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547368 tn?1440541785

Medicare Approves End-of Life Counseling

I found this as I was searching on another topic. I thought it may be of interest to we seniors. Personally I think it may be a good idea - but is it the next step TO - end our lives if we are not viewed as productive, contributing members of society? A sticky issue - or long over due? I'm hoping for comments.

Dated, October 30, 2015 Here's the article - from Medscape Medical News - in part:
A proposal too hot to handle in the nascent days of the Affordable Care Act (ACA) became a reality today when the Centers for Medicare and Medicaid Services (CMS) approved payment for voluntary end-of-life counseling as part of its 2016 Medicare physician fee schedule.

The new policy will help seniors "make important decisions that give them control over the type of care they receive and when they receive it," CMS said in a news release.

The decision to pay for so-called advance-care planning (ACP) initially will fall to Medicare administrative contractors (MACs) that process claims on behalf of Medicare.

An early version of the healthcare reform law called for paying physicians under Medicare for ACP — that is, discussing advance directives, hospice care, and other end-of-life issues with patients. Supporters of the idea said it would address the problem of physicians not taking the time for such important conversations because they were not reimbursable in a fee-for-service system. However, that provision was dropped after ACA critics erroneously claimed that the law would establish "death panels" with the goal of reducing healthcare costs by culling sickly seniors from the population.

CMS reintroduced the proposal to pay for ACP to far less flak this summer in the first draft of its Medicare physician fee schedule for 2016. Today, the agency released the final version of the fee schedule, with the proposal intact.

The American Medical Association and many other medical societies support paying for end-of-life counseling, although the small but vocal Association of American Physicians and Surgeons contends that such fees would "create financial incentives to persuade patients to consent to the denial of care."

In the final version of the fee schedule, CMS said it received roughly 725 public comments on its ACP proposal since it was first floated this summer. The agency noted that "the vast majority of comments indicate that most patients desire access to ACP services as they prepare for important medical decisions."

What do you think?

Warm Wishes to Y'all,
~Tuck
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649848 tn?1534633700
I just happened on this post by accident, so I hope you don't mind if I comment...

My primary care doctor has been bugging me for several years about whether or not I have advance directives aka healthcare surrogate and end of life plans and they keep asking for copies.  I have yet to provide them, because I'm not sure, at this point, it's any of their business.

I do feel, that in some cases, end of life counseling could cause some patients to deny certain treatments even though such treatment may be of benefit.  

I also feel that doctors may not take the time to properly explain certain treatments to their elderly patients (or the patient's advocate), thereby being able to deny simple treatments, such as administering certain vitamins/minerals, etc, that could help improve someone's quality of life...
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547368 tn?1440541785
You are always welcome here. Your comments are appreciated - and I agree.

End-of-Life Counseling can be beneficial - but like you I am concerned that not all options may be offered. Certainly as you suggested some ppl may see such counseling as "the end" and refuse to accept available treatments and such - or worse simply give up.

After too many years of experience in geriatric care - and being too much a part of end-of-life issues with close loved ones I have come to know just one thing. End-of-life wishes and so forth is a very individualized experience. What is comfortable and important to one is not for another.

I may have learned two things - end-of-life issues are not just for our seniors. I almost lost my life in my early 30s. There is no good reason why I am still on this earth. Maybe because of my upbringing and background I have verbally made my wishes known to all my loved ones since I was in my twenties.

Barb, take your time to sign those papers - do so when it's right for you. But don't take your time in letting those that may be involved in a decision making situation wait one more day without knowing your wishes. If the worse would happen tomorrow they need to know what you want and don't want. It shouldn't be a causal conversation - and it should be repeated.

It brings comfort to loved ones when they can say, "This is what dad wanted." - or - "I did exactly what mom told me to do." - or sadly, "My son gave specific directions that I was to do this." Loved ones won't second guess and be left with the burden of making a decision - and wondering if they did right.

That's my two cents for what it's worth. Again please stop by in any of "my" communities often. You're always welcome.

~Tuck  
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