Medicare proposes reimbursing doctors for having end-of-life conversations
Dr. Ken Warm is a physician with patients in subacute care at Villa Coronado. Photo by Brad Racino

Medicare proposes reimbursing doctors for having end-of-life conversations

Medicare — the federal health insurance program that covers patients 65 or older or some with disabilities — is now proposing to reimburse physicians for having end-of-life conversations, according to the New York Times.

From the story,

“This new policy, announced Wednesday, 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.”

These difficult conversations between physician and family members — today not covered by Medicare — played a significant role in an inewsource investigation published in September that explored a hidden world where thousands of Californians are kept alive by artificial means.  In these subacute centers — or as some doctors call them, “vent farms” — patients are kept alive on machines, sometimes for decades.

The project, told in print, audio and video, chronicled the lives of three families struggling with an impossible choice: keeping a loved one alive who has no hope of recovery or letting them go and living with the guilt associated with that decision.

Much of the emotional pain and financial hardship associated with this kind of decision can be avoided with something called an advanced directive — a legal document a person can fill out when they’re healthy that lays out their end-of-life wishes to family, friends, and health-care professionals.

But many people don’t know about these options because today, doctors aren’t reimbursed for the time they spend having these conversations with family members — conversations Sarah Palin infamously associated with the phrase “death panels” in 2009, effectively shutting down any proposals for reimbursement. Palin has stood by her comments, although fact-checking organizations and news sites have labeled her claim completely inaccurate. Politifact called Palin’s statement the “Lie of the year” in 2009.

According to the story in the Times, “Medicare often sets the standard for private insurers” and “the new policy will likely prompt many more doctors to engage patients in such discussions about their preferences.”

To see the entire inewsource’s project — called An Impossible Choice — including a mini-documentary,  click here.

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About Brad Racino:

Brad Racino
Brad Racino is a senior reporter and assistant director at inewsource. To contact him with tips, suggestions or corrections, please email bradracino [at] inewsource [dot] org.