Medicare to Pay for End-of-life Discussions

Under a new law, patients can discuss their medical options and goals in order to make an informed decision on the type of care they want.

For the first time, Medicare will pay this year for a conversation with your healthcare provider about your end-of-life care. When Congress attempted this coverage six years ago, it was met with charges that such conversations would result in “death panels.” Yet polls show that a majority of Americans want to talk to their doctors about their options and preferences as they approach the end of their lives. A recent Kaiser Family Foundation survey found that about 9 in 10 adults say doctors should discuss end-of-life care issues with their patients, yet only 17 percent of adults say they have had such a discussion.

Even though most adults (90 percent) say they would prefer to receive end-of-life care in their home if they were terminally ill, only about one-third of Medicare beneficiaries (age 65 and older) died at home (Kaiser Family Foundation). Conversations with healthcare provider about such wishes could guide you and your doctor to the kind of treatment that would ensure you die where you want.

Under the new rule, Medicare pays $86 for the first 30 minutes of “advance care planning” in a doctor’s office and $80 for the service in a hospital. In both settings, Medicare will pay up to $75 for 30 additional minutes of consultation. If the discussion takes place during your annual wellness visit, it is considered a preventive service and the patient’s coinsurance and deductible are waived. These voluntary discussions can take place at any time, not just when a patient is facing a serious illness or death.

Ideally, end-of-life conversations would cover a range of concerns, including understanding the patient’s prognosis and goals. Do you want everything done that would keep you alive—chemotherapy, CPR, tube feeding—even if it doesn’t meet your wishes for your end of life? Be specific about treatments and interventions you do and do not want.

Benefits of the Conversation

Far from forcing people to accept treatments that would shorten their lives, communication with your healthcare provider can help ease your fears, minimize pain and suffering and enable you and your family to experience a peaceful passing. Those who are dying often have many fears—of pain, indignity, abandonment and the unknown. By talking to your healthcare provider, your end-of-life care can become an experience of choice rather than passivity, of empowerment rather than powerlessness, experts say.

An end-of-life conversation allows your loved ones to know what to expect and know that you are receiving the care you desire. The new policy will help seniors “make important decisions that give them control over the type of care they receive and when they receive it,” the Centers for Medicare and Medicaid Services stated.

Studies have shown that advance-care planning improves the patient’s quality of care because it’s targeted to what the person wants. Directed treatments can reduce the costs of medical interventions that the patient either doesn’t want or doesn’t need.