The Centers for Medicare & Medicaid Services started reimbursing doctors this year for providing end-of-life counseling to their patients as part of the movement toward giving patients more control of their care. But it might take a while for physicians to get up to speed with the counseling sessions.
Prior to the CMS change, doctors had not performed much in the way of end-of-life counseling, and there are signs that many don’t feel prepared to provide it. A September 2015 Kaiser Family Foundation poll of the public found that 89 percent of those surveyed wanted to discuss end-of-life issues with their doctors, but only 17 percent actually did. A more recent January survey of physicians on the SERMO social network indicates that more than half (56 percent) would want additional training in end-of-life counseling.
But the CMS policy revamp should help to change that, experts say.
David Bessman, M.D., a hematologist with the University of Texas Medical Branch in Galveston, thinks physicians have known for some time that more training would be helpful and, now that CMS offers reimbursement, more will seek it, likely through continuing education. CMS now pays a doctor $86 for the first 30-minute session conducted in his or her office — or $80 if it's done in a hospital. Subsequent sessions in either setting pay $75.
"They wish they knew how to do it better," says the Rev. Myles Sheehan, M.D., a Catholic priest and former physician and instructor in geriatric and palliative medicine at Loyola University Chicago's Stritch School of Medicine. "Most clinicians in practice have stories of patients at the end of their lives who didn't get the best care possible" because the patient didn’t have the right kind of conversations with their caregivers and their expectations were unrealistic, Sheehan says.
Some may be skeptical that doctors can learn to be compassionate toward patients near the end of life, an opinion voiced by some on the SERMO website. But Matthew Wynia, M.D., director of the University of Colorado Anschutz Medical Campus Center for Bioethics and Humanities, disagrees. Much like professionalism, Wynia says "compassion can be fostered by the environment in which you train."