In the absence of a social worker or palliative care doc..

[napoleondynamite]

I work in a small clinic, solo radonc. I lack some of the resources of larger practices.

I attended a conference last weekend and listened to an interesting talk about end-of-life planning. The speaker suggested that oncology clinics implement 'Palliative Care Rounds,' essentially a meeting like chart rounds but dedicated to discussing patients who have less than 1-2 years to live.

I'm thinking of instituting this in my practice - I always try to discuss prognosis, advanced directives, etc with my patients, but I am sure I can do better and if I have a running list that my team also looks at and adds to, it creates more accountability that these discussions have taken place.

My question for you all is - any concerns about providing forms in my own office for Power of Attorney and Advanced Directives? Without having patients need to travel a significant distance in some cases for a palliative care referral and I have no social worker. Do any of you actively do this yourselves?

---

Members don't see this ad.

 

[Gfunk6]

I applaud you for trying to do this in a small clinic. Fortunately, CMS shares your vision and has instituted a special Advanced Care Management (ACM) program. This is to ensure that prognosis is discussed early with patients and that, down the road, their wishes are respected via formal documentation.

These codes are recognized and reimbursable by CMS - so you don't simply have to do the work gratis. This link will give you more information: https://www.cms.gov/Medicare/Medica...Sched/Downloads/FAQ-Advance-Care-Planning.pdf

In my practice, our Med Oncs do this extensively but certainly any Rad Onc could do so as well.

 

[napoleondynamite]

Very helpful link, thanks GFunk.

 

[scarbrtj]

I think it sounds like a good idea on paper. How it will look to your referring physicians will be maybe another matter. They (the med oncs in particular) take a little umbrage sometime if you start down that hospice-y path too soon. In truth of course we do it not soon enough most cases. Anyone with less than 1-2 years to live, if you think that, is perhaps "terminal" with no reasonable expectation of recovery and is a proper hospice referral (again, on paper). So probably you should run it by your colleagues, not us. If they have no problem, you're good. Also it will prepare them for complaints from patients--you might get some (especially patients' family members). I like your thinking. However remember oft times no good deed goes unpunished.

 

[napoleondynamite]

Meh, I'm not worried really about my colleagues on this, but I see your point and will tread carefully.

I was more asking about any legitimacy or legality concerns of filling out POA or Comfort One type paperwork without a social worker or palliative care doc involved. In my case, sometimes it is not practical. But I believe the right thing to do for the patient.

I'm not really talking about hospice or "this is the end" type discussions, more - at least addressing code status and POA.