SMOKINCHOICES (and other musings)

June 10, 2014

Pay Docs 4 simple truth?

Hot-button issue

Medicare might pay doctors for end-of-life talks

By Michael Ollove                                                                                                                                                                                                                                                                                                                                                  STATELINE.ORG

WASHINGTON — The federal government might reimburse doctors for talking to Medicare patients and their families about “advance-care planning,” including living wills and end-of-life treatment options. That could rekindle a fierce storm in the Affordable Care Act debate.

A similar provision was in an early draft of the federal health-care law, but in 2009, former Republican vice-presidential nominee Sarah Palin took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation.

Now, quietly, the proposal is headed toward reconsideration, this time through a regulatory procedure rather than legislation.

The American Medical Association soon will recommend what doctors should be paid for advance-care planning, or conferring with patients about the care they would want if they were incapacitated.        (1)

  • Every year, the AMA recommends reimbursement on a broad range of procedures and services to the Centers for Medicare and Medicaid Services, the federal agency that administers the Medicare program and works with state governments to administer Medicaid.

CMS and private insurers don’t have to follow the AMA’s recommendations , but they typically do.

Geriatricians, oncologists and other medical specialists who see gravely ill patients say it’s crucial to elicit a patient’s wishes for treatment and other pastoral or psychological supports in a dire medical situation. Would a particular patient, for instance, want to pursue additional procedures that, while grueling, offer a slim possibility of success? Or would the patient want doctors to intervene only to alleviate pain?

If Medicare reimburses doctors for such discussions, as it pays them for examining patients and performing procedures, they are much more likely to happen.

Some private insurers, including Excellus Blue Cross Blue Shield of New York, reimburse doctors who help with advance-care planning.  (2)

Under Medicaid, states largely determine what medical services are covered. At least two states, Oregon and Colorado, provide reimbursement for advance-care planning. In Colorado, doctors can be compensated up to $80 for a 30-minute conversation to discuss advance-care planning.

“We are doing this to incentivize providers to have these conversations with our clients,” said Judy Zerzan, chief medical officer of the Colorado Department of Health Policy.

Studies show that when given a choice, patients often forgo invasive procedures at the end of life. Such procedures can be costly while doing little to extend or improve the quality of a patient’s life.

But some people fear that end-of-life conversations could lead to rationing or withholding of care.

  • Burke Balch, director of the Powell Center for Medical Ethics at the National Right to Life Committee, said he wasn’t aware of the AMA’s proposal. But he expressed concern that it would result in the “denial of lifesaving medical treatment.”

“It is one thing genuinely to determine what people’s treatment wishes are, but the danger is very grave that efforts to pay for advance-care planning sessions (under) Medicare will turn into subtle efforts to pressure some of the most-vulnerable patients to surrender their right to live,” Balch said.


(My Comment:

Not the Death Panels

Please don’t think that I would believe that those in the medical profession would charge ahead as “death panels” in any manner.  While  I take an extraordinarily dim view of what passes as  adequate care today  for our ailing masses  —  this is because the practitioners of modern medicine are inordinately devoted  to pharmaceuticals or surgical routines,  over the time-honored strategy of correcting the imbalances of the human body through ridding of toxins,  and installing wholesome, healthy nutritional regimens  instead.  But, mostly, physicians of today aren’t trained in these simplicities, judging them to be passe, and so last century!  In addition, there isn’t enough money  in it.     Instead, Medicine is just another business model at work. . .and what a winner it is;  it’s might and power are crashing the American economy.  While everyone complains about it all, even the government is complacent rather than exercising control and common-sense, proportional  regulation

The Ethics of this proposed fee

Surprisingly, the content of this recent article also suggests that others with more serious and perceptive considerations are out there, like the ‘National Right to Life Committee’.  Perhaps more consideration should be given to this.   My intention is only to address the ethical issue of what we should be able to expect from a doctor in whom we trust and are familiar.  I’m a believer in old fashioned honesty and trust.  That being true, can we not expect the truth of the situation  as we seek answers to an escalating health matter which may or may not be coming to it’s end?  How does all the past treatment up to now suddenly become something different other than the doctor’s commitment to care for and treat this patient, and the patient trusting the doctor to do the right thing for him/her?  If the doctor has “any” smarts at all or training in interpersonal mechanisms, how can he not naturally segue into the next plateau of this discussion which would naturally lead to the end-of-life discussion?   It is beyond me how the AMA believes that physicians  should be ‘entitled’ to substantial, additional money to touch on this subject.  (1) and  (2)   It is this kind of crass materialism which so reviles me (and I’m sure – many others).  This is the business model at work. . .not a calling to serve and heal.

We are entitled to Truth from doctor; can make our own decision then

Why should doctors receive  $80.00 for a brief dialogue when practically everything  one can need and utilize is available for FREE online in each state and easily downloadable including last will and testaments papers and Health Care Power of Attorney  and so on.  Information for everything is on-line.  One can do a simple will on his own, but of course if assets are involved, one should generally use legal services which can be variable in cost depending on needs and complexity.

I am not meaning to over simplify this, it’s a big deal.  Most of us put this stuff off, because, lets face it, it’s not a lot of fun to do.    But, if others are anything like me. . .there are things I would still like to have some control over.  I have my druthers.  Its my life,  my stuff. . .my choice.   I’m kinda funny that way.    Additionally, I should add, states are not all the same. . .there are rules about how final papers such as wills are handled.    One can handwrite  a simple will;  needs no attorney, no witnesses or notary public signature.  But it must be completely hand written including name, address, date, signature and so on.   This is referred to as a “holographic” will.  May not be accepted if there is typing or printing involved,  so check your own state out as to legalities.  Jan)



  1. I’ve missed you Jan and your important info. I hope you are well? Big love from down in Cape Town xxx

    Comment by souldiaries — June 16, 2014 @ 11:38 pm | Reply

    • Oh, Viv
      Just come back from popping over to see you; wasn’t prepared for what I found. I absorbed too much and am helpless at the moment to ignore where you have been. I can tell you, that I’ve missed you and sometimes wonder how stuff is down under. Perhaps soon we can sit around the fireside and share. It is perhaps a bit helpful to remember that we aren’t part of some great laid out plan. You and I, all of us, are living out a manifestation of all our inmost desires, thoughts and feelings, which each in their own way have helped to create our ‘what-is’ that we live each day. Where there is pain, we ‘must’ reach for the higher, happier thought, plateau. In so doing, our ‘what-is’ becomes higher and happier too. We can change nothing and no one but ourselves. .this is the way it works.

      Love you Viv. . . , Jan

      Comment by Jan Turner — June 17, 2014 @ 7:31 pm | Reply

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