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Doctors for Dignity Bulletin – February 2017

We sent the following email, part of a monthly series, to our Doctors for Dignity:

Last week, Congressman Steve King (R-IA) introduced H.R. 410, an act that would exclude coverage for advance care planning under Medicare.The benefit, which took effect on January 1 of 2016, has helped thousands of seniors understand and prepare for end-of-life medical decisions. Despite its popularity and success, this benefit is at risk.

No hearings on H.R.410 have been scheduled but when the bill comes before the Committee we’ll send you an action alert so you can urge your lawmakers to vote against this legislation.

In the meantime, encourage your patients on Medicare to schedule appointments to update their health care directives. Our website provides information your patients need to begin planning their care.

Monthly FAQ

This month, Compassion & Choices’ National Medical Director Dr. David Grube answers the following:

Q: Shouldn’t psychiatrists be involved in assessing capacity before a patient is approved for medical aid in dying?

A: Every physician is not only fully trained to assess the capacity of all of the patients they treat on a regular basis, but is also required to document this assessment in the medical record. Shared medical decision-making requires a patient be able to understand medication side effects, treatments, and procedures, etc. This is accomplished through informed consent, and is a typical component of most medical care. Medical aid in dying should not be subject to capacity assessment requirements beyond the standard of care for any other health care decision. If a physician is concerned about a patient’s ability to understand instructions, make appropriate decisions, etc., she or he may seek a neurologic or psychologic evaluation to help determine capacity.

Capacity is the patient’s ability to participate in decision-making and may vary over time. All hospice patients are assessed upon admission and regularly by the team of caretakers (social workers, chaplains, nurses, aids, medical directors, etc.). The physician who is present at the bedside determines whether the patient is able to make a particular health care decision given the circumstances and whether the patient’s reasoning is consistent with his/her values and preferences. If capacity is in question, a mental health professional’s expertise may be sought.

Monthly Resource

Check out the Centers for Medicare & Medicaid Services FAQ about PFS and CPT codes for advanced care planning.

If you find this resource useful, please forward to a colleague andencourage them to join Doctors for Dignity.

Best regards,

Rebecca

Rebecca Thoman, M.D.
Manager, Doctors for Dignity