Medicare:
Helping You Make Your Wishes Known
Starting this year, Medicare is
making it easier for you and your doctor to have conversations about your
medical wishes. This is good news. These conversations are important. They help you think about what’s important to
you and help you get the care that you want when it matters most.
Having these conversations about
your health care wishes is part of Advance Care Planning, or “ACP” in medical jargon. ACP also includes creating legal documents about
your wishes, called advance
directives.
More good news — you might be ahead
of the game if you’ve done your estate planning. Like many estate planning attorneys, I include an advance care directive as part of my standard estate planning package.
o Advanced Health Care Directive (says whom you
want to make decisions for you if you can’t and expresses your goals for care or your
medical wishes if you can’t make decisions for yourself)
o HIPAA Release
(a special document that may or may not be separate. It names the people you want to be able to
talk to doctors and get your medical information on your behalf, in addition to
your health care power of attorney.)
If you have advance directive documents, the
next step is to talk with your loved ones and your doctor about your wishes,
and make sure both have copies of your advance directives.
Below are answers to some common
questions about your new Medicare benefit.
P.S. This is also a good time to
review your advance directive and see if it still reflects your wishes. For example: Do you want or need to change
whom you’ve appointed to make healthcare decisions for you if you can’t? Is this person still alive and capable of
performing this role? Do you still have
the same goals if your health is compromised?
Do your treatment wishes still reflect these
goals? If you’d like to change your documents please consult with an estate planning attorney.
Q&A: Medicare Benefit for Advance Care Planning
- How is Medicare making it easier to talk to my doctor
about my wishes?
Advance Care Planning (ACP) conversations are important and can be
sometimes lengthy. It was hard for
doctors to fit this conversation into the time frame of your regular office
visit, which you know can feel very rushed as it is. Medicare recognized this and decided to pay
doctors separately to have these important discussions with their
patients. By paying additionally for Advance
Care Planning conversations, Medicare is giving doctors the time to have this
discussion with you. Medicare pays
physicians in half-hour increments for ACP.
- Are discussions about my wishes voluntary?
ABSOLUTELY.
You can bring up the
subject, or your doctor can do so in the course of giving you appropriate
care.
You always have the prerogative to
accept or decline to have this conversation.
- What will a discussion about my wishes be like?
ACP discussions are for explaining and discussing your wishes and your
advance directive documents.
Since you
already have advance directives, you and your doctor will discuss the choices
you’ve made.
You can also ask your
doctor questions and get clarification about medical terms or situations that
might arise, and to make sure that the selections in your documents reflect
your actual wishes.
- Should my doctor have a copy of my advance directives?
YES.
To have this discussion, your
doctor is likely to (and should) ask you for a copy of your advance
directives.
A great option my firm offers is to enroll clients in the
DocuBank® advance directives registry to make it easy for
your doctors and hospitals to get your advance directives right away, 24/7/265.
Just give your
DocuBank® Emergency Card to
the doctor’s office staff when you sign in.
They will use it to immediately get your directives and put them in your
chart.
- Does talking about ACP mean I eventually want to “pull
the plug?”
NO!
Not at all. Advance Care
Planning is about figuring out and communicating
your wishes —
WHATEVER THEY MAY BE. This could be
a discussion about wanting everything done to extend life as long as possible
in all medical situations.
Or it could
be about wanting to be kept comfortable above all else in the case of a
terminal illness.
Or it could be a
myriad of scenarios/choices in between, depending on the circumstances.
- It is appropriate for my doctor to talk about my wishes
when I’m healthy?
YES! Advance Care Planning is not just for sick people. Your doctor may
have an ACP discussion with you at your Medicare “Annual Wellness Visit.”
ACP discussions are recognized by the medical
profession as a component of high quality care at many points in your life and
health.
In fact, hospitals have been
required for 25 years to ask patients if they have an advance directive.
- What else is included in an ACP discussion? Is ACP also about sharing whom I want to make
decisions for me if I can’t?
YES. This is at least as important as talking
about your wishes. You can also talk about organ donation and other related
matters.
- Is there a co-pay for ACP conversations with my doctor?
There is no co-pay when these discussions occur during your Medicare Annual
Wellness Visit. There may be a co-pay at
other times, depending on your Medicare plan.
- Must I always talk with my doctor for Medicare to pay for
an ACP discussion?
No, not necessarily.
You may also be
able to talk with a nurse practitioner, physician assistant, or other staff
person who is supervised by your doctor — if your the doctor’s office permits
this.
Sometimes patients prefer to talk
with these other health professionals, feeling that they are more compassionate
or not as rushed.
- This is an uncomfortable
conversation for me. Are there real
benefits to forcing myself to do this?
YES! Research shows that patients
and their loved ones benefit from having advance care planning discussions. Studies have found that talking about choices
for care – regardless of the specific care choices you make — increases patient
and family satisfaction with their care.
It also has been shown to reduce the emotional burden and distress on
caregivers. The evidence bears out that
talking about your wishes is a tremendous gift that you can give to yourself
and to your loved ones.
- Where can I
find my advance directives?
If you have completed your estate planning you should find your advance directives in your estate binder or file. If you are enrolled in DocuBank you can just view them online. Or,
if you have a fax machine, you can use your card to call and receive a faxed copy.
© DocuBank® March
2016. Reprinted with permission.
