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Medicare to Reimburse for End-of-Life Discussions

Beginning January 1, 2016, the Centers for Medicare and Medicaid will reimburse health care providers for discussions with Medicare patients about the type of medical care they want at the end of their lives. The new rule will affect about 50 million Medicare patients, and some private insurers have already adopted this practice. The nursing home negligence lawyers at Pintas & Mullins explain this new rule below.

The rule was initially proposed as part of the Affordable Care Act, however, it was vehemently opposed by Republican politicians who believed it would cause doctors to ration care to save costs. Due to the opposition, the rule was stripped from the final bill in 2009. Fortunately, the proposal is not triggering the same type of resistance this time around and has in fact gained bipartisan support, along with support from physician and hospice organizations.

According to a poll by the Kaiser Family Foundation, the public approves of the new rule as well, with eight in ten Americans saying Medicare and other insurers should pay for end-of-life care discussions. This makes sense when you look at the national landscape: Americans are living longer, often with chronic illnesses, and are better educated and more involved in their own medical care.

The Conversation

End-of-life discussions are difficult and intimidating, but important. According to a survey of California residents, 80% of people say that if they were seriously ill they would want to have an end-of-life discussion with their doctors. 82% of respondents believed it was important to put their wishes in writing, although only 23% have actually done it.

These discussions typically focus on long-term treatment options and what type of care patients want if they lose the ability to make decisions. The goal is to honor the wishes of patients when they are close to death. Topics may also include pain management options, advance directives, specialized care, and family relationships.

It is important to note that doctors are not legally required to follow patients' directives if they disagree with them on moral or ethical grounds.

In the United States, our culture is to treat serious illnesses with aggressive treatment, even if the benefits only minimally improve the length or quality of life. Too often, doctors do not have honest discussions about the long-term, so patients with fatal illnesses and their families have difficulty accepting their own mortality. This new rule is a great step in the right direction and will enable countless patients to be more accepting of death.

In his blog, Dr. Vincent DeGennaro Jr. provides a first-hand account of how our culture influences end-of-life decisions. He states that early in the 20th century, death in the United States transitioned from a natural part of life to something "distant that occurred in hospitals." Death used to be omnipresent and familiar, but as medicine advanced, death moved away from homes and became something to be feared and removed from our daily lives. Further, Americans expect to live full, successful lives and are moving away from religion, which has some impact on our decisions to prolong life as much as possible.

Dr. DeGennaro states that, ultimately, we all need to decide what we want for the end of our lives, and there is no right answer. With any luck, when the time comes, you will have a loving family who supports your wishes and a compassionate doctor who explains your options fully. For Medicare patients, these decisions just became a little less scary and a little more manageable.

Our team of nursing home negligence lawyers has been fighting on behalf of residents and their families for 30 years. We represent residents across the country that have been seriously injured by staff neglect or abuse. If you have any questions about our nursing home practice or the types of claims we handle, contact our firm for a free legal consultation.