Medicare Plans to Pay Doctors for Counseling on End of Life
Jul-09-2015

Medicare, the federal program that insures 55 million older and disabled Americans, announced plans on Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.

The proposal would settle a debate that raged before the passage of the Affordable Care Act, when Sarah Palin labeled a similar plan as tantamount to setting up "death panels" that could cut off care for the sick. The new plan is expected to be approved and to take effect in January, although it will be open to public comment for 60 days.

Medicare's plan comes as many patients, families and health providers are pushing to give people greater say about how they die - whether that means trying every possible medical option to stay alive or discontinuing life support for those who do not want to be sustained by ventilators and feeding tubes.

"We think that today's proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team," said Dr. Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid, which administers Medicare. "We think those discussions are an important part of patient- and family-centered care."

Dr. Conway said a final decision on the proposal would be made by Nov. 1. The plan would allow qualified professionals like nurse practitioners and physician assistants, as well as doctors, to be reimbursed for face-to-face meetings with a patient and any relatives or caregivers the patient wants to include. Dr. Conway said the proposal did not limit the number of conversations reimbursed.

"The reality is these conversations, their length can vary based on patients' needs," he said. "Sometimes, they're short conversations - the person has thought about it. Sometimes, they're a much longer conversation. Sometimes, they're a series of conversations."

Major medical organizations endorsed Medicare's proposal. The National Right to Life Committee opposed it on grounds that it could lead to patients' being pressured to forgo treatment.

The reimbursement rate paid under the proposal and other details will be determined after public comments are received, Dr. Conway said. People covered by Medicare account for about 80 percent of deaths each year.

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