Medicare proposal would reimburse doctors for end-of-life counseling

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End-of-Life Proposed Rules

The Center for Medicare and Medicaid Services released a proposal July 8 that would, for the first time, reimburse health care professionals for discussions they have with Medicare beneficiaries about their end-of-life choices.

Public comments will be accepted until September 8 and a final rule is expected November 1.

The proposal is part of the CMS’s latest annual rules for paying health care providers who treat Medicare beneficiaries [PDF]. According to Modern Health Care, the proposed rule would set a pay rate for the first 30-minute visit that providers discuss end-of-life options – such as patients’ preferences for when they should be removed from ventilators and other life-sustaining treatment – with patients, as well as another pay rate for additional 30-minute sessions.

Actual pay rates for these two categories will not be set until after CMS receives feedback during the public comment period.

Some disability advocates, however, have already voiced concerns that the proposals could incentivize doctors to urge elderly patients and others with disabilities to decline life-saving treatments, thus saving the system money.

For Not Dead Yet, which has long campaigned against physician-assisted suicide laws, the current health care system lacks sufficient disability discrimination protections.

“A lot of the messaging focuses on telling people they would be better off dead than disabled, and that therefore they should decline treatment,” NDY President Diane Coleman told U.S. News and World Report.

The National Right to Life Committee voiced similar concerns, although, like Not Dead Yet, it stated that it supports advanced directives, which are legally binding statements of a person’s intentions in regard to their end-of-life choices.

Contrarily, most major patient advocacy organizations have praised the proposal, including the American Medical Association, the National Hospice and Palliative Care Organization, and the American Academy of Family Physicians.

“The proposed Medicare payment rule affirms the need to support conversations between patients and physicians to establish and communicate the patient’s wishes in responding to various medical situations…,” the AMA said in a news release. “This issue has been mischaracterized in the past, and it is time to facilitate patient choices about advance care planning decisions.”

The Affordable Care Act originally included a similar provision, but the proposal was scrapped after former vice presidential candidate Sarah Palin characterized such government-provided end-of-life sessions as “death panels.” The CMS pushed a similar rule later in 2010, but backed down again due to political pressure.