The ability of Americans to receive end-of-life counseling took a major step forward last week when the Obama administration authorized Medicare to compensate doctors for those sensitive but frequently desired conversations.
The rule goes into effect Jan. 1, 2016, and follows what has been said to be overwhelmingly favorable reaction since the step was proposed in July.
The rule provides the all-important codes which doctors must have to receive payment through Medicare. The sessions can be 30 minutes in duration, with a second session of the same length, and they can occur at any time. Those covered by Medicare do not have to wait until they are ill to bring up the topic with their doctor.
The New York Times reported the issuance of the new rule on Saturday.
The rule makes it clear that end-of-life conversations can occur only at the request of the patient. They are expected to include a patient’s options when major medical treatment is declined, or might fail and how a patient’s wishes can be assured when a patient can no longer communicate.
The rule has been praised by the American Medical Association and the American Hospital Association.
A comprehensive end-of-life personal instruction package usually involves a thorough conversation with a doctor resulting in decisions affirmed by an attorney and by one or two close family members, all recorded as an advance directive. It is the conversation about the options contained in an advance directive that are so important, and which as a result of this rule Medicare will soon cover.
An individual’s ability to discuss end-of-life decisions with a doctor compensated by Medicare is long overdue. That conversation is as important, or more important, than the regular patient-doctor conversations about physical and mental health that occur over decades.
Physician payment for these conversations was an initial component of the Affordable Care Act some six years ago. But for those who wanted to up end the extensive federal health-care plan, these doctor-patient conversations were a ripe target. Critics of Obamacare painted a graphic picture of end-of-life decisions being made by anonymous panels, most likely on the basis of cost, which would doom the elderly and the infirm who were eager to live on. The hyperbole was inaccurate and harmful and was the worst kind of bad politics.
While including end-of-life conversations in Medicare reimbursement is very significant, states have roles as well. California’s governor has signed legislation allowing patients near the end of life to receive life-ending care, if they wish. California thus joins several other states which have been leaders in this field. Colorado should be a part of that group, as well.
An individual’s control over the final months and weeks of his life has been noticeably missing in a country that values freedoms. Progress is being made to change that.
