On Wednesday, officials with the federal program announced this change, claiming that doctors will now be reimbursed for their conversations with patients on end-of-life care options.
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The reimbursements would begin in 2016.
WellCare Health Plans, Inc. But right now, most Americans don’t have advance care directives that explain what type of treatment they’d like.
Federal health care regulators on Thursday proposed cutting Medicare payments to hospitals with high rates of complications for hip or knee replacements.
Obama defended the proposal at the time, saying he was not trying to “pull the plug on Grandma”, but it was subsequently removed from the health reform law. But the Obama administration is putting its foot down this time. Many health advocates believe end-of-life counseling to be an effective way of helping terminally ill patients think through whether they’d like to receive medical interventions that could be ineffective or worsen their quality of life. However, making the service voluntary to approximately 55 million Medicare beneficiaries would make such conversations a lot more common than what it is now. The proposal also would impose a value-based purchasing model on all Medicare-certified home health agencies in nine states as part of a pilot program. According to a 2007 Duke University study published in Social Science & Medicine, hospice care reduces Medicare expenditures during the past year of life by an average of $2,309 per patient. “It would allow doctors to be reimbursed for talking to patients about what they want to do about end-of-life care; not necessarily at their end of life, but before that”. “The AMA has long supported coverage of advance care planning and provided recommendations and input to help Medicare create a payment policy based on a full understanding of this medical service”, AMA president-elect Andrew W. Gurman said in a statement. This includes specifying the patient’s wishes concerning medical care and life support measures and designating a health care proxy if the patient is unable to make decisions.
Why do people oppose this?
It wasn’t immediately clear whether the new CMS rule – part of an annual physician payment regulation proposal that doesn’t go through Congress – will spark another round of recriminations about death panels and rationing. Some private-insurance companies already cover counseling, and many more are expected to follow Medicare’s lead.
Michael Mayo’s column “After Obamacare Ruling, Dissent from Past Supporter”, illustrates the deficiencies in the Affordable Care Act.
The 2009 Sarah Palin Facebook post that coined the term “death panel”. Such serious conversations with patients would be about how (and if) physicians should keep them alive if they are very sick and unable to speak.
End-of-life discussions shouldn’t be regarded as taboo. Matt Salo, executive director of the national Association of Medicaid Directors, said the issue of states not reporting encounter data is a “multi-layer problem”.
In light of the announcement to reward value regardless of the quality of care delivered from the Department of Health and Human Services (HHS), it is hopeful the healthcare industry will not only best collectively assess what needs to be done now to meet and exceed upcoming reimbursement objectives, but also how to do so intelligently.
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Without advance care planning, patients end up living a version of the scenario that the death panel rhetoric made so fearsome: giving over decisions about their last moments of life to another party. That’s meant to reflect expert advice that people should make their wishes known about end-of-life care at different stages of their lives, as early as when they get a driver’s license.
