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Article
December 25, 1991

Reimbursement, Beneficence, and Advance Directives-Reply

Author Affiliations

Lutheran General Hospital Park Ridge, Ill
American Medical Association Chicago, Ill

Lutheran General Hospital Park Ridge, Ill
American Medical Association Chicago, Ill

JAMA. 1991;266(24):3424. doi:10.1001/jama.1991.03470240046024
Abstract

In Reply.  —We thank Drs Spielberg and Grant for their interesting comments and our many other colleagues for such kind notice about our article.Advance directive consultations are slowly becoming ordinary clinical practice, often as part of the review of systems in a new or return office visit. A significant time commitment is required to gather the necessary data; that commitment should be recognized by reimbursement systems. Similar considerations apply to ethics consultations, now requested for particularly difficult clinical cases in community and university settings; in 26% of 104 community hospital ethics consultations over 2 years, requesting physicians asked the consultant for assistance with advance directives (J.L., unpublished data, July 1986 through June 1987 and January 1988 through December 1989). Discussions with Medicare and the Health Care Financing Administration about needed reimbursement for ethics consultation services have begun.Signed advance directive forms unfortunately do not signify that a detailed discussion

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