Obama to Enact End-of-Life Planning for Medicare - NYTimes.com

Image via WikipediaBy ROBERT PEAR

When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.

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.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.

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TIME GOES BY | My Bodily Remains

by Ronni Bennett


We're old, most of us who hang around this blog and with age, death becomes a topic of consideration. Try as we might to ignore it, such necessities as wills, medical directives, the question of burial versus cremation, financial arrangements, even the choice of music at our funerals and a host of other decisions make it hard to avoid thoughts of our demise.

But none of these things nor death itself are what bother me in thinking about the end of my days. They feel more like paying the monthly bills or taking out the garbage – just stuff that needs to be done.

No, what bothers me most about dying is my naked body - who will see it, who will touch it and what they will do with it.

I'm not concerned that my body isn't as cute as when I was young. Nowadays, it's pudgy, wrinkled, discolored here and there, scarred in a couple of places and an amazing number of parts are droopy. No one's interested in this body for a Playboy centerfold but, then, they never were. The aged condition of it is not the issue.

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Medicare policy may account for growing length of hospice stays in nursing homes

ScienceDaily (July 9, 2010) — Researchers at Brown University have found that the length of an average Medicare-certified hospice stay in a nursing home has doubled during the last 10 years.

The study, which will appear in the August issue of The Journal of the American Geriatrics Society, evaluated hospice use in U.S. nursing homes between 1999 and 2006. It found the typical treatment time has increased from 46 to 93 days. The researchers cited a standard daily payment rate for most Medicare hospice enrollment days as an incentive for some of the longer stays.

The study also found that the doubling of Medicare services in nursing homes is associated with a 50-percent growth in the number of hospices, primarily for-profit hospices. Currently, one-third of Medicare beneficiaries who die in nursing homes are accessing hospice services, and the study predicts that this number will increase.
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A Humorous but Serious Look at End of Life Decision Making and Healthcare

End-of-life care discussions are in patients' best interests ... American Medical News

(American Medical News Ethics Forum) Scenario: What can doctors do to break down barriers to these kinds of talks?

It's incumbent upon physicians to help patients understand end-of-life care options, even though the coding and payment system for these discussions is lagging behind. Discussions about options have been shown to lessen depression, pain and anxiety for patients in their final days. A formal payment code would help in tracking such vital data.

Reply:

Recently proposed federal legislation on health reform would have allowed physicians to code and get paid for discussing end-of-life care options with patients. This idea was not welcomed; instead, it was met with alarm and bizarre misunderstanding -- the "death panel" inference and cries of "health care rationing." The provision has been removed from current reform bills.

The rationale behind the proposal was the assumption that allowing doctors to bill specifically for discussions about goals and advance directives for health care planning would motivate them to have those discussions. If this assumption is correct, then how do we convince the public that we are not trying to "pull the plug" on old people who get sick and are viewed by some as a drain on society's resources, but that advance planning discussions are in their best interest?
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Doctors back 'right to die'

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By KEVIN DOUGHERTY, The Gazette

Euthanasia is already a reality in Quebec hospitals, the president of the federation of Quebec medical specialists, told a National Assembly committee yesterday.

Doctors know when death is "imminent and inevitable," Gaétan Barrette explained.

But doctors are aware they can be charged with murder if they administer a "palliative sedative" before a patient is on his or her last breath.

Geoffrey Kelley, chairman of the committee, explained that MNAs will hear about 30 expert witnesses on "dying with dignity" to prepare a paper for a travelling public consultation this fall.

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End of Life Care for People with Dementia

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This study was conducted in Great Britain.

The time at which a medical or social crisis occurs for a person with advanced dementia and/or their carer(s) is a pivotal point when, if appropriate services were available, the person with dementia could remain in their familiar place of care until the time of their death.

With timely support in the community, it would be possible to prevent some crises occurring, or in the event of the crisis happening, provide an intervention that would reduce the need for a hospital admission. Our findings indicate that episodes of hospital care negatively affect the health and the quality of life for people with dementia, and that frequently the reason for admission could have been appropriately treated in the community. Evidence is emerging from other cities that where rapid response community teams have been introduced it has led to a substantial reduction in end of life hospital admissions – as these services offer a co-ordinated and proactive, rather than reactive, service model.

Whilst many of the findings reinforce those of the recent National Dementia Strategy and End of Life Care strategy, it also suggests that small changes to local health and social care services could significantly improve end of life care for people with advanced dementia who live in Haringey, as well as provide potential cost efficiencies, and greater value for money. This is particularly important in the context of public sector spending assumptions in the short to medium term.
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amednews: Assisted-suicide statute challenged by 2 Connecticut doctors :: Oct. 19, 2009 ... American Medical News

The lawsuit argues that "aid in dying" is not assisted suicide and physicians who hasten terminally ill patients' deaths should not have to fear punishment.
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Taking Control of End-of-Life Care

Regardless of one's stance on the healthcare debate or the use of end-of-life counseling, everyone needs to have a plan in place for his or her own end-of-life decisions.

During the recent debate over the proposed government-provided health care option, there has been great controversy over the inclusion in that plan of "end-of-life" counseling, or "death panels," as critics of the plan have called them. In the now defunct House bill, the government would have provided financing for those receiving government-funded health care to have optional consultations with physicians on end-of-life care choices, including hospice care.

Critics of end-of-life counseling feared it would open the door to the government making decisions about the type and level of care each person should receive based on a cost-benefit analysis. They argued this in turn could lead to the government deciding who would live and who would die and sanction the use of euthanasia.

Regardless of your stance on the healthcare debate or the use of end-of-life counseling, the truth of the matter is that everyone needs to have a plan in place for their own end-of-life decisions. Those who do not have a plan will leave their treatment and care decisions in the hands of their families, doctors or maybe even the government. By using the proper estate planning tools, you can take control of your health care decisions now and ensure that your wishes are followed in the future.
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Briefing: Fact vs Fiction in Health Reform

by Chris Fleming Chris Fleming
What exactly is the U.S. government’s role in health care and how might it change under health reform? What are the implications of slowing the rate of growth in Medicare spending and what would the impact be on beneficiaries? How do the issues involved in end-of-life care really look to the people and providers who live it?

These issues were discussed at a Health Affairs briefing titled “Fact Versus Fiction: Key Issues in Health Reform,” held August 20 at the National Press Club. Video and audio of the briefing and speaker presentations are available on the Health Affairs Web site, as is a special Health Policy Brief examining the issues discussed at the briefing.

Health Affairs Blog

Howard Kurtz on the Complex Nature of the Health-Care Reform Story - washingtonpost.com

For once, mainstream journalists did not retreat to the studied neutrality of quoting dueling antagonists. They tried to perform last rites on the ludicrous claim about President Obama's death panels, telling Sarah Palin, in effect, you've got to quit making things up. But it didn't matter. The story refused to die. Read More

AMNews: Aug. 24, 2009. End-of-life care provision stirs angst in health reform debate ... American Medical News

The public outrage over reimbursement for patient counseling catches doctors by surprise but shows how delicate the discussion over advance-care planning can be. Read More

Coping With End-of-Life Decisions - Pew Research Center

by Kim Parker, Pew Research Center - Public opinion polls show that Americans overwhelmingly support an individual's right to decide whether he or she wants to be kept alive through medical treatment. In a 2005 Pew Research Center survey, 84% said they approved of laws which say medical treatment that is keeping a terminally ill patient alive can be stopped if that is what the patient desires. In addition, 70% said there are some circumstances when a patient should be allowed to die, while 22% said doctors and nurses should always do everything possible to save the life of a patient. While a heavy majority of Americans support individual rights in this area, when it comes to personal preferences about medical intervention for oneself at the end of life, the public is more evenly divided. In the same Pew Research survey a narrow majority (53%) said if they were faced with a terminal illness and were suffering a great deal of physical pain they would choose to stop medical treatment, 34% said they would ask their doctor to do everything possible to save their life. Read More

Medical News: Palliative Care Docs Push Directives, But Won't Imperil Reform - in Primary Care, Geriatrics from MedPage Today

By Emily P. Walker - Christine Cassel, MD, a palliative care physician, worked on the language in the House of Representative's healthcare reform bill that would authorize Medicare to pay doctors for talking with patients about end-of-life care. The provision itself seemed innocuous. It would pay physicians about $75 to do what many geriatricians and palliative care specialists already do for free: create a written plan with patients who still have cognitive function to specify the type medical care they want -- or don't want -- at the end of their lives. Read More