End-of-Life Choice, Palliative Care and Counseling

New Medicare Regulations Empower Patientsby Barbara

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New Medicare regulations to take effect January 1 will include a provision physicians, social workers and families pushed for. The New York Times reports:

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

In truth, the consultation is not about forgoing treatment, as advance directives are equally suited to requesting life-sustaining treatment. Thus, this Medicare enhancement simply encourages communication, promotes choice, compensates doctors for important care and empowers patients.

The AP explains:

The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

Experts on advance directives have stressed the importance of discussing end-of-life options before patients and families become vulnerable in a crisis. The Washington Post last year hosted an online discussion with executives from Gundersen Lutheran Hospital of LaCross, Wis., to discuss end-of-life care. A pioneer in the field, Gundersen has urged this Medicare compensation for physicians who consult with patients on end-of-life planning.

With a chance to plan with their personal physician, some patients might decide, if they become terminally ill or permanently unconscious, they’ll want a peaceful death with as little intervention as possible. Others will decide to utilize every kind of life-sustaining therapy as long as medically possible. The conversation protects either decision. These conversations empower patients and make sure that their wishes are heard.

With the new regulations, Medicare will now compensate physicians for that consultation. Why is reimbursement important? When physicians are asked why they do not regularly engage in advance care planning with their patients, they report that they do not have the time for such conversations.

As Muriel Gillick wrote last year in the Boston Globe,

Survey after survey indicates that most patients want to have end-of-life discussions but most do not have them.

Most people believe individuals themselves are the best decision-makers when it comes to these very personal, private healthcare choices. In November, 2005, the Pew Research Center found a whopping 84% of Americans approve of letting patients themselves decide about extraordinary treatments to prolong life.

Re-enforcing your decision by discussing it with your doctor makes it more likely your wishes will prevail. Solid research shows that people who talk with their doctor about end-of-life wishes are more likely to have those wishes honored, and more likely to experience a peaceful, pain-free death when the time comes.

Even patients with a living will benefit from consulting with their personal physician. Laws vary from state to state. Having specific documents in order may be necessary to make sure your wishes are carried out and that the loved one you choose is empowered to act on your behalf.

As Kristina Chew writes at Care2:

But without any end-of-life planning, patients are left to the mercy of others [when they cannot] speak up for themselves. They have no control at all about what happens to them, with health care decisions left to whoever has power of attorney.

When seniors tell their doctor what treatments they would want or not want in a given situation, they protect their families from struggles over decisions about life-sustaining treatment if they became unable to speak for themselves.

This improvement to Medicare is a long-awaited response to those families who didn’t know their loved ones’ preferences when confronted with difficult decisions in an emergency. With the coming of the New Year, Medicare will begin empowering seniors to consider the care that is right for them when they face the end of life, and better ensure their wishes control the care they receive.