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December 25, 1991

Reimbursement, Beneficence, and Advance Directives-Reply

Author Affiliations

University of Virginia Health Sciences Center Charlottesville

University of Virginia Health Sciences Center Charlottesville

JAMA. 1991;266(24):3424-3425. doi:10.1001/jama.1991.03470240046025

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In Reply.  —In response to Dr Spielberg that a separate billing category be created for "advance directives consultation," we could not agree more. Reimbursement to physicians for time spent in relevant discussions with patients regarding personal values, health care goals, and treatment preferences is essential and long overdue. Reimbursement would not only recognize the fact that such discussions are time consuming and preclude income from performing physical procedures, but would also acknowledge the real value of the communication itself. Without some method of compensation for this time, many physicians, already overburdened by burgeoning paperwork and administrative responsibilities in addition to patient care, will simply not engage in these crucial dialogues. An advance directives consultation billing category for both Medicaid and private insurers would remove one of the most significant barriers to these discussions.Fervent support of new creative methods for enabling and encouraging patient-physician communication does not mean, however,