The Washington Examiner had a nice little article on a small bipartisan bill for a Medicare payment tweak. The Center for Medicare and Medicaid Services would be authorized to pay a one time incentive of $75 for an advanced care directive or a living will to be filed by a Medicare member.
A bipartisan bill set to be introduced on Tuesday would pay seniors $75 to put together a living will that lays out a patient’s wishes on medical treatment to doctors and family members should they become incapacitated.
The bill, provided exclusively to the Washington Examiner, is aimed at getting seniors to talk with family members about how to deal with end-of-life issues, according to a Senate aide familiar with the bill. The problem today is that many family members don’t talk about these issues until it’s too late….
…The program would be completely voluntary….
a 2015 study by the healthcare consulting firm Avalere found that a one-time incentive could have reduced federal spending by $13.8 billion from 2015 to 2024. While the incentive could cost $7.2 billion, it would be offset by an estimated $21 billion in savings from reduced end-of-life Medicare spending.
It has bipartisan support in both chambers and most of the major interest groups that could grind this to a halt are on board with it.
We know that end of life is often chaotic. We know that end of life pits multiple interests against each other. We know that the person who is dying may not be able to fully inform everyone of their wishes. We know this.
CMS, in 2016, authorized physicians to be paid for end of life and advanced care counseling sessions. There is a now dedicated procedure code for that. The early evidence (some of it by my boss and colleague Don Taylor**) is that there are significant barriers to providers actually billing for these sessions but the incentives are lining up to actually allow for more patient autonomy and voice at the end of life.
I don’t know how much a $75 incentive payment will prompt an incremental increase in advanced care directives being filed and then more importantly, being followed but this is a worthwhile experiment. This bill is a little nibble at the edge of the US healthcare system but it is an attempt to encourage more talking which will lead to a little less doing.
** Tsai, Gawin, and Donald H. Taylor. “Advance care planning in Medicare: an early look at the impact of new reimbursement on billing and clinical practice.” BMJ Supportive & Palliative Care (2017): bmjspcare-2016.
Baud
Isn’t the Washington Examiner a wingnut paper?
Another Scott
@Baud: Yup. But, stopped clock and all that.
Is Betsy booked on TDS with Trevor to explain how Donnie and Price are still trying to kill Grandma with Teh DEATH PANELS? Or is she Ambassador to NATO now, or something?
(sigh)
Cheers,
Scott.
Ohio Mom
Don’t get me wrong, I’m all for this, but how is this different from the infamous Death Panels of yore?
HeleninEire
@Ohio Mom: It’s not.
AnonPhenom
IOKIYR
Sab
This is so important. My dad in his 90s has dementia. He never documented his end of life wishes and now it’s too late. He did discuss it with my mother, but she died several years ago. From conversations with her I think I know what he would want, but that’s very second hand.
Fortunately, for her own sake, she did leave a directive and was quite determined in letting medical professionals know what she wanted.Otherwise they would have asked Dad, who couldn’t remember, and would have decided the opposite of what she wanted.
The Right to Lifers have pretty much taken over my state government and passed some terrible legislation. If Dad ends up in the hospital, his doctors’ and my hands are tied. He gets every kind of extreme care until we run out of money.
rikyrah
@Ohio Mom:
Thought it sounded familiar ?
Sab
@Ohio Mom: Death panels are evil for the elderly, but fiscally prudent for everyone else, especially indigent mothers and children.
Baud
@Ohio Mom: No black president in sight.
Victor Matheson
The difference between this and at least one version of the death panels is that the ACA authorized payments to doctors for engaging in end of life planning. This pays the actual person doing the dying.
MomSense
This is so similar to the “death panels” it makes me want to scream. The Republicans scare mongered their way to control of the House and a bunch of the statehouses in 2010 with this whopper of a lie and we are still paying for it.
Will anyone in our fearless news media call them out for this? Ever?
Soprano2
I heard a podcast that talked about a city in MI where almost everyone has an advanced directive, even young people. There is a doctor in this city who started this with dialysis patients about 25 or so years ago, and it eventually spread to almost everyone. They have some of the lowest Medicare costs in the U.S. because they don’t spend millions of dollars on futile end of life care because of these directives. He said doctors and hospitals are beating down his door asking how he got costs so low. Over and over in discussions about health care I repeat the argument that good end of life planning can save loads of money, because most people don’t want all that expensive care anyway, and that the last few months of life are one place where the big expenses are. That saves more money than kicking that relatively young person with a minimum wage job off Medicaid. I think this idea is slowly penetrating into the American consciousness, thus this bill that has bi-partisan support. I wanted to scream when “death panels” ruled the day, because it was so stupid!!!
John Cole
Oh, death panels
Ohio Mom
@Victor Matheson: I missed that on my first read-through.
Since I already have my affairs in order, including an advanced directive, does this mean I can collect $75 (assuming this passes, etc.)?
Again, I am all for this but it does seem a bit of a give-away to people like me. Also makes me wonder if there are going to be minimum requirements to make sure everything is properly drawn up, legal and clear.
A lot of what people believe about end-of-life care comes from TV and movies, and is misleading. That was the advantage of paying the doctors directly, they are better-informed about what is realistic.
satby
This is so important for everyone, not just older people, to have. My father died almost 30 years ago from cancer, but he had to be very forceful about his wishes for no further resuscitation or extreme measures when it became obvious his disease was terminal because he was only 54 and the doctors’ bias was to do everything possible to prolong his life in spite of the futility.
David Anderson
@Another Scott: Their editorial page is.
Their health policy group is pretty solid. They choose conservative friendly stories but they are well sourced and mechanically they are sound. I have fairly frequent conversations with one reporter there and every time I talk with that individual, we both learn something.
Health policy reporting is a lot like the sports section — editorial lean is often quite independent of the ability to count to 10 and give an accurate score of yesterday’s game.
David Anderson
@Victor Matheson: CMS is paying the docs through a revised and expanded CPT-4 code that went live on 1.1.16 for advanced care planning counseling sessions.
Victor Matheson
@Ohio Mom: While it is a giveaway to people who have already done this, and I should note that I have done this already as a relatively “young” person in my 40s, you can afford a lot of giveaways if it really does prevent a lot of unwanted and unnecessary care. Just one day in intensive care with all of the bells and whistles might cost $10,000 after all of the line item stuff is added up. So, if paying 133 people $75 to think about advance planning prevents just a single day of ICU, you are in the black. And remember, without an advance directive, the fallback is always do everything you can for a patient at all costs.
Victor Matheson
@David Anderson: Does this code allow for payments to multiple medical care personnel at the same time? I would think there would have to be at least 2 or more medical professionals involved for something like this to qualify as a true death “panel”.
Another Scott
@David Anderson: Thanks.
I cringe when I click over to TheHill. They have far too many RWNJ columnists, and their comment section is insane (close to 10,000 comments on some stories? Really? Are they all bots???). And the news stories often twist the language beyond recognition (“moderate Republicans”). But they’re plugged into what the Teabaggers are trying to do in Congress (and they don’t treat it quite so much as a social club the way RollCall does in my occasional glances over there), so I think it’s important to see what shows up there.
It’s really, really hard for me to separate Good Reporting from Insane Propaganda on the Editorial Page. Every click sends them money and supports the system that helps them push the propaganda that is destroying our government. If it were a single old Mobile OpEd in a sea of Lefty McLeftish commentary, it would be one thing. But it’s not….
Thanks for keeping us informed, in spite of all the dreck you have to sort through!
Cheers,
Scott.
Matt
Sorry, the only way this should get “bipartisan” votes is if every GOPer behind the bill goes on TV and publicly denounces the whole “death panels” bullshit. They’ve turned this sector of policy space into a radioactive wasteland by lying: cleaning it up starts with them telling the truth.
stinger
I’ll be interested to see Grassley’s (my Senator, alas) vote on this bill.
ETA key word
StringOnAStick
I have a therapist friend who did a lot of work in an oncology group in PA when she was first practicing. Since it was a hospital-associated group, it got a cross section of patients and also a lot of doctors from Europe here doing extended observation/education/training sabbaticals. We’ve been talking about her time in that job, and she says that the Europeans were to a person appalled at how the US system keeps doing painful and expensive interventions in hopeless cases at the end of life. They found it to be morally repugnant both for the patient and family, but also for a system where money isn’t in an endless supply with no constraints like they were used to dealing with at home.
I think where the R’s got a lot of mileage out of the Death Panels crap is too many here have internalized too many Hollywood plot lines of the “exotic disease/miraculous cure” and “sudden reversal of terminal case” variety, and they’re scared they won’t get lucky and get Dr. House on their case if we start looking more at exactly what those end of life care dollars are actually doing. The whole crazy swirl around baby Charlie from Britain is such a clear case if that, and I find it repugnant that the R’s are using this family’s tragedy to show how “bad” socialized medicine is. Baby Charlie’s case is incurable and terminal, and dragging such a medically compromised child over here for a way-too-early-to-be-tested-on-a-human shoot the moon treatment is the ultimate example of how much a parent loves and wants to save their child (honorable) can be manipulated and co-opted by the moral vacuums of the kill-the-ACA party.
satby
@StringOnAStick:
from my time working on the trauma floor of a regional trauma center in Chicago, I was often appalled by the family members who would fight with each other in the halls about “killing xxx” when some were unable to accept their loved ones terminal condition. The patient could be brain dead and some family members would refuse permission to turn off the machines despite the advice of the doctors. Hospitals are reluctant to act of there’s an open family battle going on because people sue. Sure, the hospital will eventually win, but the time, expense, and bad feelings are astronomical sometimes. It wasn’t uncommon that the person most insistent on continuing futile measures was someone a bit estranged from the patient or family. Tragic really.
These directives are so vital to have to protect yourself and your family!
TenguPhule
I would honestly pay for the GOP to be prepped for their end of life.
TenguPhule
@Matt:
So first of Never, then.
Bruce.desertrat
@Ohio Mom: This is EXACTLY the “Death Panels” of yore…this is the actual thing that was spun into “death panels” by the sociopaths who want us to all die broke and ill.