IOM: End-of-life care planning needs better physician-patient communication

Improved physician communication, increased palliative care training, and revised payment systems will be key to transforming end-of-life care planning in the U.S., according to a recent report from the Institute of Medicine (IOM).

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The report, “Dying in America,” examines end-of-life care and the barriers that prevent effective planning and delivery of care to patients, including a limited number of palliative care specialists and a lack of financial incentives within the system.

The IOM issued five recommendations:

• Focused patient-centered, family-oriented care delivery,

• Improved physician-patient communication and advanced-care planning,

• Increased palliative care training and professional development,

• Reformed payment systems to encourage planning conversations and

• Increased public education and patient engagement

“Many people nearing the end of life may not be physically or mentally capable of making their own care decisions. In addition, family members and clinicians may not be able to accurately guess what a person’s care preferences may be. Therefore, advance care planning is critically important to ensure that patients’ goals and needs are met,” the report says.

While advance directive documents can explicitly state a patient’s wishes, the report cautions that these documents cannot replace the benefits of consistent provider communication, because a patient’s wishes may change. Physicians are encouraged to begin these conversations with their patients, regardless of their age or current health condition, the report says.

Primary care physicians may soon be paid for having these end-of-life discussions with their patients. The American Medical Association recently submitted reimbursement codes for those services to the Centers for Medicare and Medicaid Services (CMS). If CMS approves the codes, they will be included in the 2015 physician fee schedule, which CMS will release in November.

READ: Physicians may soon be paid for end-of-life discussions