End of Life Planning

Medicare removed the End of Life Planning option on the Annual Wellness Visit in 2011 on or about the same date as the new statute hit the street. But don’t think for a second that Medicare WANTED to remove the option; on the contrary, the court of public opinion forced them to remove it. Medicare actually WANTS the option to be part of every Annual Wellness Visit. And why not? It makes perfect sense for every Medicare patient to have a frank and honest discussion with their primary care provider about what should happen and when should the patient become seriously ill.

Why was it removed in the first place?

In 2009, former Republican vice-presidential candidate Sarah Palin took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation 1. The Administration, not wanting to have Pailin’s misguided agenda scuttle the Affordable Care Act launch, removed the provision completely, but with obvious regret.

Why is it beneficial?

Healthcare for the elderly person escalates like a rocket toward their end of life. Families who face the daunting fees and charges for their elderly patient relatives are often left in the lurch with huge debts that mount for years. More importantly, the quality of life of the patient toward the end of their life can be dramatically minimized by prolonged and unnecessary healthcare. End of life planning, therefore, is all about fairness to the patient and the families. More importantly, it’s about full disclosure of the truth.

“We think it’s really important to incentivize this kind of care,” said Dr. Barbara Levy, chairwoman of the A.M.A. committee that submits reimbursement recommendations to Medicare. “The idea is to make sure patients and their families understand the consequences, the pros and cons and options so they can make the best decision for them. 2

What is on the horizon?

The American Medical Association’s Relative Value Scale Update Committee (RUC) soon will issue recommendations to the federal government regarding the resources doctors expend when they provide advance care planning to patients, or confer with them about the care they would want if they were incapacitated. Every year, the AMA makes such recommendations on a broad range of procedures and services to the Centers for Medicare and Medicaid Services, the federal agency that administers the Medicare program and works with state governments to administer Medicaid. CMS uses these recommendations, along with input from others, to set reimbursement rates, which private insurers also tend to use 2.

In essence, doctors may soon see a plan of reimbursement for their time to discuss End of Life Planning. Now that Pailin’s rhetoric about “death panels” has withered away along with her failed political career, the topic is back on the table once again. This time, CMS is making strides to accept recommendations of physician advocate groups such as the AMA.

What it means for patients and their families

Geriatricians, oncologists and other medical specialists who see gravely ill patients say it’s crucial to elicit a patient’s wishes for treatment and other pastoral or psychological supports in a dire medical situation. Would a particular patient, for instance, want to pursue additional procedures that, while grueling, offer some slim possibility of success? Or would the patient want doctors to intervene only to alleviate pain?

If Medicare reimburses doctors for such discussions, as it pays them for examining patients and performing procedures, they are much more likely to happen. 1


1. USA Today article written by Michael Ollove, Pew/Stateline Staff Writer, June 4, 2014
2. NY Times article written by Pam Belluck, August 30, 2014

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