Medicare Okays End-of-Life Discussion Reimbursements

The Centers for Medicare and Medicaid Services has approved a rule that will provide Medicare reimbursements for health care practitioners to hold discussions with patients about end-of-life decisions.

“We received overwhelmingly positive comments about the importance of these conversations between physicians and patients,” Dr. Patrick Conway, chief medical officer at the CMMS, told the New York Times. “We know that many patients and families want to have these discussions.”

Under the final rule, he said, “patients and families can have the discussions when and where they want”—before patients become ill, after they receive a diagnosis of cancer or other serious illness or while they are receiving hospice or palliative care. In such conversations patients could discuss whether and how they would want to be kept alive if they became too sick to speak for themselves. Doctors can advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment. Under the rule, officials said, Medicare would pay $86 for the first 30 minutes of “advance-care planning” in a doctor’s office and $80 for the service in a hospital. In both settings, they said, Medicare will pay up to $75 for 30 additional minutes of consultation. These standard amounts can be adjusted for differences in costs in different parts of the country.

The CMMS issued the new rule Friday. It takes effect in January. It specifies that advance care planning is to take place “at the discretion of the beneficiary.” When the proposal was first discussed in the year before the Affordable Care Act was passed, former vice presidential candidate Sarah Palin warned that it would lead to the establishment of “death panels.”

When the rule was revived this summer, Burke Balch, director of the National Right to Life Committee’s Powell Center for Medical Ethics, commented in an interview, “We all support the idea that individuals have the right to make decisions about their treatment. The problem is that in practice there’s a deliberate effort not to give a sort of neutral, balanced, informed-consent type of information so that people can indicate their own preferences, but rather to ‘nudge’ them, in the words of a Health Affairs article we cite, towards the preferred result.”