October 2014

Medicare Mulls the Politics and Policies of End-of-Life Care Planning

By Alan M. Schlein

Bypassing the political process, Medicare is once again trying to pay doctors to talk to patients about “advance care planning,” including living wills and end-of-life care options.

This fight comes five years after the issue became a political inferno over “death panels,” and rationing of care. But this time, some private insurers have already begun reimbursing doctors for these “advanced care planning” discussions, prompting a push for all of Medicare to go that way.

Medicare is considering a request from the American Medical Association (AMA), the country’s largest doctors’ trade association, to designate billing codes for these conversations, allowing doctors to get reimbursed for their time in talking with patients about how they want to spend their final days – including whether they want to die at home or in a hospital, nursing home or hospice care, and whether they want complete life-sustaining treatment, just pain relief or something in between.

Right now, doctors have had to squeeze such conversations into medical appointments ostensibly held for another purpose. Many say that forces them to give short shrift to a discussion intended to help a patient — and often, family members — understand all the medical options and the risks associated with these complicated end-of-life issues. Those sessions take time and need to be carefully vetted instead of being squeezed in during medical procedures or exams.

Also, currently, doctors are not reimbursed for any phone conversations involving relatives who don’t live in the area, nor are they compensated for patients who are still healthy but want to plan ahead and discuss advance directives.

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Halloween History and Tradition

By Neil Wyrick

“Who are you?” I was six years old and it was my next-door neighbor pretending she didn’t know who I really was. It was a night for witches and some of my friends went all out to look like one. Where I lived, street lights were not in abundance. This was good. Imagination works better when it’s dark.

It’s time again to decorate our front porch with a smiling plastic Peter pumpkin as against the old-fashioned kind that grows in the field and waits for its harvest. I emphasize “smiling” because who needs a frowning pumpkin?

Everything has a beginning and Halloween is no different. It began as an ancient Celtic festival when giant bonfires signaled there were significant supplies ready for the upcoming winter. The Gaels also believed that on this day the boundaries between the living and the dead overlapped and the deceased came back to life and created all kinds of catastrophe.

Masks were worn not for the fun of it but to scare away and confuse any energetic evil spirits.

Geography plays an interesting role in the celebration of this celebration of All Hallows' Eve. In Germany they hide their knives to avoid an unpleasant encounter with malicious bent on mischief spirits.

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