Medicare Proposes Reimbursing Doctors For End-of-Life Planning Talk: Here's What It Means

Doctors being reimbursed for end-of-life discussions with patients is not a new topic. If you remember the “Death Panel” rhetoric from years back it made it seem as if doctors and the government were being incentivized to evaluate your health and determine your fate. PolitiFact deemed this the biggest lie of 2009 and it’s taken six years — and a really well-written letter — to revisit the issue in a rational manner.

A few months ago, 66 organizations that represent senior citizens as well as medical conditions and professionals — including AARP, American Heart Association, American Nurses Association, and The National Hospice and Palliative Care Organization — sent this letter to Health and Human Services Secretary Sylvia Matthews Bruwell asking the federal government to start paying Medicare providers to discuss advance care planning with patients. Here’s an excerpt:

“Complex ACP involves one or more meeting(s), lasting 30 minutes or more, during which the patient’s values and preferences are discussed and documented, and used to guide decisions regarding future care for serious illnesses. These consultations are voluntary on the part of the patient and the patient’s preferences are paramount. The patient may choose to include his/her family, caregiver (if applicable) in the decision making process.”

This could be a real thing come January 1, 2016 if Congress approaches this topic like rational adults. Rather than get too bogged down in the details, we’re going to answer the simple question: What is advance care planning?

It’s an Advance Directive, which is a Living Will combined with a Health Care Proxy. This simply states how you want to be treated if you’re suffering from a terminal disease or accident with no chance for recovery.

You don’t even have to talk to a doctor to fill this out. We have them on our site right here: State-by-State Advance Directive Forms. Find your state, print it out, fill it out, and you’ve just done some advance care planning.

But wouldn’t it be nice to talk to your doctor and get all the facts and details? To learn what life support does to your body. To know how medical professionals might diagnose your condition at that point of your life. To help you actually fill out this document and make informed decisions — whether you want to be kept alive at all costs or if you’re all in favor of having your plug pulled when the time comes.

Shouldn’t doctors get paid to offer this expert advice and guidance? Of course they should.

It’s Not Always Easy For Doctors To Talk About Either

Data presented at an American Heart Association event stated only “12-percent of health care providers surveyed reported having annual discussions about end-of-life care with patients with [heart failure] and their families.” The reasons given:

• Perception of patient
• Family unreadiness
• Provider discomfort
• Fear of destroying hope
• Lack of time

This isn’t an easy discussion to have. It’s rarely easy to talk about death. If these talks become part of the process for all patients, perhaps it’ll get easier. Or at least more normal.

Advance care planning helps medical professionals do their jobs better. The default for all doctors, nurses, paramedics, etc. is to keep you alive at all costs. That’s their job. An Advance Directive is a way for them to respect their patient’s decisions. This doesn’t mean they give up and watch you die. It means they can be more judicious when ordering multiple tests and invasive procedures, especially if you don’t want or need them.

This brings us to the touchy subject of cost.

The Financial Component Involved...

No one can put a price on life, but healthcare, as we all know, is often outrageously expensive. Let’s agree that beneficial treatments, regardless of the cost, are worth it. But what about the ones that aren’t necessarily beneficial?

Forbes touched on this topic in an article titled “Why 5% of Patients Create 50% of Health Care Costs,” which cited such statistics as “30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life.”

The most eloquent part of the article didn’t involve numbers:

“It seems that no matter how much money you use during that last year/month, if the person is sick enough, the effort makes things worse. A lot of the money being spent is not only not helping, it is making that patient endure more bad experiences on a daily basis. The patient’s quality of life is being sacrificed by increasing the cost of death.”

Everplans is in the making “plans” business. It’s right there in our name. Part of planning is making sure you don’t force other people to make decisions you should have made yourself.

There’s nothing wrong with knowing all the options you have available. There’s nothing wrong with using that knowledge to make informed decisions based on your beliefs and preferences. There’s nothing wrong with being uncomfortable when speaking about these topics because they can be sad and scary. And there’s nothing wrong with incentivizing doctors to have these tough discussions and, hopefully, make it all little easier.