Doctors Will Be Paid To Talk About End-of-Life Care. For Nurses, It’s Just Part of Our Job.

Article Categories: Nurse On the Job & Nurse Employers

The Centers for Medicare and Medicaid Services (CMS) recently announced that starting January 1, 2016, physicians will be able to invoice for the end-of-life discussions they have with Medicare beneficiaries. Patrick Conway, Chief Medical Officer for CMS, said the proposal “supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team, as part of coordinated, patient and family-centered care.”

Of course, some doctors have always taken time to discuss these matters with their patients, whether or not they were paid. And some specialties, such as oncology, do this as part of the natural course of treatment. With Medicare who is the second largest insurer in the country taking the lead, other insurance companies will likely also approve this long overdue discussion.

For nurses, these conversations with sick and dying patients have been happening as long as there have been nurses. In 2010, the American Nurses Association (ANA) published a position statement on the role of the RN at the end of a patient’s life: “Nurses have always been at the bedside of dying patients. Their role in providing the highest quality of remaining life and support at the end of life for both patients and their loved ones is traditional, accepted, and expected. Increasingly, this means the nurse’s role includes discussions of end-of-life choices before a patient’s death is imminent.”

Doctors are simply not trained on death and dying. They are taught in a “culture of cure,” where there are always more options, treatments, and therapies. For many doctors, death means failure, in spite of the fact that everyone dies. They come to view death as the enemy, not the patient’s pain, suffering, and wish to be included. The result is that patients don’t receive the care they want or need, and they die in the hospital or nursing home, instead of their own chosen place of comfort.

Here’s where nurses can help doctors get better at end-of-life discussions. Share some of the things that nurses have always done:

• Make a connection with the patient and family.
• Take a deep breath and ask the patient what he or she wants.
• Listen carefully and then do your best to follow the patient’s wishes.
• Grieve with the family. Cry if you feel like it.
• Find someone to discuss the death.
• Know that tough discussions get easier over time.
• Your patients and their families will be more grateful than you can imagine.

In years to come, perhaps all providers will become comfortable talking about all phases of life. And nurses will likely be the first to do so.