Medicare has announced that it will pay doctors for conversations with patients and family about “advance care planning.” This proposal was derailed during debate over the Affordable Care Act, when opponents called them “death panels,” according to The New York Times.
The goal is said to be to “decrease confusion at the end of life” and “potentially decrease unnecessary use of resources because it will be very clear what the patient did and did not want.”
Filling out advance directives is of limited value, some experts said, “because many patients needed several conversations to consider their options and to talk them over with their families.”
Dr. Diane Meier, director of the Center to Advance Palliative Care, told the Times that the proposal was “a huge step forward,” but that paying for the conversations was not enough. She said that Medicare should identify and require documentation of specific components of end-of-life discussions. “What you don’t want to have is a check-box,” she said. “‘Yes I had a conversation — I’m billing for it,’ should not be enough.”
While proposed to be voluntary in Medicare, New York already requires all doctors to offer end-of-life counseling to patients with terminal illnesses, reports Betsy McCaughey, under pain of heavy fines, even jail time, for doctors who don’t. The law prohibits exemptions, even for patients who are religiously or culturally opposed.
McCaughey writes in the New York Post that the Medicare proposal is “being sold as ‘death with dignity,’ but it’s more like dying for dollars. Seniors are nudged to forego life-sustaining procedures and hospital care to go into hospice. That enriches the booming hospice industry and also frees up dollars for the left’s favored social causes.”
The Institute of Medicine doesn’t mince words, McCaughey states. “Scrimping on seniors will free up money ‘to fund highly targeted and carefully tailored social services for both children and adults.’”
“Most advance directives these days consider ‘artificial nutrition and hydration’ (food and water) to be ‘life-sustaining’ medical care,” states AAPS executive director Jane M. Orient. M.D. “Patients who don’t want to risk a prolonged, agonizing death from starvation or dehydration need to be very cautious in preparing their advance directives.”
“They also need to be aware that Medicare or the insurer may give their doctor an incentive to encourage them to ‘choose’ death over potentially life-saving treatment,” she stated.
The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943 to preserve private medicine and the patient-physician relationship.