Medicare to pay for ‘end of life’ counseling
Most experts agree voluntary service beneficial
Medicare will pay doctors to counsel patients about endof-life care, the same idea that sparked accusations of “death panels.”
WASHINGTON — Medicare said Wednesday it plans to pay doctors to counsel patients about end-of-life care, the same idea that sparked accusations of “death panels” and fanned a political furor around President Barack Obama’s health-care law six years ago.
The policy change, to take effect Jan. 1, was tucked into a massive regulation on payments for doctors. It suggests that what many doctors regard as a common-sense option is no longer seen by the Obama administration as politically toxic. Counseling would be entirely voluntary for patients.
Some doctors already have such conversations with their patients without billing extra. Certain private insurers have begun offering reimbursement. But an opening to roughly 55 million Medicare beneficiaries could make such talks far more common. About three-quarters of the people who die each year in the U.S. are 65 and older, making Medicare the largest insurer at the end of life, according to the Kaiser Family Foundation.
“As a practicing physician, and a son, and someone who has dealt with this in his own family, I would say these are discussions … that are critical to highquality care,” said Patrick Conway, Medicare’s chief medical officer. “I would want any American who wanted to have this conversation with their clinician to have the opportunity to do so.”
Medicare is using a relatively new term for end-oflife counseling: advance care planning. 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.
The counseling aims to discern the type of treatment patients want in their last days, with options ranging from care that’s more focused on comfort than extending life to allout medical efforts to resuscitate a dying patient.
Before former Alaska Gov. Sarah Palin ignited the “death panels” outcry, there was longstanding bipartisan consensus about helping people to better understand their end-oflife choices and decisions.
Andrew Gurman, president-elect of the American Medical Association, praised the rule.
“The proposed Medicare payment rule affirms the need to support conversations between patients and physicians to establish and communicate the patient’s wishes in responding to various medical situations. This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional,” Gurman said in a statement. “This issue has been mischaracterized in the past, and it is time to facilitate patient choices about advance care planning decisions.”