ICBioethics Blog 

Regarding Medicare’s End-of-life Planning Reimbursement: Consider Proper Goals and Train Providers for Discussions

A recent article in the NY Times (8 Jul 2015) commented on the Medicare decision to begin offering reimbursement for end-of-life planning discussions. The plan would allow “qualified” professionals like doctors, nurse practitioners, and physician assistants to be reimbursed for face-to-face conversations with a patient and whomever the patient chooses to include. Some private insurers are already covering these and more will once Medicare’s new rules are in place.

From an ethicist’s standpoint this sounds like good news, but the NYT article goes on to quote other professionals whose concerns mimic my own. Dr. Diane Meier, Director of the Center to Advance Palliative Care said, “it’s not enough to pay for it. You have to make sure people know what they’re doing and are well trained.” Good point!

Also, Burke Balch, Director of the National Right to Life Committee’s Powell Center for Medical Ethics fears a bias occurring in some advance care or end-of-life planning “nudging individuals to reject lifesaving medical treatment,” which is “motivated in large part by a desire to cut health care costs.”

Q: Well, who is to say what lifesaving treatments should be accepted or rejected?
A: The patient, of course!

However, that may not always be the case in health care today where patient’s rights can get overlooked and their voices may not be heard for a number of reasons (but that is another blog).

My hope is that the following genuine goals of advance care planning will be kept front and center:

  • Maximize the likelihood that medical care serves the patient’s goals;
  • Minimize the likelihood of over/under treatment;
  • Reduce the likelihood of conflicts between family members/friends and healthcare providers; and
  • Minimize the burden of decision making on family members or close friends.

Some of us will be watching to make sure . . . .

Mitch Gennuso