0709-News-End of life_Blog

Medicare wants to begin reimbursing doctors who hold end-of-life conversations with their patients, a type of service that years ago led to erroneous claims that the government was setting up “death panels” to cut the sick and elderly off from health care.

Under the new policy proposed Wednesday as part of a larger set of regulations updating reimbursement rules for physicians, Medicare beneficiaries could meet with doctors to specifically talk about their “advance-care” wishes.

Currently, Medicare does not pay doctors for such separate meetings. But under the proposed policy change, which if finalized would go into effect Jan. 1, physicians would get paid for conversations with patients about the directives they want followed in the event of a life-threatening illness or health emergency.

“While our mission is to save and improve lives, unfortunately too many people still suffer from the devastating effects of illness like advanced heart failure and stroke,” said American Heart Association CEO Nancy Brown. “Creating an environment where healthcare providers, patients and their families are encouraged to have open and proactive dialogue about their advanced illness care will provide the practical and emotional support needed.  This proposal aligns with our fundamental belief that all Americans deserve proper care, no matter where they are on the health spectrum.”

Medicare currently insures about 55 million elderly and disabled Americans. Its proposed rule will be open for public comment for the next 60 days.

“Today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team, as part of coordinated, patient- and family-centered care,” Dr. Patrick Conway, Medicare’s chief medical officer and principal deputy administrator, said in a statement issued after the proposal’s announcement.

Organizations that advocate advance-care planning applauded the government’s proposal, calling end-of-life discussions critical to long-term health planning.

“It’s essential that these conversations take place before a crisis happens,” said J. Donald Schumacher, president and chief executive officer of the National Hospice and Palliative Care Organization. “More and more Americans are facing advanced illness and are aging with multiple chronic health conditions, so it’s now more important than ever to have these vital conversations.”

Momentum has been building toward acceptance of such end-of-life care discussions, which health-care experts have widely supported.

Last year, the independent Institute of Medicine released the report, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.” The report addressed a lapse in end-of-care conversations taking place between patients and the health care community. Most Americans lack advance-care directives that would spell out the treatment they prefer on areas ranging from feeding tubes to resuscitation efforts. That means those difficult decisions often are left to physicians or the patient’s family members.

Previous efforts to encourage such sensitive conversations were derailed in 2009 during national debate over President Obama’s health care legislation, the Affordable Care Act.

Former Alaska Gov. and Republican vice presidential candidate Sarah Palin said an end-of-life policy that was at one point included in the measure would result in bureaucratic “death panels,” ones that would decide which sick people would get health care – and ultimately the chance to live.

The claim was quickly debunked. But the term — and the image it conjured — lingered for years, hampering serious efforts to address the issue.

Anita Brikman, senior vice president of communications for NHPCO, said having Medicare reimburse doctors for end-of-care talks would give patients the time necessary to hear meaningful answers to the complicated questions they are likely to ask.

“These are not conversations that are done easily in a doctor’s packed schedule, and they are not best done in a crisis situation when someone is gravely ill,” she said.

“The idea that you would have a time set aside with your physician to talk about all kinds of scenarios, whether you’re in a serious illness or right now, is crucial for better health care for all Americans.”