Congress takes up Medicare/Medicaid reimbursement - again - for physician-patient discussions of end of life preferences

Remember the "death panel" brouhaha back in 2009? That's what opponents of the proposed Affordable Care Act called the bill's provision to compensate doctors under Medicare and Medicaid for discussing end-of-life preferences in depth with patients. The specter of "death panels" so spooked a large swath of the public that the provision was jettisoned from the final law.

That's too bad. In my experience, clients are not threatened by such discussions. On the contrary, my clients want to take control of their medical destinies, make informed decisions, and make sure their families are at ease with their plans if their families must ever make life-and-death decisions for them. Clients would welcome the opportunity to have a frank, free discussion with their physicians about these most sensitive and personal matters.

Evidently many on Capitol Hill agree. The Wall Street Journal  reports that this week, Senators Mark Warren (D-VA) and Johnny Isakson (R-GA) will introduce a bill that provides Medicare and Medicaid coverage for doctors' time-intensive discussions with critically ill patients regarding end-of-life care. According to the report, both senators have had experiences that fuel an intense personal interest in the proposed legislation. When Senator Warner's mother, Marjorie, developed Alzheimer's Disease, she had not put her wishes in writing. "We didn't know what to do," Warner says. In contrast, Senator Isakson and his family were well prepared for his parents' declining health, thanks to frank discussions his parents had with their doctors and with the family. They had "had terrific quality of life at the end," Isakson recalls.

A bill similar to the Senate bill has already been introduced in the House of Representatives, according to Politico. Rep. Earl Blumenauer (D-OR) and 17 bipartisan co-sponsors have put forward the "Personalize Your Care Act" of 2013, which would amend the Social Security Act to permit Medicare and Medicaid coverage when patients request advance planning discussions with their doctor. The bill would reimburse doctors for time-intensive discussions every five years, or sooner if the patient has a significant change in health status. The proposal also adds on several elements not present in the 2009 legislation, including the requirement that advance health care directives are honored across state lines, and provisions for incorporating end-of-life wishes into electronic medical records. You can read more about HR1173 here, 

Notwithstanding the bipartisan initiative, many legislators remain resistant to dealing with end-of-life issues, considering it to be a political third rail. Even so, I think the issue will inevitably take center stage as voters realize the proposed laws are designed to give citizens more control over their lives, not less. Also, the  Baby Boomers - that huge demographic behemoth that has always liked to do things its own way - will likely push the conversation to the forefront in the near future.

 Continue to check this blog and my website for new developments.