Medicare Proposes to Pay Doctors to Have End-of-Life Care Discussions

Federal health officials are proposing that Medicare begin paying doctors to discuss end-of-life issues with their patients, six years after the “death panel” controversy erupted in the early days of the debate over President Obama’s health-care legislation.

The Centers for Medicare and Medicaid Services (CMS) released the new plan Wednesday as part of its annual Medicare physician payment rule. The proposed rule includes reimbursement for “advance care planning.” The final rule is due Nov. 1, and payments would start Jan. 1. The discussions would be voluntary.

Sarah Palin, the Republican vice presidential candidate in 2008, ignited a political firestorm in 2009 when she denounced a provision in the health-care legislation that would have allowed Medicare to reimburse doctors for discussing living wills and other end-of-life issues with older patients. She said it would create a “death panel” that could decide who received care. The provision was removed from the final Affordable Care Act legislation.

If a doctor is treating, for example, a 68-year-old man with heart failure and diabetes who is taking multiple medications, the talks could include long-term treatment options, such as a heart transplant if his congestive heart failure worsened. They also could deal with advance care planning, including a patient’s desire for treatment if a health problem “adversely affects his decision-making capacity.”

Patrick Conway, chief medical officer for CMS, said the 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.”

Many doctors already have these often-difficult conversations with their patients without being paid to do so. Medicare reimbursement is significant because the government program is the second largest insurer of health care, and many private insurers follow its lead.

“If it’s not being reimbursed by Medicare, it’s often not valued,” said R. Sean Morrison, a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York.

In recent years, Medicare’s role in end-of-life care has been at the center of the debate about whether physicians and other health-care professionals should be reimbursed for talking to patients about their options.

Patient advocacy and physician groups have been calling for Medicare, the federal health program for the elderly and the disabled, to reimburse doctors who have such conversations because of the increasing number of aging Americans and the growing public awareness that aggressive intervention at the end of life often don’t lead to a better outcome or quality of life.

The groups, including the American Medical Association, applauded the proposal.

“This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions,” the association said in a statement.

“Rigorous research has shown that seriously ill patients derive significant benefits from advance care planning and having their end-of-life wishes known, documented and respected,” said Allan Coukell, senior director for health programs at the Pew Charitable Trusts.

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