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Advance Care Planning and Health Care Reform

Dominating the news this week was the furor over a provision in the House health reform bill for Medicare to reimburse physicians for discussing advance care planning with their patients. The uproar and misinformation were disheartening to those who work in bioethics, a field that has long supported the need for patients to have their wishes at the end of life heard and honored.

But some saw a silver lining – and it wasn’t only the critics of health care reform. Some doctors who regularly talk with patients about advance care planning thought the controversy could have an upside.

Kaiser Health News reported today that “physicians who work with patients on end-of-life planning say that while they are surprised and upset about criticism of the proposal, it has brought needed attention to what they view as a long under-funded and overlooked service.”

At present, Medicare doesn’t reimburse doctors for advance care planning per se, but they can bill for it under a funding code that covers counseling and discussion of psychosocial problems such as depression. Medicare typically pays just $92.33 for a 40-minute consultation, according to the Kaiser report, a fee that “drastically underpays for the complexity and importance of this discussion,” Dr. Ted Epperly, president of the American Academy of Family Physicians, told Kaiser.

Meanwhile, many reliable sources discredited the misinformation about advance care planning being spread by critics of health care reform.

The Association of Bioethics Program Directors: In a statement issued this week, it said of end of life planning, “This right is part of the culture of American medicine, defended since the beginnings of the field of bioethics, and supported by case law going back over 50 years.” Read the full statement here.

The White House: In a video on its Web site, Melody Barnes, the President’s Director of the Domestic Policy Council, debunks the malicious myth that reform would encourage or even require euthanasia for seniors. See it here.

The New York Times: “There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure,” stated a page-one article.

Published on: August 14, 2009
Published in: Health Care Reform & Policy

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