Comments on: Reimbursing doctors for discussing goals of care with their patients- finally, a good health care reform idea! http://doctorfisher.com/2009/07/reimbursing-doctors-for-discussing-goals-of-care-with-their-patients-finally-a-good-health-care-reform-idea/ Health News and Advice from a Family Physician Tue, 30 Aug 2011 01:59:20 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: David Fisher, MD, MPH http://doctorfisher.com/2009/07/reimbursing-doctors-for-discussing-goals-of-care-with-their-patients-finally-a-good-health-care-reform-idea/comment-page-1/#comment-33 David Fisher, MD, MPH Mon, 10 Aug 2009 12:48:57 +0000 http://drdave.socialmediawisdom.com/?p=30#comment-33 Thanks for the comments everyone. To answer thedoglady's question, I have a post about the Power of Attorney for Health Care, what I believe is the most useful and important advance care planning document.<br />http://doctordavidfisher.blogspot.com/2009/08/advance-care-planning-101-its-easy-and.html Thanks for the comments everyone. To answer thedoglady's question, I have a post about the Power of Attorney for Health Care, what I believe is the most useful and important advance care planning document.
http://doctordavidfisher.blogspot.com/2009/08/advance-care-planning-101-its-easy-and.html

]]> By: risaden http://doctorfisher.com/2009/07/reimbursing-doctors-for-discussing-goals-of-care-with-their-patients-finally-a-good-health-care-reform-idea/comment-page-1/#comment-32 risaden Sun, 09 Aug 2009 02:30:44 +0000 http://drdave.socialmediawisdom.com/?p=30#comment-32 Your post is featured in this month's palliative care Grand Rounds!<br /><br />http://risaden.blogspot.com/2009/08/palliative-care-grand-rounds-august.html Your post is featured in this month's palliative care Grand Rounds!

http://risaden.blogspot.com/2009/08/palliative-care-grand-rounds-august.html

]]> By: thedoglady http://doctorfisher.com/2009/07/reimbursing-doctors-for-discussing-goals-of-care-with-their-patients-finally-a-good-health-care-reform-idea/comment-page-1/#comment-31 thedoglady Fri, 07 Aug 2009 00:51:16 +0000 http://drdave.socialmediawisdom.com/?p=30#comment-31 My mother died 10 months ago of cancer at the age of 72. I'm 50 and want to know what papers my husband and I should have to make sure if one of us in incapable of making decisions, the other can show the doctors exactly what to do. Living Will, DNR, medical power of attorney? Things are so complicated for patients these days. Can you advise? My mother died 10 months ago of cancer at the age of 72. I'm 50 and want to know what papers my husband and I should have to make sure if one of us in incapable of making decisions, the other can show the doctors exactly what to do. Living Will, DNR, medical power of attorney? Things are so complicated for patients these days. Can you advise?

]]> By: hospiceLCSW http://doctorfisher.com/2009/07/reimbursing-doctors-for-discussing-goals-of-care-with-their-patients-finally-a-good-health-care-reform-idea/comment-page-1/#comment-30 hospiceLCSW Thu, 06 Aug 2009 15:41:32 +0000 http://drdave.socialmediawisdom.com/?p=30#comment-30 As a medical social worker I have discussions with my patients everyday that I consider paramont to informed consent. If a physician agrees to care for a patient then isn't it understood that part of that care involves going over options, what if's. If I have heart disease, if I'm over age 50, if I have a asthma for that matter...I expect my physician to say..."In order for me to do my best in providing medical care for you, it is important that i understand what your preferences are regarding your care...Right now you are realitivley healthy but i plan on taking care of you for a long time...i'd like you to take some time to think about what kinds of treatments or interventions you would want if at some point in the future you develop a life threatening illness that i can not cure. Make no mistake i will be as aggressive with treatment for as long as you want me to but i do want you to think about if there would ever be a time or a scenerio when you'd want me to stop treating you aggressively." Having had hundreds of these conversations with patients over the last 10 years I know how lenghty they can become...but isn't this type of conversation the backbone of what a physician-patient relationship is? I am not opposed to physicians getting paid to have this conversation...i just think it is sad to think that a physician would have this conversation if she/he could get paid for it but wouldn't if they couldn't get reimbursed. My theory is that if a physician is not having this conversation with their patient already then attaching money to it will not motivate phyisicans to have these conversations. How about passing a piece of legislation which mandates it. How about offering a class in medical school on communicating bad news, or how to have end-of-life conversations with your patients. ~Audrey As a medical social worker I have discussions with my patients everyday that I consider paramont to informed consent. If a physician agrees to care for a patient then isn't it understood that part of that care involves going over options, what if's. If I have heart disease, if I'm over age 50, if I have a asthma for that matter…I expect my physician to say…"In order for me to do my best in providing medical care for you, it is important that i understand what your preferences are regarding your care…Right now you are realitivley healthy but i plan on taking care of you for a long time…i'd like you to take some time to think about what kinds of treatments or interventions you would want if at some point in the future you develop a life threatening illness that i can not cure. Make no mistake i will be as aggressive with treatment for as long as you want me to but i do want you to think about if there would ever be a time or a scenerio when you'd want me to stop treating you aggressively." Having had hundreds of these conversations with patients over the last 10 years I know how lenghty they can become…but isn't this type of conversation the backbone of what a physician-patient relationship is? I am not opposed to physicians getting paid to have this conversation…i just think it is sad to think that a physician would have this conversation if she/he could get paid for it but wouldn't if they couldn't get reimbursed. My theory is that if a physician is not having this conversation with their patient already then attaching money to it will not motivate phyisicans to have these conversations. How about passing a piece of legislation which mandates it. How about offering a class in medical school on communicating bad news, or how to have end-of-life conversations with your patients. ~Audrey

]]> By: Dr Bob http://doctorfisher.com/2009/07/reimbursing-doctors-for-discussing-goals-of-care-with-their-patients-finally-a-good-health-care-reform-idea/comment-page-1/#comment-29 Dr Bob Thu, 06 Aug 2009 01:33:51 +0000 http://drdave.socialmediawisdom.com/?p=30#comment-29 Thank you for this thoughtful discussion. AAHPM and NHPCO have also put out statements basically saying the same thing. I very much appreciate your mention of the dangers relative to PAS/euthanasia. My fears are that these misconstructions of what good advance care planning are will detract from the true issues surrounding palliative and hospice care. Clearly, these are highly valuable discussions, and there is no current reimbursement mechanism for them. We need to move beyond the idea that our work is "the visit", and learn (and pay for) the idea that our work is THE CARE. Thank you for this thoughtful discussion. AAHPM and NHPCO have also put out statements basically saying the same thing. I very much appreciate your mention of the dangers relative to PAS/euthanasia. My fears are that these misconstructions of what good advance care planning are will detract from the true issues surrounding palliative and hospice care. Clearly, these are highly valuable discussions, and there is no current reimbursement mechanism for them. We need to move beyond the idea that our work is "the visit", and learn (and pay for) the idea that our work is THE CARE.

]]>