The Obama administration plans to pay doctors to hold end-of-life planning conversations with patients, a controversial decision that will nearly certainly revive the “death panel” debate that has long dogged the Affordable Care Act.
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About 4 in 10 Americans ages 65 and older lack written instructions for their end-of-life treatment, according to the Kaiser Family Foundation.
A 1992 law passed under Republican President George H.W. Bush requires hospitals and nursing homes to help patients who want to prepare living wills and advance directives.
Dr. Joe Rotella, chief medical officer of the American Academy of Hospice and Palliative Medicine, called Medicare’s move a “little miracle”.
“Conversations among physicians, patients, and loved ones is the standard of care”, Wayne J.
Advanced care planning doesn’t mean shunning aggressive care or choosing a Do Not Resuscitate Order; people can also specify in their care directives that they want “everything done”. 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.
Medicare now provides coverage to more than 50 million mostly older Americans and is projected to grow steadily as baby boomers retire. 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. Those accusations were misleading because the counseling is voluntary and the rules would not have created panels of any kind.
“If Medicare is saying to doctors, ‘We value your time talking to people about choices at end of life, ‘ other payers are going to say the same thing”, Back said.
The agency said that in 2013, there were more than 400,000 inpatient knee and hip procedures, costing Medicare more than $7 billion for hospitalization alone.
“This is absolutely a signal to patients and families that having a visit to the doctor to talk about these things so they can understand what they’re dealing with and voice their preferences is important”, he said. The phrase quickly gained traction and health experts say it chilled efforts to include end-of-life discussions as part of paid-for medical services.
“They all involve a system of forced choices of boxes to check, the appropriateness of which can not be predetermined in the originally recommended (by the federal government) timeframe established for patient review and revision, of five years”, said Hilliard, the NCBC’s director of bioethics and public policy. When patients don’t leave explicit directions, it’s their families who are left to make decisions on their behalf-which leads to some situations in which patients are artificially kept alive for years because their families refuse to let go. “Beginning Medicare is one of those times, since it can be a point of awareness and reflection”.
Although, the Medicare proposal has already received support from leading medical organizations; the National Right to Life Committee challenges this proposal as, they feel it could result in pressuring patients to forgo receiving treatment.
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Information for this article was contributed by Matt Sedensky and Ricardo Alonso-Zaldivar of The Associated Press; by Zachary Tracer of Bloomberg News; by Pam Belluck of The New York Times; and by Noam N. Levey of Tribune News Service.
