End-of-Life Conversations and New Medicare Rules

Dec 26, 2010 | 0 comments

The top story in today’s New York Times focuses on a new Medicare policy that goes into effect on January 1, 2011 to pay doctors who discuss and advise patients on options for end-of-life care. The conversation may include advance medical directives from the patient as to whether they may wish to forgo aggressive life-sustaining treatment.

It’s about time.

The furor over “death panels” related to end-of-life planning that erupted last year caused the Democrats to drop that element from the legislation to overhaul the health care system. But the same goal will be achieved by regulation in the New Year.

The final version of the health care legislation signed into law by President Obama in March authorized Medicare coverage of yearly physical examinations, or wellness visits.  The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

Imagine, doctors can actually provide information to patients on how to prepare an advance directive! This is a statement by the patient of how aggressively he or she wishes to be treated if the person is so sick that he/she cannot make health care decisions for themselves. It’s a guideline for the family on what the patient wants, not a death threat.

Our family has personal experience with this. Advance medical directives can be enormously helpful to avoid confusion in the hospital in a health care crisis situation. Yet even with directives in place, there can be discord in the family over treatment. Read our family’s story here.

The Obama administration said research shows the value of end-of-life planning. From the New York Times story:

“Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives,” the administration said in the preamble to the Medicare regulation, quoting research published this year in the British Medical Journal.

The administration also cited research by Dr. Stacy M. Fischer, an assistant professor at the University of Colorado School of Medicine, who found that “end-of-life discussions between doctor and patient help ensure that one gets the care one wants.” In this sense, Dr. Fischer said, such consultations “protect patient autonomy.”

Opponents said the Obama administration was bringing back a procedure that could be used to justify the premature withdrawal of life-sustaining treatment from people with severe illnesses and disabilities.

Pretending we are going to live forever makes it that much harder when we find out that’s not going to happen. Would you prefer medical interventions, some of which might be painful, to stretch out quantity of time, but perhaps not quality of life? Or might hospice or palliative care, the relief of pain without pursuit of a cure and support for the family, be more your preference?

To start thinking about what end-of-life directives you might embrace, check out the Five Wishes from Aging With Dignity and The One Slide Project from Engage With Grace.

Just as talking about sex won’t make you pregnant, talking about end-of-life care won’t make you dead – and your family will benefit from the conversation. No matter how old you are, make a resolution to have a conversation, with your family as well as your doctor, in the New Year.

A Good Goodbye