Medicare will begin
reimbursing doctors for appointments with patients who want to discuss end-of-life care, a proposal that had the crazy right-wing screaming "death panels" five years ago. No, it's not death panels—it's giving elderly patients and their doctors the ability to have these critical discussions and gives those patients a degree of self-determination in how their last days will be spent.
The policy change, to take effect Jan. 1, was tucked into a massive regulation on payments for doctors. It suggests that what many doctors regard as a common-sense option is no longer seen by the Obama administration as politically toxic. Counseling would be entirely voluntary for patients.
Some doctors already have such conversations with their patients without billing extra. Certain private insurers have begun offering reimbursement. But an opening to roughly 55 million Medicare beneficiaries could make such talks far more common. About three-quarters of the people who die each year in the U.S. are 65 and older, making Medicare the largest insurer at the end of life, according to the Kaiser Family Foundation.
"As a practicing physician, and a son, and someone who has dealt with this in his own family, I would say these are discussions ... that are critical to high-quality care," said Patrick Conway, Medicare's chief medical officer. "I would want any American who wanted to have this conversation with their clinician to have the opportunity to do so."
Medicare is calling the program advance care planning, reflecting the fact that it is all about a person's ability to plan their end, with the advice of their physician. That could range from just palliative care to full-on intervention to keep you alive, but it's a decision that all too often isn't left up to the patient. Extending this to all Medicare beneficiaries can help change that, and it can help change that through the healthcare system. It's not just the elderly who should be making a plan for the end. Living wills and advanced directives should be a standard of care for every adult.