting from Medicare’s coverage of advance care planning during a Medicare annual wellness visit, but it’s still just a small percentage of the people who could. The advance care planning benefit, which has been available for only five years, is designed to provide people with help from their doctors in deciding their end-of-life wishes. It helps you plan ahead.

    For background, Medicare covers the full cost of an annual wellness visit whether you are enrolled in traditional Medicare or a Medicare Advantage plan. During the visit, you can discuss your medical history with your doctor and any health risks. Your doctor might conduct a depression screening, assess your ability to care for yourself and provide you with any preventive care services that you need.

    You can also discuss your health wishes with your doctor should you not be able to speak for yourself, at no cost to you. This advance care planning helps ensure that you get the care you want later in life and the people you love are best able to respect your wishes. Who would you want to make decisions on your behalf? That person is your health care proxy. What instructions would you give the person with regard to life-sustaining treatment? This is a living will.

    Whether you are enrolled in traditional Medicare or a Medicare Advantage plan, Medicare covers the full cost of advance care planning during an annual wellness visit. The visit is different from a physical, which Medicare does not cover.

    The researchers found that only about one in 12 people with Medicare took advantage of the annual wellness visit to do advance care planning. More people should do so in order to discuss their wishes should they become seriously ill and unable to express their wishes.

    Your doctor also can help with advance care planning during other types of outpatient visits and still bill Medicare for it. But, if done outside of the annual wellness visit, it could cost you more. You or your supplemental coverage is responsible for the 20 percent coinsurance if you’re enrolled in traditional Medicare or a copay if you’re enrolled in a Medicare Advantage plan.

    Here’s more from Just Care:

  • Artificial intelligence machines can prompt physicians to discuss end-of-life issues

    Artificial intelligence machines can prompt physicians to discuss end-of-life issues

    StatNews reports on how artificial intelligence machines are prompting physicians to discuss end-of-life issues with their terminally ill patients. At its best, artificial intelligence leads physicians to identify patients who need to consider advance care planning.

    Physicians do not have the same ability as artificial intelligence machines to recognize when their patients are terminally ill. Physicians can be pressed for time. And, like everyone else they have a variety of biases that could keep them from recognizing which patients would benefit from advance care planning. Artificial intelligence machines, in sharp contrast, can review and process all the information in a patient’s electronic medical records objectively.

    Of course, that doesn’t mean that artificial intelligence machines are better than physicians at predicting whether a patient is terminally ill. And, the data suggests that these machines get it right less than half the time. But, as the machines improve, some believe they could be helpful.

    With the help of artificial intelligence, physicians might be prompted to have different conversations with patients than they would otherwise have. If patients are terminally ill, physicians would want to understand their goals and health care wishes. Without prompts from artificial intelligence machines, physicians might be far less likely to discuss end of life wishes with some patients.

    It can be hard for physicians to prioritize, especially when it comes to talking to their patients about end-of-life care. And timing is important. If physicians put off talking with their patients about their wishes, they might not be able to. Patients can lose their mental acumen and their ability to share their health care wishes.

    Of course, with artificial intelligence, ethical questions are at play. For example, how much should doctors be told about their patients. If artificial intelligence suggests a patient will die in three months, does the doctor need to know that? Should the patient know? What if the doctor disagrees with the artificial intelligence prediction?

    Until the accuracy of artificial intelligence machines improves–they are now no better than 45 percent accurate-most physicians will not be inclined to use them. Moreover, these machines predict likelihood of death, not who is most likely to benefit from advance care planning. But, inevitably, there will come a time when many physicians rely heavily on artificial intelligence for their treatment decisions, perhaps for the good and perhaps not.

    Here’s more from Just Care:

  • What care do you want if you become seriously ill? Talk to your doctor

    What care do you want if you become seriously ill? Talk to your doctor

    One fourth or so of Medicare annual spending–about $33,500 a person–goes to the cost of care for the 1.8 million people over 65 who die each year.  The cost of their care is high largely because they often have complex conditions, and two-thirds of them die in the hospital.What care do you want if you become seriously ill? Medicare now covers advance care planning to ensure that older adults have their care wishes honored in the days, weeks and months before they die.

    Medicare will cover the full cost of a visit with your doctor to discuss your end-of-life wishes as part of your Medicare annual wellness visit. If you do a separate trip to the doctor, traditional Medicare covers 80 percent of the cost. If you’re in a Medicare Advantage plan, call the plan to find out your out-of-pocket costs. Here are six reasons why you and your loved ones should do advance care planning and create advance directives.

    The data suggest that most people do not plan ahead–through advance care planning–and do not understand their care options. For example, most people prefer to die at home if they are terminally ill. But, they often have not had the chance to decide their care wishes or to share them with trusted family members, doctors or others in their social network. And, they end up dying in the hospital. So, ask your loved ones about end of life care.

    Hospitals and nursing homes are required to ask patients on admission whether they have advance directives–living wills and health care proxies–under the Patient Self-Determination Act of 1991.   These care facilities must keep a record of whether patients have advance directives in their files. But, patients are not required to have them.

    About 40 percent of people over 65 have not done advance care planning and do not have advance directives. Each state has its own law regarding advance directives.  To find out how to get advance directives for your state as well as information on how to complete them, check out Just Care’s get help page here.

    Medicare also covers hospice services, including pain management, palliative care to offer comfort, pain and other symptoms management for people with complex and chronic conditions, and up to five days of respite care for caregivers. Hospice services are usually available in patients’ homes. Today, more than four in ten people with Medicare elect hospice care, more than double the rate from 2000 (23 percent).

    Here’s more from Just Care:

  • Medicare proposes to pay for advance care planning

    Medicare proposes to pay for advance care planning

    In a newly released proposed rule, Medicare is proposing to pay for individuals to talk to their doctors and care teams about their health care wishes as part of their advance care planning. Medicare already pays for advance care planning under people’s Welcome to Medicare visit. But, the agency wants to give people additional opportunities and greater flexibility to have a conversation about end-of-life decisions with their doctors.

    For their peace of mind and for the comfort of their family, an increasing number of people are planning ahead for their care and creating advance directives even before they enroll in Medicare.  Some are ready to discuss end-of-life planning with their doctors when they first enroll in Medicare, and others would prefer to wait.  People also might want to start the conversation at the onset of a serious illness or as an illness progresses.

    Making decisions about the kind of care you would want when you cannot speak for yourself takes some serious thinking.  There are a number of factors to consider, including Medicare coverage options and who you would want to make decisions on your behalf.  The proposed rule would allow Medicare to cover patient conversations with providers about the kind of care patients desire—from every treatment possible to minimal intervention–along with a range of other issues, when the patient wishes to have them.

    In May 2015, 66 organizations sent a letter to Sylvia Burwell, head of the Department of Health and Human Services, urging that Medicare pay for advance care planning discussions with medical providers. “Published, peer‐reviewed research shows that ACP [advance care planning] leads to better care, higher patient and family satisfaction, fewer unwanted hospitalizations, and lower rates of caregiver distress, depression and lost productivity.”

    And, there is a bi-partisan Senate bill, the Care Planning Act of 2015, from June 11, 2015, that would authorize Medicare to pay physicians to counsel patients on end-of-life decisions.

    A proposal to cover advance care planning was taken out of the Affordable Care Act before it was passed, after Sarah Palin called these voluntary discussions to plan for end-of-life care “death panels.”