Six Years After ‘Death Panels’ Debate, Medicare To Pay For End Of Life Talks

Six Years After ‘Death Panels’ Debate, Medicare To Pay For End Of Life Talks

Posted on Thursday, July 9th, 2015 at 9:34 am by lifemediamatters

Courtesy WikiMedia Commons

Courtesy WikiMedia Commons

Medicare plans to reimburse physicians for counseling patients about their end of life care options.

The unexpected change comes nearly six years after similar proposals were dropped from President Obama’s health reform law and inaccurately compared to “death panels” by some conservative politicians, most notably former Alaska Gov. Sarah Palin.

The policy change, effective January 1, is part of a massive regulation released Wednesday. The change follows recommendations from the American Medical Association to make advance care planning services a separately payable service under Medicare.

“As a practicing physician, and a son, and someone who has dealt with this in his own family, I would say these are discussions … that are critical to high-quality care,” Patrick Conway, Medicare’s chief medical officer, told the Associated Press. “I would want any American who wanted to have this conversation with their clinician to have the opportunity to do so.”

The Centers for Medicare & Medicaid Services could not be reached for further comment.

Some physicians already have end of life conversations with their adult patients without billing for it, and some private insurers offer reimbursement.

But advocates hope Medicare coverage for some 55 million older Americans will make such talks more common and encourage patients to complete advance health care directives, such as a living will or power of attorney document.

The National Hospice and Palliative Care Organization praised the policy change.

“NHPCO has long championed the need for Americans to talk about and document their healthcare preferences with their loved ones and healthcare professionals,” said NHPCO President J. Donald Schumacher in a statement sent to Life Matters Media.  “More and more Americans are facing advanced illness and are aging with multiple chronic health conditions, so it’s now more important than ever to have these vital conversations.”

Concerned parties have 60 days to comment on the new regulation before it is finalized.

The ruling comes almost a year after a widely circulated report from the Institute of Medicine found that far too many Americans avoid serious discussion about their care wishes and as a result receive unwanted, unnecessary and often painful treatments in their last moments of life.

The report cited the present as the best time to encourage advance care planning, partly because of the aging population and growing number of Americans living longer with chronic diseases.

“Most people nearing the end of life are not physically, mentally, or cognitively able to make their own decisions about care…Therefore, advance care planning is essential to ensure that patients receive care reflecting their values, goals, and preferences,” according to the 2014 report. “Of people who indicate end of life care preferences, most choose care focused on alleviating pain and suffering. However, because the default mode of hospital treatment is acute care, advance planning and medical orders are needed to ensure that these preferences are honored.”

Video Urges Hospice Providers To Treat Patients’ Terminal Prognosis

Posted on Sunday, April 12th, 2015 at 9:03 am by lifemediamatters

The National Hospice and Palliative Care Organization (NHPCO) is circulating a video that encourages hospice providers to think in terms of terminal prognosis and not only principal diagnosis when caring for dying patients.

“Determining what aspects of care hospice providers are responsible for has become an issue of growing importance in recent months,” according to a NHPCO statement sent to Life Matters Media. “There is significant concern from regulators on Capitol Hill that some providers may be relying on a single diagnosis, thereby defining their scope of responsibility too narrowly, ultimately failing to provide and coordinate all the care and services that they should.”


President J. Donald Schumacher talks about treating patients’ terminal prognosis

The Centers for Medicare and Medicaid Services (CMS) requires a principal diagnosis on reimbursement forms for patients using the Medicare hospice benefit. However, “principal diagnosis” is often only part of what should be reported to provide more comprehensive reasoning for a patient’s short life expectancy. In 2013, 67 percent of claims listed only one diagnosis.

Hospice care aims to provide comfort and pain management for terminally ill patients with a life expectancy of six months or less. It is most often used when curative treatments are no longer effective.

“As providers of hospice care, we must properly frame the way we think about and characterize our patients and the scope of our responsibility in providing care to them,” said J. Donald Schumacher, NHPCO president and CEO, in a statement. “The question can be asked, ‘Does this diagnosis or condition contribute to or influence the patient’s terminal prognosis?’ If so, then it is our responsibility.”

The NHPCO, the nation’s largest nonprofit organization representing hospice and palliative care programs, created the 10-minute video for use during hospice staff meetings and training. Jonathan Keyserling, senior vice president of health policy, said a series of complex issues needed clarification among providers, including a congressional mandate to reform payment methodology..

“An effective tool is to look at all those items that are connected to the prognosis that qualifies a patient and their family for hospice services under Medicare,” Keyserling said. “It’s really a reiteration of the existing statute. The Affordable Care Act has nothing to do with this affirmation.”

Although the video is not targeted to patients and families, Keyserling hopes it encourages them to have a conversation about their end of life care wishes, even if it does not involve hospice.

“We think it’s critically important that families sit down and have a conversation about their goals and objectives at the end of life,” he added. “It’s therapeutically neutral, but we encourage families to have that conversation so that there are no surprises, so that when a patient is not able to speak, then their loved ones have a good idea about what that patient would have wished.”

Hospice Use: New Facts and Figures

Posted on Tuesday, November 12th, 2013 at 9:36 am by lifemediamatters

In 2012, 1.6 million Americans received hospice care; 36 percent died or were discharged within seven days of admission.

Image: 'Love' by Denise Mayumi via Flickr

‘Love’ by Denise Mayumi

New findings published in the annual hospice facts and figures report show nearly 80 percent of hospice patients receive care for less than 90 days before dying. The median length of a hospice stay is only about 19 days, and the findings are both consistent with those of 2011 and troubling to study researchers.

The report, “Facts and Figures: Hospice Care in America,” was conducted by National Hospice and Palliative Care Organization. It provides data on hospice trends and updated information on the growth, delivery and quality of hospice care throughout the U.S.

“As hospice and palliative care professionals, we need to continue reaching out to patients and family caregivers to help them understand all the benefits that hospice care brings,” said NHPCO President and CEO J. Donald Schumacher, Psy.D in a press release. “As part of our ongoing engagement efforts, we must continue our efforts to reach communities that are under-utilizing hospice care.”

Hospice Use

Hospice is care that aims to provide comfort and pain management rather than aggressive treatments– usually only for terminally ill patients with six months or less to live. It is most often used when curative treatments are no longer effective. Cancer remains the most common diagnosis for patients seeking hospice; 37 percent of enrollees are cancer patients.

Sixty-six percent of patients who receive hospice benefits remain in the place they call home, whether it be a private residence or nursing home, unchanged from 2011. The gender divide between hospice patients also remains unchanged; 56 percent of hospice patients are female.

Since the founding of the first American hospice in 1974, more than five thousand hospice programs have opened throughout the U.S. The Medicare hospice benefit, enacted by Congress in 1982, remains the predominant source of payment. Eighty-four percent of patients receive coverage through the benefit.

Palliative Medicine, Hospice Care?

Posted on Tuesday, December 4th, 2012 at 7:50 pm by Life Matters Media

Despite its growing popularity in hospitals, most Americans remain unaware of the comfort and benefits palliative care can provide some terminally ill patients.

“There is a clear need to inform consumers about palliative care and provide consumers with a definition of palliative care,” researchers commissioned by the Center to Advance Palliative Care advise. According to Public Opinion Research on Palliative Care, seventy percent of the general population doesn’t know anything about palliative care, and 14 percent were “somewhat knowledgeable.”

The researchers also found that it is difficult to inform physicians about palliative care, because they often wrongly equate it with hospice or end of life care.

Public Opinion Strategies

Palliative care becoming more popular

Palliative care is treatment that enhances comfort and improves the quality of life for patients in life’s last phase. No therapy is excluded from consideration, according to the National Hospice and Palliative Care Organization (NHPCO).

Palliative care is becoming increasingly widespread. There are more than 1,600 hospitals that have palliative care programs in the U.S., according to Dr. Diane Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine. Some 85 percent of large hospitals have a palliative care team. Sixty-seven percent of small hospitals have programs.

Dr. William H. Frist, a heart transplant surgeon and former U.S. Senate Majority Leader, recommends palliative care. “[A] brand new field in medicine is making chronic, agonizing, and even terminal illnesses much more manageable… palliative care has emerged as the best solution for those facing serious, painful diseases, and introduces the very real possibility… that we can now live with these diseases for a long time,” he wrote recently for The Week.

Public Opinion Strategies

Palliative care also costs much less than aggressive end of life regimens. Patients who receive palliative care services cost hospitals between $1,700 and $5,000 less per admission, according to findings published in the Archives of Internal Medicine.

Hospice care remains overlooked

Hospice care is different from palliative care; its aim is to manage symptoms so that a person’s last days are spent with dignity and quality. The care is not intended to treat the disease but the person, according to the American Cancer Society.

Hospice is most often used when curative treatment is no longer effective, and a terminal patient is expected to live about six months or less.

“Many people believe that hospice is only for people who have cancer. This may be due to the fact that many of the patients cared for in the early days of hospice were cancer patients,” Becky Hillier, public relations director for Rocky Mountain Hospice, wrote for the Montana Standard. Less than 25 percent of hospice patients admitted to the hospice are cancer patients.

The NHPCO reports that 36 percent of hospice patients die or are discharged within seven days of treatment. Many terminally ill suffer more than they need to because they wait to enroll in a hospice program.

“We continue to see more dying Americans opting for hospice care at the end of their lives, yet far too many receive care for a week or less,” said the NCPCO’s J. Donald Schumacher. “We need to reach patients earlier in the course of their illness to ensure they receive the full benefits that hospice and palliative care can offer.”

One reason the terminally ill wait for hospice, he said, is due to the misconception that hospice means giving up.