End-of-Life Planning Would Be Covered in Medicare Proposal

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Medicare may begin paying doctors to discuss end-of-life care with U.S. patients, under rules proposed Wednesday by the Obama administration.

Doctors who see patients in Medicare, the insurance program for the elderly, would be reimbursed for having the complex and sensitive conversations needed to plan for the end of life. Talks may include outlining the sorts of medical treatments patients desire, or helping to fill out standard forms about how they should be cared for if they’re unable to make decisions for themselves.

The idea caused a political uproar during debate over President Barack Obama’s 2010 health-care overhaul, called the Affordable Care Act. Opponents declared the conversations a step toward “death panels” that would have the government ration care for the elderly and infirm. The administration’s proposal says the discussions should occur in the context of medical treatment.

“Conversations among physicians, patients, and loved ones is the standard of care,” Wayne J. Riley, president of the American College of Physicians, which represents internists, said in an e-mail. He said the group is pleased that Medicare “has recognized what the medical community is doing to address the needs and requests made by patients and their loved ones.”

The college was among health-care groups including the American Medical Association that were pushing for Medicare to pay for the planning.

“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,” Andrew Gurman, president-elect of the AMA, 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.”

Changing Debate

Since the law’s passage, claims of “death panels” have quieted and physicians and policy experts have stepped in.

The National Academy of Medicine said in a 2014 report that end-of-life planning has an important role. Such plans can help patients and doctors figure out the right balance between quality of life and pursuing intensive treatments, said the academy, then called the Institute of Medicine.

“Because most people who participate in effective advance care planning choose maximizing independence and quality of life over living longer, advance care planning can potentially save health care costs,” the academy said in the report. “The misrepresentation of the ACA provisions for advance care planning as ‘death panels’ confused many Americans about the benefits and goals.”

The end-of-life care rule takes up two pages in a more than 800-page set of proposed changes to Medicare’s physician payment policies released Wednesday. Comments on the document can be submitted for the next 60 days.

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