In 2009, former Republican vice presidential candidate Sarah Palin poured gasoline onto a fire that needed little stoking – the effort to craft and pass the Affordable Care Act – when she infamously declared that a proposed health law provision aimed at encouraging end-of-life planning would lead to the “rationing” of care, labeling them Obamacare’s “death panels.” Now, the death panel debate may be poised for resurrection as the American Medical Association (AMA) is expected to propose Medicare reimbursement rates for physicians who discuss difficult matters such as living wills, end-of-life medical treatment options, and DNR orders, according to Pew’s Stateline.
As Michael Ollove notes, these can often be difficult conversations for physicians to have with elderly or terminal patients and their families. Explaining the logistics and treading through the delicate territory of end-of-life care may take hours and multiple visits. Unfortunately, there is no current nationally standardized billing code (although an AMA panel has proposed one) or set reimbursement rate for such discussions, meaning they often have to be shoehorned into other medical visits or end up being forgone altogether.
By issuing a formal set of recommendations for advanced care planning payments, the AMA may put pressure on the Centers for Medicare and Medicaid Services (CMS) and private insurers to foster an environment where doctors are incentivized to have end-of-life planning consultations with their patients. Although it is unclear exactly what rates the AMA will propose, Stateline points that one of the few private insurers that does reimburse for such services pays doctors $80 for a half-hour conversation about advanced medical planning. Regardless, if CMS and other insurers begin picking up on the recommendations, be prepared for another contentious debate about government-rationed health care.
By: Sy Mukherjee