Patient-Physician End-of-Life Discussions in the Routine Care of Medicare Beneficiaries

Abstract

Objective: Medicare reimbursement for physicians who discussed end-of-life care and planning with a patient during an office visit was cut from the 2010 Affordable Care Act. We assessed the characteristics of patients who reported having had such discussions, and whether these discussions are associated with trust in one's physicians and with rates of family advance care planning (FACP).

Method: The sample consisted of 5,199 Medicare beneficiaries who reported having an ongoing relationship with a primary care physician. We estimated ordinal and multinomial logistic regressions that controlled for health care utilization, current health, and recent family deaths.

Results: Less than 1% (n = 310) reported an end-of-life conversation with a physician during the course of routine care. However, conversations were associated with greater trust in one's physician and higher rates of completion of FACP.

Discussion: Findings support renewed efforts to reimburse physicians for discussing end of life with their Medicare patients.

Keywords: advance directives; discussion; end-of-life care preparation.