Doctor-patient consultationMedicare beneficiaries may now discuss options for care at the end of life with their health care providers. 

Beneficiaries of course were already free to talk about advance care planning with their doctors or other qualified health professionals, but the practitioners could be reimbursed for such discussions only during a patient’s “Welcome to Medicare” visit, a time when the topic may not seem very relevant. As of January 1, 2016, Medicare will pay physicians for speaking at any time with Medicare beneficiaries and their families about different options for care and treatment at the end of life. 

These purely voluntary conversations will help enable patients to end their lives on their own terms. Patients are often unable to express themselves when a crisis is at hand and a decision needs to be made about how much or little care they want when facing a terminal illness. According to the Kaiser Family Foundation, one-quarter of Medicare’s budget is spent on patients in their last year of life.  For many patients, life-prolonging medical procedurs are unwanted and unwelcome.  A 2011 study found that when medical personnel know what kind of care a patient wants at the end of life, Medicare can be spared significant sums and the patient is more likely to die at home rather than in a hospital in some areas.

Now that discussions about advance care planning are a regular Medicare benefit, seniors and other Medicare beneficiaries will be able to learn about health care options that are available for end-of-life care, such as advance directives, palliative care and hospice care.  They can then determine which types of care they would like to have, and share their wishes with their practititioners and family.  After sufficient conversations with their doctors and other health professionals, the beneficiaries may be ready to execute legal documents, such as advance directives or “POLST” forms, and name a health care proxy to ensure that their wishes will be carried out. Studies have found that 40 percent of people over age 65 have not written down their wishes for end-of-life treatment. 

An early version of the Affordable Care Act (aka “Obamacare”) would have allowed Medicare to pay for these patient discussions, but former vice presidential candidate Sarah Palin and other opponents of health reform characterized them as government “death panels,” and the provision never made it into the final health care legislation. The Obama administration tried again in 2011, enacting a Medicare regulation that would have reimbursed doctors for discussing end-of-life planning with patients during their annual checkups, but quickly reversed course and withdrew the regulation, apparently fearing that it would revive the specter of  “death panels” at a time when the health reform law was under fierce attack from Republicans. 

Under the new regulations, the advance care planning discussions can take place during the annual wellness visit or at a separate appointment.  They are a reimbursable benefit under Medicare Part B and there will be a copayment if the conversation is not part of the annual wellness visit.

Talk to your elder law attorney about drawing up the documents to help ensure you receive the end-of-life medical treatment you want — no more and no less.

 

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