Medicare to Cover End-of-Life Discussions

Beginning in January, Medicare will reimburse physicians for discussions held with patients about end-of-life treatment options. The provision, which Democrats had to drop to get health care reform passed, allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

It requires only that Medicare cover end-of-life consultations for patients who want it. The "voluntary advance care planning" language was included in a regulation issued in early December that deals with annual wellness visits.

According to a New York Times article, the regulation was issued quietly in hopes of avoiding the controversy raised early in the reform debate when former Alaska Gov. Sarah Palin and some other Republicans claimed such counseling would create "death panels."

The new Medicare rule will pay for elective annual discussions about end-of-life plans, which can be used to prepare an advance directive stating which treatments a patient would want and which they would not want.

For years, federal laws and policies have encouraged Americans to think ahead about end-of-life decisions and make their wishes known in advance through living wills and similar legal documents. But when House Democrats proposed last year to pay doctors for end-of-life counseling, it touched off a wave of suspicion and anger.

Opponents said end-of-life planning should be left to families, while proponents said doctors' advice was a basic element of health care. Prominent Republicans singled it out as a glaring example of government overreach.

Although advance planning never made it into the law, few Republicans joined in supporting the health care overhaul, President Barack Obama's signature domestic legislative achievement.

Rep. Earl Blumenauer (D-OR) was one of the main supporters of the provision and had urged the Obama administration to count end-of-life planning as a wellness benefit. Blumenauer praised the new regulation but said his office wanted to keep news of the regulation quiet as long as possible so critics—especially Republican leaders—would not try to reverse the regulation or bring up the old "death panel myth," according to the New York Times article.

Recent studies on advance directives have shown that planning improved the likelihood that a patient's wishes would be followed and reduced emotional trauma among family members.

For more:

• Medicare to Cover End-of-Life Planning Talks (MedPage Today)
• Obama Returns to End-of-Life Plan That Caused Stir (New York Times)
• Medicare regulation revives end-of-life planning (AP)