Medicare to Pay for Advance Health Care Planning

• Tweet

• Tweet

Starting January 1, Medicare will reimburse doctors for voluntary advance health care planning. The new rule encourages doctors and patients to discuss end-of-life treatment options during patients’ annual wellness visits. The information and insight gained can then be used to create an advance health care directive or living will, which communicate instructions for end-of-life care in the event that the patient is unable to do so. In 2009, a similar provision was struck from the Obama health care reform bill after inciting an uproar over government “death panels.”

The White House has said that the George W. Bush administration had already put in place guidelines allowing for Medicare to pay for end-of-life consultations. “The only thing new here is a regulation allowing the discussions to happen in the context of the new annual wellness visit created by the Affordable Care Act,” said White House spokesman Reid Cherlin.

That Obama achieved another element of his health care reform agenda through regulation rather than legislation suggests a strategy that may become more common as control of Congress shifts to the Republican party.

Dr. Donald M. Berwick, Administrator of the Centers for Medicare and Medicaid Services, has said that “using unwanted procedures in terminal illness is a form of assault. In economic terms, it is waste. Several techniques, including advance directives and involvement of patients and families in decision-making, have been shown to reduce inappropriate care at the end of life, leading to both lower cost and more humane care.”

End-of-life treatments for patients with chronic illnesses account for 32% of all Medicare spending, according to the Dartmouth Atlas Project, which analyzes Medicare data. Individuals who make voluntary decisions to reduce or eliminate useless interventions near the end of life can save Medicare billions of dollars annually. As aging baby boomers increasingly rely on Medicare, the need to control health care spending grows urgent.

The new Medicare rule is as much about compassionate care as it is about cost control. Advance health care directives ensure that a patient’s end-of-life wishes and values are respected even if he or she is unable to communicate them. As the United Methodist Church states, advance health care directives “assert the right of every person to die in dignity without efforts to prolong terminal illness merely because the technology is available to do so.”

Related articles

• Living Wills, Health Care Powers of Attorney and Advance Directives (rocketlawyer.com)
• Denounced As “Death Panels,” Funding For End Of Life Counseling Makes A Comeback (outsidethebeltway.com)
• Once more into the end-of-life breach (washingtonmonthly.com)