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Obama Enacts Medicare Coverage for End-of-Life Counseling

Last updated on 2011.01.05

One more Christmas present: we got our death panels! Or at least that's what the Palindrones (you know, the Teabags whose repetitious big lies sound as shrill and meaningless played forward or backwards) will be saying as soon as they read the new Medicare regulation that provides coverage for end-of-life counseling:

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

...The new rule says Medicare will cover "voluntary advance care planning," to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an "advance directive," stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves [Robert Pear, "Obama Returns to End-of-Life Plan That Caused Stir," New York Times, 2010.12.25].

Now you will hear Sarah Palin and other opponents of common sense cry again that President Obama is trying euthanize your grandma. So read carefully: this regulation, just like the Section 1233 of the health care reform bill that Dems dropped in the face of baseless conservative freak-out propganda, does not deny anyone care. This regulation increases the quantity and quality of care and patient autonomy:

"Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives," the administration said in the preamble to the Medicare regulation, quoting research published this year in the British Medical Journal.

The administration also cited research by Dr. Stacy M. Fischer, an assistant professor at the University of Colorado School of Medicine, who found that "end-of-life discussions between doctor and patient help ensure that one gets the care one wants." In this sense, Dr. Fischer said, such consultations "protect patient autonomy" [Pear, 2010.12.25].

President Obama has taken some lumps in his first two years. But with this move, along with successfully pushing DADT repeal and New Start ratification through a balky lame-duck Senate, the President is showing he can take an elbow and still drive to the net and score.

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Update 2011.01.05: Hold the phone! The White House chickens out on terminology and removes "end-of-life counseling" from that Medicare regulation! Opponents ought to be pleased: the Obama Administration says they pulled the words because there was insufficient opportunity for public discussion of that language in the rule. But don't be fooled: the explanation I just heard on NPR is that Medicare patients and their doctors have been able to discuss end-of-life planning in their initial Medicare physical since 2008, when Congress overrode a Bush veto to add end-of-life plannign to Medicare coverage. The 2010 PPACA extends Medicare coverage from one physical ever to one physical each year. So doctors can discuss end-of-life planning at every one of these physicals. And that's a good thing, since patients may change their minds about end-of-life options as the grow older.

8 Comments

  1. Kevin J. Weiland 2010.12.27

    Thank you Mr. President for this vital piece of Health Care Reform. Nearly 80 to 90% of our over two trillion dollar health care dollar is spent near the end of life. What better way to save health care dollars than to have, at least, a civil, informed, end of life discussion with our patients, to honor their wishs, not ours. As a physician with an aging population and increasing overhead, the cost of medicine has required our clinics to see more patients and not allowing enough time to discuss this very important issue. Chaulk one up for the preservation of the primary care phsycian on this one Mr. President.

  2. nonnie 2010.12.27

    Wow, is this really Dr. Weiland posting this? With the misspellings, punctuation errors, and grammar errors? Past that, how is that going to save health care dollars if it is not intended to encourage patients to withhold or end treatments that could extend their lives or make their lives more comfortable, if there is no hope for cure? I have a cousin who is alive today who would have been dead years ago as her treatments have not cured her but have extended her life. I have a cousin who was born with health issues years ago who is still alive, but under Obamacare probably would not have been. A doctor who needs to be paid extra to take a few extra minutes to confer with a patient regarding end of life issues during an office visit is not honoring his Hippocratic oath. They can and should do this as part of medical care, and probably do, but I don't think that is the aim of this "vital piece of health care reform." As stated before, the only way this is going to save health care dollars, while spending more, is if the intent is to convince patients not to attempt treatments and incur additional expense if the end result will not be cure. Is this truly where our country is heading? It is very dangerous to give the fed gov't bureaucrats the authority to determine who deserves medical care and to what extent, and I fail to see any reason for this "vital piece" if this is not the final intent.

  3. Thad Wasson 2010.12.27

    This has been in place for decades. Its called D.N.R....do not resuscitate. Its a legal document explaining your end of life wishes.

    This insert is nothing more than the government growing larger and more invasive.

  4. caheidelberger Post author | 2010.12.27

    Thad, where's the invasive part of Medicare saying to patients and doctors that Medicare will cover one more service?

    Linda, the regulation does none of what you fear. As the original article stated, end-of-life counseling improves quality of life and patient autonomy. The regulation does not empower any bureaucrats to make any decisions about who gets what care. This Medicare reimbursement will make it easier for doctors to fulfill the Hippocratic oath by having these conversations on the clock with patients... unless you're suggesting that doctors should give this kind of service for free....

  5. nonnie 2010.12.27

    So why the big hush-hush to keep this "big accomplishment" secret for as long as possible? According to an email from Rep Earl Blumenauer (D-Oregon) in November when these new regulations were being drafted, "We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ – emails can too easily be forwarded… Thus far, it seems that no press or blogs have discovered [the new Medicare regulations]...The longer this goes unnoticed, the better our chances of keeping it.” And why after this was taken out of the health care bill was this now implemented via regulation? Just another example of how Obama is bypassing Congress and usurping power. The purpose of this is to influence people to use less Obamacare, plain and simple. Doctors already can talk to patients about this issue in any office visit and be paid for it. Why a special regulation, and who knows if this is voluntary or mandatory, how often it needs to be done, if a doctor is penalized financial wise if he does not do this yearly, what type of brochures and information will be provided by the gov't and how it will be geared to be informational or biased in favor of less care, etc. This is just bad and gives too much power to the feds to influence care.

  6. caheidelberger Post author | 2010.12.28

    If there's any hush, it's probably because the administration knows the Palindrones are just waiting to scream their lies again. The administration does us a disservice by trying to keep positive actions quiet simply because they fear propaganda from the other side.

  7. Barbara Hall 2010.12.28

    OK, this is why this is important.

    First, doctors generally do not get paid for talking to patients. They are usually only paid for treating a diagnosis. If they include a discussion of end-of-life options it is rolled into payment for the treatment. (i.e. the talk is free.) And with the focus on seeing more patients to maintain productivity, this is one discussion that is often set aside.

    Having a doctor take time to seriously talk to you about death is rare. Even rarer is the patient who really gets the complexity of dying. It starts long before and goes far beyond a DNR scenario. Doctors, because of our training, our unawareness of costs, and our fear of lawsuits can and will spend a lot of health care dollars, not just on treatment, but on futile care that many patients do not even want once they actually see what is involved. (But then it can involve withdrawing care and it gets even more emotional.)

    So, if doctors are paid to take the time to talk to their patients once a year, if patients can have an informed voice in their end-of-life care, and if unwanted care can be reduced, it will be better and yes, cheaper for everyone. Without anyone rounding up the grandparents or denying them care.

  8. JOHNSD 2010.12.29

    My physician knows I don't want to be a vegetable. That's good enough.

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