Six years ago, a proposal to compensate physicians for talking to patients about their treatment in their last days was stripped from the Affordable Care Act after critics made dark predictions about “death panels” and government rationing of care to senior citizens.
Last week, with little fanfare, the federal government announced that as of Jan. 1, it would begin paying doctors for these counseling sessions — and millions will get more of a voice in their end-of-life treatment.
Nothing currently stops physicians from offering end-of-life consultations, of course. Some doctors provide the service without getting paid for the counseling time, and some private insurers already reimburse for it.
But because Medicare covers 55 million people, making it the largest insurer at the end of life in the United States, its decision to cover advance care planning is significant — and not just because private companies often follow Medicare’s lead.
The move recognizes that people need to be involved in treatment decisions before they become seriously ill or unable to make their wishes known. Patients aren’t getting the care they want, according to a landmark 2014 Institute of Medicine report, “Dying in America“: Instead of dying at home, with measures to ease pain, Americans are receiving unwanted interventions and not enough comfort care.
That said, there are also people who would want doctors to pursue more aggressive steps. And the new Medicare rule wouldn’t keep patients from expressing, in advance, their desire for such procedures.
Encouraging advance care planning discussions also is critical to getting Americans to put their preferred end-of-life treatment options in written form. Only about 30 percent of us have legal documents such as advance care directives or living wills — a situation that too often leaves relatives in the position of deciding what to do next after a parent has had a stroke or is on life-supporting machines in the hospital.
Fears that the new rule is a slippery slope toward rationed care should be allayed by the fact that advance care planning is voluntary. It’s up to each patient whether they have end-of-life discussions with their physician.
In a society where more of us are living longer, we should welcome physician reimbursement for advance care planning as a way to help ensure a dignified conclusion to those additional years of life.
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