#1 Dinosaur: “Recognizing the sensitive, difficult and time-consuming nature of the effort required by a physician to discuss end-of-life issues with patients and families, Medicare (and by extension, all other insurers) should create and pay for a procedure code for obtaining a DNR order. This payment should be significant; I’d suggest on the order of at least a Level 4 office visit (”25 minutes face to face time”) given the time usually needed for these conversations.”
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well put. In providing NO incentive whatsoever, coupled with the threat of lawsuits for the 95-year-old demented nursing patient with an “involved” family, it’s just so much easier to pursue agressive measures & hospital transfer for even minor things, rather than address DNR status and comfort-care.
It’s the hospital that should provide a hefty payment to each physician who obtains a DNR order from the family. The hospital is receiving a fixed payment from Medicare for each patient (depending on final diagnosis). The DNR status determines whether the hospital has to pay for days and weeks in the ICU, multiple expensive trips to the OR, and a course of Xigris ($6800/treatment), or a few days of “comfort care,” at minimal cost. We’re talking tens of thousands of dollars, at a minimum, to the hospital’s bottom line. How about giving the doc a 15% or so gratuity to show gratitude?
jb –
the hospital gets paid a fixed rate from medicare part A for a “DRG”.
The physician’s reimbursement is separate, covered by medicare PART B. I think the point is that the DNR discussion w/family should be a separate billable service, akin to e.g. a procedure like insertion of a central venous catheter.
Just fyi.
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