Feds want Medicare doctors to talk about death

healthcare proxy

The Obama administration wants to pay Medicare doctors who talk to their patients about death.

This highly controversial proposal to foster end-of-life planning discussions -- which Sarah Palin and Republican lawmakers decried as creating "death panels" in 2009 -- would pay doctors to have 30-minute meetings with patients and family members to discuss so-called advance directives. This includes specifying the patient's wishes concerning medical care and life support measures and designating a health care proxy if the patient is unable to make decisions.

"Today's proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team, as part of coordinated, patient- and family-centered care," Dr. Patrick Conway, Centers for Medicare and Medicaid Services' principal deputy administrator, said Wednesday.

About 4 in 10 Americans ages 65 and older lack written instructions for their end-of-life treatment, according to the Kaiser Family Foundation. This can leave family members and doctors scrambling to figure out what the patient would want.

Currently, Medicare -- which provides coverage for about 54 million people -- only covers such discussions in certain circumstances. The administration has tried several times to revise the rules to facilitate end-of-life planning, only to encounter severe backlash. The issue sparked a furor in 2009 when former Republican Vice Presidential candidate Sarah Palin accused President Obama of wanting to set up panels of doctors that would ration care when patients are near death as part of the Affordable Care Act.

Obama defended the proposal at the time, saying he was not trying to "pull the plug on Grandma," but it was subsequently removed from the health reform law.

The American Medical Association, which has strongly backed expanding end-of-life discussions, applauded the proposal.

"This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions," said Dr. Andrew Gurman, the association's president-elect.

The proposed rule is now open to comment. A final decision will be issued by November 1.

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