Reimbursing Doctors for Discussing End-of-Life Care

June 12, 2014

Medicare may begin reimbursing doctors for discussing end-of-life issues with patients, reports Stateline.

The American Medical Association (AMA) issues annual recommendations to the Centers for Medicare and Medicaid Services (CMS) regarding a number of health care procedures and practices. While CMS is not required to implement the AMA's recommendations, CMS often uses the recommendations to set reimbursement rates for Medicare and Medicaid. Private insurers also tend to follow the reimbursement guidance.

Medicare, the largest health insurer in the United States, has 50 million beneficiaries. The AMA's recommendations will focus on reimbursement for doctors who confer with patients about advance care planning in the case of incapacity. If Medicare reimburses doctors for these services, doctors are more likely to sit down with patients and discuss their end-of-life treatment.

According to studies, patients often forgo invasive, and costly, end of life procedures when given a choice. But some fear that these conversations could lead to rationing or withholding of care. According to Burke Balch, director of the Powell Center for Medical Ethics at the National Right to Life Committee, "It is one thing genuinely to determine what people's treatment wishes are but the danger is very grave that efforts to pay for advance care planning sessions (under) Medicare will turn into subtle efforts to pressure some of the most vulnerable patients to surrender their right to live."

On Capitol Hill, lawmakers are also looking at this issue. Senator Tom Coburn's Medicare Choices Empowerment and Protection Act gives seniors up to $75 for completing advance care directives with CMS. However, the records would not be kept in a national registry -- individuals would tell Medicare where their directive is kept.

Source: Michael Ollove, "Medicare May Begin Paying Doctors Who Discuss End-of-Life Issues," Stateline, June 2, 2014; Randi Belisomo, "Lawmakers propose incentives for end-of-life planning," Reuters, May 6, 2014. 

 

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