One of the most important services family physicians provide to patients is help with decision-making near the final stage of life. But how and when does a physician initiate these important conversations about a patient's preferences during that time?
And how does a practice get paid for providing advance care planning services?
An upcoming AAFP webinar aims to answer these questions and more. The live webinar, titled Advance Care Planning: Communicating End-of-Life Decisions, will take place on March 6 at noon CST. The event will be archived for those who are unable to participate live.
AAFP members can purchase this webinar for just $30; nonmembers pay $69.
Webinar presenter Karen Smith, M.D., of Raeford, N.C., told AAFP News that she will address the payment piece by guiding learners through a review of CMS' advance care planning coding requirements. She'll also discuss the importance of providing this care.
"As family physicians, we spend a lifetime developing wonderful relationships with our patients," Smith said. "And at the end of life, the fruits of that relationship are acknowledged; we play a special role as we interact with patients and their families."
Smith said one easy way to open the door to patient conversations about end-of-life care is to take the time to complete the Medicare annual wellness visit for every patient and "use that discussion for advance care planning."
As a physician who's been practicing in the same community for 26 years, Smith said she has walked this path with many patients. She shared a story about a patient who recently died after several years of decline.
"We had the discussion about her wishes at the end of life two years ago when her health began to deteriorate. She was able to say she didn't want life support machines, she didn't want any extra means, she wanted to be kept pain-free -- and she was able to communicate that."
Four weeks ago, the patient's health began to fail rapidly.
"We were still able to adhere to her wish of no aggressive intervention at the end of life -- hospice was called in and her care was maintained," Smith said. "She passed at 12:23 Sunday afternoon, and when I spoke to her son, he said 'My mom was free of pain, she was at peace and we are satisfied with everything and the way it happened.'
"When I hung up the phone with that family, I was at peace, they were at peace, and the patient had transitioned peacefully," said Smith.
She acknowledged that some physicians worry about the time it takes to talk with patients and families about advance care planning, but she pointed out that once that initial conversation takes place, subsequent exchanges last less than a minute.
"We introduce the subject and then we gently ask questions repetitively over time, and when you have a continuous relationship with the family and the patient, you get a little more and a little more information, and finally that solidified plan is in place."
Smith noted that although the webinar focuses on the care of Medicare patients, discussing end-of-life wishes shouldn't be reserved just for elderly patients.
"We actually start that discussion when our folks turn age 18," Smith said. "And I say to them, these high school students about to graduate, 'Next month, you're going to be 18 years old … and you're going to be responsible for yourself. You need to designate somebody who you trust and feel comfortable with in your family who can speak up for you at the time when you aren't able to speak for yourself."
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