The CMS will pay physi­cians to help Medi­care pa­tients plan the type of care they want at the end of life, an idea that touched off the “death panel” con­tro­versy six years ago, but which has since gained broader ac­cep­tance.

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The CMS rule, pro­posed last sum­mer and fi­nal­ized Fri­day, takes ef­fect Jan. 1. The physi­cian coun­sel­ing is vol­un­tary, and could be pro­vided dur­ing se­niors’ an­nual well­ness vis­its, or other reg­u­lar of­fice vis­its. “We be­lieve pa­tients and fam­i­lies de­serve the op­por­tu­nity to dis­cuss th­ese is­sues with their physi­cian and care team,” said Dr. Pa­trick Con­way, the CMS’ chief med­i­cal of­fi­cer .

The CMS de­cided not to limit how of­ten such coun­sel­ing could take place, Con­way said, in part be­cause of feed­back from doc­tors and the pub­lic stat­ing that peo­ple may need re­peat coun­sel­ing as their health needs change. “If you made a choice and you be­come more ill, you might want to have the dis­cus­sion again,” Con­way said.

U.S. Rep. Earl Blu­me­nauer (D-Ore.), who pushed for the pol­icy, said ad­vance di­rec­tives must be made eas­ily ac­ces­si­ble, and that doc­tors should re­ceive train­ing on how to have th­ese dif­fi­cult con­ver­sa­tions.

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