Jul 152015

Medicare announced last week it will finally pay doctors for their time spent talking to patients about their end-of-life preferences, among the most important medical decisions most people will make.

The decision overcomes years of setbacks brought about by Sarah Palin's politicizing of the Affordable Care Act's provision for end-of-life counseling as endorsing "death panels" of bureaucrats who would nefariously decide whether your Grandma's ventilator remained on.

The new plan will be open for public comment for 60 days, and is expected to be approved in November and in effect in January 2016.

Nurse practitioners, physician assistants, or physicians may submit claims for payment to Medicare. Dr. Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid, which administers Medicare, did not state any limit to the number of counseling sessions that would be paid for, saying "The reality is these conversations, their length can vary based on patients’ needs ... Sometimes, they’re short conversations — the person has thought about it. Sometimes, they’re a much longer conversation. Sometimes, they’re a series of conversations."

The payment amount is yet to be announced. There was no minimum words-per-minute announced, nor payment reductions for counselors with thick accents or who say "um" a lot.

Private insurance companies are expected to follow Medicare's lead and start paying for end-of-life preferences counseling. Some, like Blue Cross Blue Shield of Michigan, already do: $35 per conversation by a doctor or midlevel provider, in a 2014 report. Excellus Blue Cross Blue Shield of New York was reported to recently be paying doctors $150 for an hourlong advance care planning conversation and completion of its documentation form, and $350 for a two hour conversation.

In 2010, Medicare tried to sidestep the political theater surrounding the 2009 debate over the Affordable Care Act, and used its regulatory authority to include coverage for advanced care planning in annual checkups. However, subsequent political pressure from the right forced the Obama administration to remove the coverage.

Major medical associations praised Medicare's new policy. A few right wing nutjobs condemned it. The original death-panel paranoia seems to have subsided -- with Republican presidential front-runner Jeb Bush (former "savior" of Terry Schiavo) actually going on record stating that advance care planning should be mandatory (wait! that sounds like a vast left-wing conspiracy...)

Now, we just need to train doctors how to actually have these very difficult conversations productively. Paying for their time should at least get more physicians to show up, ready to talk.

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Medicare will pay for death panels, I mean end-of-life counseling