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Medicare May Pay Doctors To Talk To Patients About How They Want To Die

CREDIT: SHUTTERSTOCK
CREDIT: SHUTTERSTOCK

The government program that insures 55 million elderly and disabled Americans hopes to encourage more conversations between doctors and patients about end-of-life decisions.

Medicare released a proposal on Wednesday that suggests reimbursing doctors for these discussions with patients, which currently aren’t covered in most cases. The idea would be to help more patients decide exactly what kind of care they want at the end of their lives — for instance, whether they would want to be resuscitated and placed on life support if they become very sick, or whether they want to spend their final days in hospice care.

“We think that today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team,” Dr. Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid, told the New York Times. “We think those discussions are an important part of patient- and family-centered care.”

Encouraging end-of-life counseling is not controversial among medical professionals or major health policy experts, who have long been advocating to move forward in this area. Several studies have found that most Americans haven’t planned for their deaths, and may end up prolonging their pain because they’re not aware of all their options. Plus, if Americans haven’t clarified their final wishes, their family members may be left to make difficult and serious decisions about their health care without much guidance.

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Patient advocates have characterized the proposed change as a big step forward that shows the federal government values meaningful conversations about end-of-life care, which they hope will make these decisions less confusing for terminally ill patients and their loved ones.

Nonetheless, this particular Medicare reform threatens to spark political controversy. Six years ago, when it was proposed as part of President Obama’s health care law, it led to accusations of “death panels” that nearly derailed the effort to pass Obamacare.

The “death panel” claim, driven mainly by former vice presidential candidate Sarah Palin, construed end-of-life discussions as decisions about health care handed down from above and forced upon unwilling patients. Palin suggested that Obamacare would result in a panel of bureaucrats deciding whether to euthanize her son, who has Down Syndrome, based on his projected contribution to society. Other Republicans picked up on the messaging, telling Americans that there were good reasons to be afraid.

It was a wild logical leap that PolitiFact determined to be the “lie of the year” in 2009, but it had a concrete impact on the American public’s attitudes about health care reform. The Obama administration has repeatedly dropped the provision in order to avoid stoking controversy.

Now, major medical groups appear to be hoping that enough time has passed, and the “death panel” myth perhaps won’t undermine this Medicare reform any longer. “This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions,” the American Medical Association said in a statement praising the proposal.

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A final decision about whether Medicare will start paying for end-of-life counseling will be made this November, after the proposal undergoes a public comment period.

This topic has been gaining momentum in recent years, as physicians and advocates have been pushing to help Americans feel more comfortable talking about death. End-of-life planning has even hit the bookshelves: The bestselling book Being Mortal, published by physician Atul Gawande in 2014, argues that the Americans aren’t thinking about these issues in the right way.