Medicare will pay docs to discuss dying

Medicare announced today that it will pay physicians to discuss dying, and the preferences, choices and options that patients have when they face the inevitable (it is only a matter of when, and from what). Six Augusts ago, the summer congressional recess exploded into “death panels” as a way to argue against the ACA. The offending provision would have simply paid physicians to have this type of planning discussion. Five Augusts ago, a RCT of early palliative care showed that patients with stage-4 lung cancer who essentially had such “goals of care” discussions–but who could subsequently choose whatever care options they wanted–actually lived longer, had better quality of life and cost a little less as compared to those who did not have such a discussion.

The idea that Medicare wouldn’t pay for a discussion of preferences and options for patients is absurd since over 8 in 10 persons who died last year in the U.S. were insured by the program. Medicare is inherently in the dying business, and each of us will do it once. The policy announced today will allow physicians to get paid to have goals of care discussions with patients and family members (see p 246), which is important to help patients to make the most informed choice possible. This policy represents a small step toward sanity in this area.

We at Duke have a Center for Medicare and Medicaid Innovation Award on palliative care with Four Seasons, which is seeking more to develop more comprehensive payment changes to how the Medicare program pays for end of life care, but we are still early days in the project (CMMI billboard May 16).

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

4 Responses to Medicare will pay docs to discuss dying

  1. Dennis Byron says:

    Your writing is usually an island of sanity in the left wing war on Seniors (e.g., the Democrats’ die-at-75 campaign) so I’m surprised that you write “Medicare announced today that it will pay physicians to discuss dying… Six Augusts ago, the summer congressional recess exploded into “death panels” as a way to argue against the” Patient Protection and Affordable Care Act (PPACA). I cannot tell if you are weasel wording the term “death panel” into your column to up click count or if you really do not remember that the term death panel in the Medicare/PPACA context when first used in August 2009 was unrelated to end of life counseling in the Medicare/PPACA context. I hope it is the latter.

    • Don Taylor says:

      I think you are incorrect. My recollection is that the first ‘death panel’ charge was related to advanced care planning. That aspect of what became the Senate version (and the essence of the ACA that passed) dropped this provision (which has now been put forth; it was almost put forth in 2011, but pulled back). The second ‘death panel’ charge was related to IPAB. In August, 2009, I think it was still being called Health Services Commission, and it looked like a type of consensus in the Senate gang of 6 talks as it was patterned on the Base Closing Commission.

      • Dennis Byron says:

        Your recollection is correct that criticism of end of life counseling in a Medicare/PPACA context (starting in February 2009 if you count criticism of some of the stimulus bill money devoted to rationing studies) preceded criticism of an actual Medicare rationing panel in a Medicare/PPACA context (which began in late July 2009). My point is different. What I am saying is that it is not correct to conflate the two. The two issues are unrelated at least in a policy discussion and in the history of the debate surrounding PPACA (what was said at political town meetings if both subjects were brought up at the same time–who knows).

        More simply, what I am saying is the word “panel” and the word “counseling” do not mean the same thing and no one ever used the interchangeably that I can find. The proposal to the House of Representatives by the Obama administration’s Peter Orszag in July 2009 was for group called the Independent Medicare Advisory Council (I didn’t think the Senate even had a bill at that time?) that basically became IPAB. It was Orszag’s proposal that led to a series of op-eds and Congressional speeches that led to the coining and first use of (in August 2009 according to Politifact on December 18, 2009) the term “death panel.” According to Politifacts, criticism of end of life counseling proposals in a PPACA/Medicare context had already been declared a “Pants on Fire” lie before the term “death panel” was ever thought of.

        (I thought you would find the Politifacts sources most convincing but the whole sequence/timing described by Politifacts also agrees with what the Wall Street Journal, Concord Coalition, Facebook, and other middle of the road sources said at the time.)

  2. Pingback: January 1, 2016: Huge Day for Medicare End of Life Policy Changes | freeforall

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