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Posted by on Jul 9, 2015 in Health, Politics | 22 comments

(Updates) Medicare-Covered End-of-Life Counseling Proposed



The New York Times, Los Angeles Times and other news sources are providing additional details on Medicare’s plans to reimburse doctors for “conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.”

New York Times:

“The new plan is expected to be approved and to take effect in January, although it will be open to public comment for 60 days.

Medicare’s plan comes as many patients, families and health providers are pushing to give people greater say about how they die — whether that means trying every possible medical option to stay alive or discontinuing life support for those who do not want to be sustained by ventilators and feeding tubes.


[Dr. Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid] said a final decision on the proposal would be made by Nov. 1. The plan would allow qualified professionals like nurse practitioners and physician assistants, as well as doctors, to be reimbursed for face-to-face meetings with a patient and any relatives or caregivers the patient wants to include. Dr. Conway said the proposal did not limit the number of conversations reimbursed.


The reimbursement rate paid under the proposal and other details will be determined after public comments are received, Dr. Conway said…

…Some private health insurancecompanies have recently begun covering such advance care planning conversations, and more are likely to do so once Medicare formally adopts its new rules.

As a big part of the American population ages, and more people live longer with grave illnesses, a growing number of people want to be able to talk over options with their doctors — deciding, for example, whether they want to die at home or in the hospital, or under what circumstances they would want life-sustaining treatment.


Filling out advance directives can help, and some states have created central databases of these forms so they are easier for a patient’s doctor or specialist to find in moments of crisis. But end-of-life experts, and the members of the national panel, said simply checking boxes on a form was of limited value because many patients needed several conversations to consider their options and to talk them over with their families.

The Los Angeles Times:

“The new proposal from the Department of Health and Human Services would not require Medicare patients to sign any order or even to talk with their physicians about end-of-life care.

Rather, the proposed regulation would allow medical providers to bill Medicare for “advance-care planning” should a patient want to have the discussion.

Such a session could include “the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed) by the physician or other qualified health professional,” according to the proposed rule.

Original Post:

It is natural for those of us with sixty, seventy or more years of living under our belt to think, even worry, about what those last years on this planet will be like and perhaps do some planning and make some decisions on how we would like to spend those “golden years.”

Some call this natural interest “end-of-life planning.”

Since we already have a program that deals with health care needs for senior citizens — called Medicare — it follows that such end-of-life planning should fall within the purview of that program.

Moreover, since most Americans finally have a program that also deals with health care issues of both the young and the old, called the Affordable Care Act (ACA), perhaps it might have been a good idea to include such end-of-life planning aspect in that program.

Thanks to Conservatives led to battle by none other than Sarah Palin under the false battle cry of “death panels,” such provisions were not included in the ACA.

Readers might well remember the shamefully false demagoguery by Palin, echoed by many other prominent Republicans, five or six years ago, that not only killed any possibility for covered end-of-life planning under Obamacare, but also “spelled the end of a proposal for Medicare to reimburse doctors for voluntary end-of-life consultations with patients.”

Well, six years later, although repeatedly proved to be false, perhaps the myth of those death panels is being shown for what it is: a myth, a lie.

The New York Times reports today:

After years of debate about whether the government should encourage end-of-life planning — an idea that Sarah Palin claimed would lead to “death panels” cutting off care to the sick – Medicare, the federal program that insures 55 million older and disabled Americans, is now proposing to reimburse doctors for having conversations with patients about whether and how they would want to be kept alive if they become too sick to speak for themselves.
This new policy, announced Wednesday, comes at a time when patients, families and health providers are placing greater emphasis on allowing people to choose the way they die – whether that means trying every possible medical option to stay alive or discontinuing life support for those who do not want to be sustained by ventilators and feeding tubes.
Efforts to support end-of-life planning were derailed during the debate over the Affordable Care Act. In 2009, Sarah Palin labeled a plan to include doctor reimbursement for advance care planning conversations under the law as tantamount to setting up “death panels,” effectively killing the provision. The next year, Medicare decided through its regulatory powers to allow coverage for “voluntary advance care planning” in annual wellness visits. But soon after, the Obama administration capitulated to political pressure and rescinded that part of the regulation.

In contrast to Justice Thomas’ “dignity” of slavery argument, such a new Medicare provision should be called “Dignity at the End of Life.”

Read more here.

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