We’re all going to die one day. And though we like to think we’ll have some control over how we die, that’s not always the case in the U.S.  People who want to die at home surrounded by their families instead breathe their last breath in a hospital or nursing home.

“Patients’ preferences actually had no effect on the treatments that they received, absolutely none,” says Dr. Sean Morrison, a professor of geriatrics and palliative medicine at Mount Sinai Hospital, referring to a study of 9,000 patients that found some receive more care than they want.  Others don’t get enough. 

The problem: they don’t have an end-of-life, heart-to-heart with their doctor about what they want. One reason? Most doctors don’t get paid for that. Dr. Morrison does, because he’s salaried.

“I couldn’t do that if I was in private practice,” he says.

These aren’t easy conversations. Dr. Vicki Jackson has them a lot.  She’s chief of the division of palliative care at Massachusetts General Hospital.

She says doctors will need training on things like, what questions to ask the patient.

For example: “What worries you?  When you think about what’s coming next, how do you want to be spending this time?” she says.

Medicare plans to start paying for these conversations this January. And private insurers usually follow Medicare’s lead. 

“They’ll cover the same types of services and diagnostic tests,” says Vivian Ho, a health economist at Rice University. “So it’s not just a question of how much they’ll reimburse, but also what services they’ll reimburse for.”

Ho says that eventually doctors could be paid to have end-of-life talks with everyone. So the people they’re trying to help are actually heard.