WASHINGTON -- Medicare said Wednesday that it plans to pay doctors to counsel patients about end-of-life care, the same idea that sparked accusations of "death panels" and fanned a political furor regarding President Barack Obama's health care law six years ago.
This new policy comes at a time when patients, families and health providers are placing greater emphasis on allowing people to choose the way they die -- whether that means trying every possible medical option to stay alive or discontinuing life support for those who do not want to be sustained by ventilators and feeding tubes.
The counseling will be voluntary for patients.
The policy change, to take effect Jan. 1, was tucked into a regulation on payments for doctors. The American Medical Association recommended the change, which will face a 60-day comment period before it is finalized.
Many doctors have said they regard such counseling as a common-sense option, and some already have such conversations with their patients without billing extra. Certain private insurers have begun offering reimbursement for such counseling.
About three-quarters of the people who die each year in the U.S. are 65 and older, making Medicare the largest insurer at the end of life, according to the Kaiser Family Foundation.
"As a practicing physician, and a son, and someone who has dealt with this in his own family, I would say these are discussions ... that are critical to high-quality care," said Patrick Conway, Medicare's chief medical officer. "I would want any American who wanted to have this conversation with their clinician to have the opportunity to do so."
Medicare is using a relatively new term for end-of-life counseling: advance care planning. That's meant to reflect expert advice that people should make their wishes known about end-of-life care at different stages of their lives, as early as when they get a driver's license.
The counseling aims to discern the type of treatment patients want in their last days, with options ranging from care that's more focused on comfort than extending life to all-out medical efforts to resuscitate a dying patient.
"This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional," Andrew Gurman, president-elect of the American Medical Association, said in a statement. "This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions."
Before former Alaska Gov. Sarah Palin ignited the "death panels" outcry, there was long-standing bipartisan consensus about helping people to better understand their end-of-life choices and decisions.
A 1992 law passed under Republican President George H.W. Bush required hospitals and nursing homes to help patients who want to prepare living wills and advance directives for their care.
Similar efforts gained resonance after the 2005 death of Terri Schiavo, a brain-damaged Florida woman whose family fought for years over whether she would want to be kept alive in a vegetative state.
Then-Florida Gov. Jeb Bush got embroiled in the family's ordeal, ordering feeding tubes reinserted for Schiavo against her husband's wishes. The husband ultimately prevailed in a legal battle with Schiavo's parents, who wanted her kept alive.
In 2008, a year before debate over the federal Patient Protection and Affordable Care Act spiraled into Tea Party protests, Congress overwhelmingly passed legislation requiring doctors to discuss matters like living wills with new Medicare enrollees.
And, just months before being tapped as running mate for GOP presidential nominee John McCain, Palin herself signed a proclamation recognizing Healthcare Decision Day in Alaska, with the goal of a statewide effort of spreading the word about the importance of advance-care directives.
That history dissipated almost instantly when Palin said the provision on end-of-life conversations in Obama's health care legislation would create "death panels" in which bureaucrats could force the elderly and the sick into accepting minimal care at the end of their lives.
Palin and other opponents argued such legislation would put too much emphasis on the cost of caring for the elderly and the very ill, leading to rationing of care.
After Palin's attack on the language in the health care measure, the language, modeled after a bill by Rep. Earl Blumenauer, D-Ore., was ultimately removed.
Since the health law's passage, claims of "death panels" have quieted as physicians and policy experts have stepped in.
Blumenauer said Wednesday that the nation now seems to have come to a consensus that Americans need access to information about their end-of-life options.
"There was a time when the federal government could have been a leader on this, but now it's basically responding to where the rest of America is going," he said.
Nothing in the discussions approved by Medicare will be focused on cost, officials said. But many experts believe that if patients truly understood their alternatives, and doctors listened to them, bills would inherently go down.
The National Academy of Medicine said in a 2014 report that end-of-life planning has an important role. Such plans can help patients and doctors figure out the right balance between quality of life and pursuing intensive treatments, said the academy, then called the Institute of Medicine.
The report said few people make their wishes known, resulting in many deaths that are filled with breathing machines, feeding tubes, powerful drugs and other treatments that fail to extend life, and make its final chapter more painful and unpleasant.
"Because most people who participate in effective advance care planning choose maximizing independence and quality of life over living longer, advance care planning can potentially save health care costs," the academy said in the report. "The misrepresentation of the [Affordable Care Act] provisions for advance care planning as 'death panels' confused many Americans about the benefits and goals."
Supporters have said counseling would give patients more control and would free families from painful decisions or conflicts, such as in the Schiavo case.
After the report, Medicare said it would consider a change in policy for 2016.
"End-of-life discussions should be part of the life cycle," said Dr. Philip Pizzo, former dean of Stanford University medical school and the report's co-chairman. "Beginning Medicare is one of those times, since it can be a point of awareness and reflection."
Information for this article was contributed by Matt Sedensky and Ricardo Alonso-Zaldivar of The Associated Press; by Zachary Tracer of Bloomberg News; by Pam Belluck of The New York Times; and by Noam N. Levey of Tribune News Service.
A Section on 07/09/2015
Print Headline: Medicare will pay for end-of-life counseling