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.”