Medicare Outlines End-Of-Life Planning Proposal That Will Make Sarah Palin's Head Explode

WASHINGTON, DC - SEPTEMBER 26:  Former Alaska Gov. Sarah Palin (R) speaks at the 2014 Values Voter Summit September 26, 2014
WASHINGTON, DC - SEPTEMBER 26: Former Alaska Gov. Sarah Palin (R) speaks at the 2014 Values Voter Summit September 26, 2014 in Washington, DC. The Family Research Council (FRC) hosting its 9th annual Values Voter Summit inviting conservatives to participate in a straw poll. (Photo by Mark Wilson/Getty Images)

WASHINGTON -- Physicians would be paid to discuss end-of-life options with Medicare patients who want their wishes spelled out in advance under a regulation proposed by the federal government Wednesday.

Medical societies and seniors' groups like the AARP have long supported so-called advance care planning as a way for patients to consider whether they want intensive medical care in the event of a life-threatening illness near the close of their lives, and to make their preferences known to their loved ones in writing. But Medicare has never had a mechanism with which to pay doctors for this counseling, except during a physical exam when beneficiaries first enroll in the program.

“Today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team, as part of coordinated, patient- and family-centered care," Centers for Medicare and Medicaid Services Chief Medical Officer Patrick Conway said in a statement. "CMS looks forward to gathering public input on this proposal.”

An early version of the legislation that became the Affordable Care Act, President Barack Obama's health care reform law, would have established a way for Medicare to pay physicians who discuss end-of-life options with patients. The plan was derailed, however, when ex-Alaska Gov. Sarah Palin, the 2008 Republican vice-presidential nominee, falsely labeled these voluntary counseling sessions as "death panels" that would cut off medical care to older Americans against their wills.

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil," Palin wrote in an August 2009 Facebook post.

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The "death panel" charge earned the dubious distinction of being named PolitiFact's "Lie of the Year" in 2009, but its power extended beyond the pressure that led Congress to remove the provision from the health care bill. The false claim penetrated the public consciousness, and polls have shown that large pluralities of Americans continue to believe the Affordable Care Act allows the federal government to cut off medical treatments for people deemed too sick. And that's despite the fact that the term "death panel" has been used to describe several other parts of the health care law, such as a commission charged with containing Medicare spending.

In May, 66 organizations representing medical providers and senior citizens, including the AMA and the AARP, wrote to Health and Human Services Secretary Sylvia Mathews Burwell urging the federal government to establish a way to pay for advance care planning.

"Published, peer‐reviewed research shows that ACP [advance care planning] leads to better care, higher patient and family satisfaction, fewer unwanted hospitalizations, and lower rates of caregiver distress, depression and lost productivity," the organizations wrote. "ACP is particularly important for Medicare beneficiaries because many have multiple chronic illnesses, receive care at home from family and other caregivers, and their children and other family members are often involved in making medical decisions."

Sens. Johnny Isakson (R-Ga.) and Mark Warner (D-Va.) are the lead sponsors of a bill that would establish Medicare physician payments for end-of-life discussions between doctors and patients. The provisions that were excised from the health care reform legislation in 2009 were based on a bill also sponsored by Isakson.

The policy proposed Wednesday by the Centers for Medicare and Medicaid Services, which would take effect next year, builds on recommendations made by the AMA to create billing codes under Medicare that physicians can use to charge for these counseling sessions. During the sessions, patients would get advice on a range of options, from minimal medical interventions to demanding that every treatment possible be offered near the end of life. Patients can choose whether or not to schedule end-of-life counseling.

The proposed regulation, whose main purpose is to establish all physician payment rates for 2016, now faces a public comment period that closes on Sept. 8.



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