Medicare said last week it will pay doctors to help patients plan what kind of care they want at the end of life, an idea more broadly accepted than six years ago, when it touched off a political uproar about “death panels.”
Numerous physician and health groups urged the policy change. Some doctors provide this “advance-care planning” to their patients without getting paid for the counseling time, and some private insurers already reimburse for it.
But the Obama administration’s policy change could make the talks more common among about 55 million Medicare beneficiaries.
The rule, proposed last summer and completed Friday as part of broader doctor-payment regulations, is scheduled to take effect Jan. 1. The counseling is voluntary and could take place during a patient’s annual wellness visit or during regular office visits.
“As a physician and a son, I personally know how important these discussions are for patients and families,” Dr. Patrick Conway, Medicare’s chief medical officer, said in an interview. “We believe patients and families deserve the opportunity to discuss these issues with their physician and care team.”
Most Americans say they’d prefer to die at home, with treatment to free them from pain. But the landmark “Dying in America” report from the prestigious Institute of Medicine found the reality too often is unwanted invasive care and not enough comfort, in part because too few people make their wishes known to doctors and loved ones.
The movement toward advance-care planning also reflects that this isn’t just an issue for people who already are seriously ill, but a process that may prompt different decisions at different stages of life.
Involving a doctor in those decisions can help people fully understand their options. A relatively healthy person might want all-out resuscitation efforts after an accident, for example, but if diagnosed with advanced cancer, a patient might make different decisions as his or her health worsened.
Medicare decided not to limit how often such counseling could take place, Conway said, in part because of feedback from doctors and the public that people may need repeat counseling as their health needs change.
About three-quarters of the people who die each year in the U.S. are 65 or older, making Medicare the largest insurer at the end of life, according to the Kaiser Family Foundation.
A 1992 law passed under Republican President George H.W. Bush requires hospitals and nursing homes to help patients who want to prepare living wills and advance directives. Momentum stalled with outcry over including end-of-life conversations in the president’s health-care law, which some termed “death panels.”