Originally published August 4, 2015, last updated August 5, 2015

Medicare Change Involves Your End-of-Life Decisions

You may be hearing the term “death panel” in the news again, but this time, it appears mostly as historical context.

Medicare announced on July 8 that it will start paying doctors to provide “advanced care planning,” also called “end-of-life planning,” for beneficiaries on Jan. 1. When a similar proposal appeared in the federal Affordable Care Act six years ago, opponents called it a government-sanctioned “death panel,” veering the debate into political territory — and off course. Subsequently, it was dropped from the health reform law then. Now, rather than ignite the same firestorm, the proposal is being heralded as “groundbreaking,” a “game-changer” and a “seismic” shift for Medicare. Why the shift? What does it mean for you?

The government already pays doctors to discuss end-of-life issues — but only during a “Welcome to Medicare” visit. Under the new proposal, which would begin in 2016, physicians will get paid by Medicare for having voluntary consultations with patients and their families about end-of-life medical planning and needs. By establishing separate payment codes, the government is providing beneficiaries and practitioners greater opportunity and flexibility to discuss end-of-life issues at the most appropriate time, according to the Centers for Medicare and Medicaid Services. Instead of only discussing these issues at the Medicare enrollment visit — which is often years before needed — the proposal aims to better enable seniors to make important decisions that give them control over the type of care they receive and when they receive it. For example, would you want to be kept alive if you become too sick to speak for yourself? An advanced care planning discussion would be voluntarily, meaning you could talk to your doctor about it when you feel comfortable, and ideally, before a crisis.

This is considered a major shift for several reasons. It pushes end-of-life discussions into the mainstream of medical care. In a system that typically reimburses doctors only for procedures, it creates an incentive to engage in a difficult, often hard-to-broach subject. And it could ease families into the discussion, in hopes of eliminating the stress on them and their families of having to make decisions during a crisis. According to a 2014 study from Fidelity recently reported in a Forbes.com article, 75% of adult children and their parents think it’s important to have honest conversations about things like wills and end-of-life wishes — but 64% can’t agree on when.

While death is still a tough topic to approach, there’s a greater cultural understanding today of the need to discuss advanced care planning versus six years ago. This is partly due to greater understanding of diseases such as Alzheimer’s.

"More and more Americans are facing advanced illness and are aging with multiple chronic health conditions, so it's now more important than ever to have these vital conversations," said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. In a press release, the organization said it enthusiastically supports this new proposed rule and has long championed the need for Americans to talk about and document their health care preferences with their loved ones and health care professionals. The new rule also was welcomed by the American Medical Association (AMA).

Despite greater acceptance and support of the idea of advanced care planning, some people still oppose government-sponsored end-of-life discussions. The National Right to Life Committee feels that health care providers will pressure patients into forgoing treatment, according to the StarTribune.com.

The “death panel” rhetoric is not as fierce as in 2009 — so far, anyway. We’re currently in a 60-day comment period. Medicare hopes to follow it by filing its proposal by Nov. 1 and activating the new regulation by Jan. 1, according to the Boston Globe. (You can review the proposed rule here and submit your comment at the top of the same government website by clicking on the green “submit a formal comment” button.)

To access resources to help you address end-of-life planning issues, visit:

• NHPCO's Caring Info website, which has state-specific advance directive forms and information on advance care planning
• The Conversation Project’s starter kit

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