Can raising end-of-life concerns with seniors pressure them? Not necessarily

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WhiteHouseThe Centers for Medicare and Medicaid Services (CMS) announced it has decided to cover/reimburse caregivers for end-of-life (EOL) planning discussions with Medicare patients. The officials are seeking public comments until September 8th, and the edict would not take effect until next January, if final approval is decided.

Medicare proposes to reimburse doctors, nurse practitioners and some physician assistants for EOL discussions. Previously only one such discussion was covered, during an Introduction to Medicare visit. Now, there is no specific limit on the number of discussions billed for, nor is there any specificity about the required complexity of discussions, nor whether family members should be present.

ACSH s Senior Director of Medicine and Public Health, Dr. Gil Ross, had this comment: Many physicians and patients will benefit from this measure (if enacted), as the topic of EOL planning/advanced care planning is a topic that is fearful understandably so for older patients, their families, and (sadly) their doctors. Both the proposed coverage and the message this topic falls under the purview of good medical care will encourage more frank dialogue of EOL wishes for life-prolonging measures we prefer and oppose, that most of us will face at some point. In the best case circumstance, it will allow patient preferences to be made manifest rather than inferred by sometimes-distant or conflicted family members.

Some will find such governmental intrusion repugnant or unnecessary, and the bad old days of Palinesque death panels will rear its ugly head again. But there is nothing in the measure that will coerce any older person to deny him or herself desired EOL care, and surely the opportunity for introducing the concepts of advanced directive, living wills, and health care proxies to identify a spokesperson in the event of a patient s incompetence to verbalize decisions at the end. Everyone should have such paperwork easily accessible, but few do.