By Lena H. Sun
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.
Related Online CEU Course:
End of Life: Helping with Comfort and Care is a 1-hour online CEU course that takes a respectful look at the end of life, what might be expected, and offers practical suggestions on how to bring comfort.
End-of-life care is the term used to describe the support and medical care given during the time surrounding death. Such care does not happen just in the moments before breathing finally stops and a heart ceases to beat. An older person is often living, and dying, with one or more chronic illnesses and needs a lot of care for days, weeks, and sometimes even months. Generally speaking, people who are dying need care in four areas—physical comfort, mental and emotional needs, spiritual issues, and practical tasks. This course is intended to make the unfamiliar territory of death slightly more comfortable for everyone involved. This publication is based on research, such as that supported by the National Institute on Aging, part of the National Institutes of Health. This research base is augmented with suggestions from practitioners with expertise in helping individuals and families through this difficult time. Throughout the booklet, the terms comfort care, supportive care, and palliative care are used to describe individualized care that can provide a dying person the best quality of life until the end. Course #10-45 | 2008 | 72 pages | 10 posttest questions
This web-based course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document).
Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more.
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