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Start the most difficult conversation American isn’t having- the conversation about our end of life preferences

Iowa GOP Rep. Works To Prevent Reimbursement Of End Of Life Talks: Calls Policy “Life-Devaluing”

Courtesy Wikimedia Commons
Courtesy Wikimedia Commons

Proposed legislation would prohibit Medicare from covering advance care planning services.

Rep. Steve King, R-Iowa, introduced H.R. 3251 in response to a sweeping policy change from the Centers for Medicare and Medicaid Services (CMS) to pay doctors for end of life counseling in 2016. The policy change follows recommendations from the American Medical Association to make advance care planning services a separately payable service under Medicare.

“Allowing the federal government to marry its need to save dollars with the promotion of end-of-life counseling is not in the interest of millions of Americans who were promised life-sustaining care in their older years in exchange for their compelled funding of the program during their working years,” read a statement following the bill’s introduction on July 29. “We need to block this harmful regulation before the Administration imposes yet another life-devaluing policy on the American people.”

Rep. Steve King, Courtesy WikiMedia Commons
Rep. Steve King, Courtesy WikiMedia Commons

King did not respond to requests for comment from Life Matters Media.

The bill has little chance of becoming law. However, it reflects deep concerns about so-called “death panels,” a widely discredited claim from former Alaska Gov. Sarah Palin that bureaucrats would choose which seriously ill patients receive life-saving treatments.

“Obamacare is about unnecessary government intervention and, ultimately, it’s all about government control,” Palin wrote on her Facebook page following the rule change. “Government needs to stay the hell out of our ‘end-of-life’ discussions.”

The CMS policy change, praised by major medical associations,  hospice providers and patient advocates, comes nearly six years after similar proposals were dropped from the Affordable Care Act.

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

Former Alaska Gov. Sarah Palin. Courtesy WIkiMedia Commons.
Former Alaska Gov. Sarah Palin. Courtesy WikiMedia Commons.

The change was announced about a year after a widely circulated report from the Institute of Medicine found that far too few Americans have serious discussions about their care wishes.  As a result, they receive unwanted, unnecessary and often painful treatments in their last days 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.”