Medicare has announced that it will reimburse doctors for helping patients create a plan for what kind of care they want at the end of their lives. During the debate over the creation of the Affordable Care Act, such an idea had been derided by critics of healthcare reform as "death panels."
For years there had been bipartisan agreement that people needed to understand their end-of-life choices. A 1992 law passed under President George H.W. Bush required hospitals and nursing homes to help patients prepare living wills and advance directive, if they wished. But there was a political outcry over including end-of-life counseling in President Barack Obama's healthcare reform. Some opponents called counseling sessions "death panels" and said they could make older or disabled people feel pressured into cutting off care.
Many physician and health advocacy groups had been pushing for such a move by Medicare for many years. Many doctors provide help and advice with advance care planning for their patients without getting paid for their time. Some private insurers already reimburse for these counseling sessions. The policy change by Medicare could make such talks more common among about its 55 million beneficiaries.
The rule change is part of broader changes in the regulations for payment to doctors that will take effect Jan. 1. Advance care planning or end-of-life counseling is voluntary and Medicare will not require people to take part. The counseling session could take place during a person's annual wellness visit or a regular office visit.
Most Americans report that they would prefer to die at home, with treatment to keep them comfortable. But a report from the Institute of Medicine found the reality for most people often includes unwanted invasive care and not enough comfort, in part because too few people make their wishes known in advance to their doctors, friends, and families.
Advance care planning is not necessarily a one-time event, but can be a process that may prompt different decisions at different tine or under different circumstances. A relatively healthy person might want no effort spared to resuscitate him or her after an accident, but if diagnosed with advanced cancer, might make different decisions as their health gradually worsened. Because of this, Medicare will not limit how often such counseling could take place.