Thanks for framing the [end-of-life discussion] issue so eloquently (Check Up: “Let's Talk About the Hard Stuff,” September/October 2009, pg. 6). Making end-of-life decisions, like deciding to be an organ donor, is an emotionally charged issue for many individuals and families who find it easier to not think about, discuss, or plan for their final exit — especially when they are healthy and feeling invincible. This is precisely where properly educated and trained healthcare providers can assist, by facilitating the discussion and providing accurate information in a less emotional, yet compassionate, manner. And yes, of course they should be compensated for this counseling time, otherwise it will never be included in their already jammed appointment schedules.
Carol Krugman
Comment via the Web

Let's talk about … the rest of the story. One of the reasons for the “hue and cry” over end-of-life counseling reimbursement is the apparent targeting.

Look at the Baby Boomers. They are beginning to enter their 60s and we've known for years that Medicare can't manage their costs. Rationed care has been an underlying fear of many in this age group for over 15 years. Now there is legislation that specifically singles out the Medicare population for end-of-life discussion reimbursement. Gee, why would anyone think that the goal is to get rid of a particular age group?

There are newborns in neonatal intensive-care units across the country who are being kept alive with little chance of survival. Don't their loved ones deserve counseling? There are children and adults suffering from terminal illness or conditions. Don't they and their loved ones deserve counseling? Why should one age group be singled out?

Then there is the issue with incentivizing end-of-life discussions in the first place. The money would be better spent developing education, resources, and tools to facilitate these discussions, regardless of the patient's age.

Let's reflect on the comment about the fine management of end-of-life discussion by veterinarians without incentives. There is excellent counseling for our “furry” loved ones. Do our human loved ones deserve anything less?
Barbara A. Fuchs, MS, CCMEP, CPHQ
EPiQ Services, LLC, Collegeville, Pa.

Your editorial caught my eye when I saw “political” — If you have the feeling you should hesitate, then for goodness sake hesitate and don't continue with the political views.

And as a nurse and healthcare professional, I would really like to say that it is usually the nurse who has these talks with patients, not the doctor, who doesn't have the time. I am also not sure that if they were paid to do it they more likely would — it would probably again go back to the nurse, medical assistant, or support staff.

My advice: Stay out of politics and work on CME meetings.
Mary L. Blish, RN, BSN
Clinical Education Coordinator, Medical Education Department, Eastern Maine Medical Center, Bangor

Your editorial about healthcare providers being able to include end-of-life strategies (as general information or specific plans) in conversations that are covered by the government solution to the healthcare crisis was especially straightforward and to the point. This is something that the media has not been able to accomplish with many parts of this bill under consideration. If a lawyer can charge for the time providing this service, among others — then so should the healthcare expert.
Christian D. Panasuk, CHSP
Director of Sales and Marketing, The Joseph B. Martin Conference Center at Harvard Medical School, Boston

Lobby Time

I am responding to columnist Lawrence Sherman's call-to-action inquiry in the September/October issue of Medical Meetings. What can we do and who can lead our mission to right the wrongs of politicians' misinterpretations of accredited CME? If we wait for the Alliance for CME to be our voice, we will all be out of a job shortly. We need to communicate with the politicians and the naysayers in a language they understand … that of a lobbyist.

I propose that we pool the funds we have set aside for ACME membership renewal to buy the lobbying power we desperately need. We the CME industry have a giant, evidence-based pool of information with which to set the record straight, and it's time we got some face-time to do that effectively.
Frank L. Urbano, MD, FACP
Medical Director, PRIME, Tamarac, Fla.

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