Obama to enact end of life planning as part of Medicare

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   C.J. Wrightposted 13 years ago

   Some would say this is basically the precursor to death panels.
   Others would say those who believe this are crazy conspiracy theorist. Here is my question. The provision allows medicare to pay for a doctors visist that includes end of life planning discussions. Why do we need to have federal regulations for this? Can't a person have this discussion with or without the governments approval? Even if this isn't the boogie man the hard right would have you believe. Isn't it just inviting waste? Now we are going to have a doctors visit designed to provide NO care, but be chargable to the tax payer via Medicare?
   
   Here is the NYT article:
   http://www.nytimes.com/2010/12/26/us/po … &scp=1

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      Shadesbreathposted 13 years agoin reply to this

      Sounds like a Hospice consultation to me.

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         C.J. Wrightposted 13 years agoin reply to this

         Exactly. So why is the government going to pay for this? Don't you think this could be handled via PSA's, faith based groups or even hospice doing free consults? I mean lawyers do free consults, so do many plastic surgeons.

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            I am DB Cooperposted 13 years agoin reply to this

            This is something that is going to save Medicare money in the long run. Some people do have the option to reach out to faith based groups and other alternatives for this type of consultation, but free alternatives from charities are NOT always available to everyone. The government should not rely on private charities to handle this type of care. Lawyers and plastic surgeons give free consultations because they want potential clients/patients to feel comfortable with choosing them, not because they are feeling charitable.
            
            The most expensive part of a dying person's care can come in the months before death when they become gravely ill and might spend weeks at a time in the ICU and receive treatment that can cost hundreds of thousands of dollars without improving their quality or length of life. I think if most people were able to evaluate their options before this time comes, they would choose not to be put on life support for an extended period of time just to be kept on the brink of life while having no capacity to communicate with loved ones or even maintain consciousness. We absolutely should encourage everyone to evaluate their end-of-life options. They might decide on a more humane way of dying while placing less of a burden on their loved ones and the Medicare system as a whole. In no way does this policy force hospitals to cut off life support to people who did not choose it.

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               Ralph Deedsposted 13 years agoin reply to this

               We're on the same wavelength. The hospitals tend to pull out all the stops and run the costs up even though the care is futile and not even wanted by the patients. End of life care is a huge percentage of Medicare costs.

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                  Evan G Rogersposted 13 years agoin reply to this

                  If the market were free in the first place, this entire argument would be moot.
                  
                  "Helping people survive is good... ... .. to a point" is basically your argument.
                  
                  But why is the government the one that's being allowed to decide? It makes no sense.
                  
                  Clearly a free-system where those responsible for their own money and savings voluntarily make their own decisions about their health is the only system that makes sense.
                  
                  Yet here we are - those who earlier claimed that "death panels" would never exist are facing the reality of supply-and-demand that everyone knew was going to come to effect. Sure, these aren't REALLY death PANELS, but it's essentially the same thing - government mandated "asking people to not spend the money that they invested into the government".
                  
                  It's clearly CLEARLY nonsense, and an OBVIOUS failure of government.

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                     Ralph Deedsposted 13 years agoin reply to this

                     The government isn't deciding anything. It's merely encouraging people who are covered by Medicare to voluntarily discuss the options for end of life care with their personal physicians and if they wish indicate their preferences. This is an opportunity that is often not provided with the result that patients, against their will are subjected to painful, costly and futile care during the last days or months of their lives. This will benefit the recipients and is likely to save a significant amount of money for Medicare and American taxpayers. Sounds like a no brainer to me.

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                        I am DB Cooperposted 13 years agoin reply to this

                        Bingo. This isn't about "death panels" and the government saying it's time to give up on grandma, this is about the government making access to end-of-life planning easier so grandma can decide how far a hospital should go to save her while she still has the capacity to make that kind of decision.

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                           C.J. Wrightposted 13 years agoin reply to this

                           There is no current restriction to this type of discussion. There are loads of information in Hospitals and Doctors Offices about this now. What road block is the government removing?

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                              PrettyPantherposted 13 years agoin reply to this

                              I don't understand how you cannot see this for the cost-savings measure that it is.  It will work much like being given the option to become an organ donor when you get your driver's license renewed.  People who might not otherwise take the steps to legally legally select their preferences for end-of-life care will follow through when it's right in front of them.  In the long run, this will both serve the wishes of the patient and save money.

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                                 C.J. Wrightposted 13 years agoin reply to this

                                 Because it's not care. It's a consult. At the end of the visit, if it actually occurs at all, the patient is no better than they were to start. The idea that there is going to be a separate visit for this is ridiculous.

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                              I am DB Cooperposted 13 years agoin reply to this

                              There isn't a current restriction, but that doesn't mean there are barriers. Some groups that deal with these types of decisions are faith-based and therefore not an option that all people would choose. Just about any consultation with a doctor about anything is going to cost money, so that's a barrier right there. The government is trying to make those consultations free or very low cost for the patient to encourage use of these services.
                              
                              If surveys show that 80% of people would not want to be put in the ICU and pumped full of drugs while unconscious and with no chance of recovering just to keep their heart beating, but only 10% of people put in this situation actually have clearly-written out instructions on when to "pull the plug", there is clearly a major gap here that is costing Americans a lot of money. If the government spends $500 per person who uses these consultation services and it significantly increases the people who clearly define their end-of-life care, the overall cost savings could be HUGE, as in billions of dollars per year.
                              
                              The numbers are as clear as night and day. People are being put on life support for longer than they would wish for if they had defined how to be cared for in their final days. Not only is keeping someone alive in a nearly vegetative state against their will (which isn't known unless they consult with someone beforehand) a sick thing to do, it's also a major expense. This is a win-win for patient care and the government.

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                                 C.J. Wrightposted 13 years agoin reply to this

                                 So basically your saying that your willing to pay to have them decide. Your logic being that it will save money in the long run. Based on the statistics you cited, people are well informed. There is just no place to "log" their decision.

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                        C.J. Wrightposted 13 years agoin reply to this

                        It may benefit the person. However with annual visits, it's not going to save money. The result will be that MEDICARE will be charged for this when the person is actually recieving a type of care not covered. It's happening today, it will only continue. I can't believe you don't see this. Now we are paying for NON CARE!

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                           I am DB Cooperposted 13 years agoin reply to this

                           My grandmother was kept on life-support for 3 weeks at the end of her life. I don't know if she wanted it that way. Nobody does, because she never took the time to tell anyone. She knew she was sick, doctors told her she was sick, but at no point did anyone ask "how long do you want to hang on when you are no longer capable of making your own decisions and we can no longer bring you back?". The cost for those 3 weeks on life support was over $50,000.
                           
                           I don't know if my grandmother died peacefully. I don't know when her last conscious thought occurred. I couldn't even narrow it down to a week. At the end she was hooked into a bunch of machines pumping her full of god knows what. Some people might want to go that way. I doubt my grandmother was one of them. She could have gone quickly within a few minutes of speaking her final words, with dignity.
                           
                           I don't understand why you call these consultations "non care". They are 100% about care. The costs for life support are so staggering that saving just a day or two of life support treatment would easily make up for the cost of a lifetime of annual end-of-life consultations, and most people wouldn't do these consultations that often (who likes talking about their own death over and over again?).

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         Doug Hughesposted 13 years agoin reply to this

         "Sounds like a hospice consultation."
         
         Righto, Shadesbreath. But probably you only get a hospice consultation if/after you have been diagnosed with a terminal illness. The fact is we are all 'terminal' and there's no good reason not to get information about the choices you have as a patient. We are talking about a voluntary consultation with a doctor.
         
         If you have not left written instructions about how far to prolong your life after the quality of life is gone and hope of recovery is nil, the hospital MUST make every effort to keep you alive. Period. The family can step in  and make a decision, but if they can't or won't,  then he patient  can linger like a bedridden borg plugged into machines in a drug-induced coma until something quits that the doctors can't fix. BTW, this is expensive and Medicare pays the bill.
         
         The suggestion that the government will decide - or wants the power to decide - is totally bogus. Medicare doesn't want to decide when to pull the plug any more than the hospital wants to decide. They want the patient to decide - and it has to be an informed choice.
         
         How do you insure the choice is informed? Umm - have it done by a qualified professional, maybe. Like an MD who works with geriatric patients. How do you ensure the consult is complete? You list the items that have to be covered in the consultation to qualify for payment. And Medicare does.
         
         My father died in ICU of Lou Gehrig's disease - and he did not live a living will or medical directives. The point being, I have seen this issue up close and personal.  If you knew what might happen at the end of life, you would take control before.  That's all this does - inform and empower the patient.

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            C.J. Wrightposted 13 years agoin reply to this

            I have wittnessed the same with my Father. None of this stops them from running up the bill in the end.

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               Doug Hughesposted 13 years agoin reply to this

               When we (the family) decided to take my father off the ventilator that was breathing for him, no one at the hospital objected or tried to 'run up the bill'. Up until we decided, the hospital performed as if recovery was a possibility (and it wasn't) and gave him the highest quality of care they could.
               
               For this medical  professionalism, I am forever grateful. If you want to pretend it's 'running up the bill', you can.

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                  C.J. Wrightposted 13 years agoin reply to this

                  The illness your father had was terminal from DAY ONE. By the time he was brought to the hospital in his final days he was actively expiring. Why did you have to tell the doctor that? You didn't. However up until you decided, the doctors pretended like they were going to save your Fathers life. Yes Doug, I call that running up the bill.

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                     Doug Hughesposted 13 years agoin reply to this

                     You are arguing for euthanizing my father.
                     
                     I am arguing that it was HIS decision first - that it should have been an informed decision that he made through a living will or medical directives. Absent that, it was the decision for the family to make after THEY became informed.
                     
                     It was never the decision for the hospital or the government to make.
                     
                     I'm glad this example allowed us to clarify the differences in our opinions.

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                        C.J. Wrightposted 13 years agoin reply to this

                        What I'm saying Doug is this. You and I both knew our Fathers fates were sealed. WE should have had those discussions. THEY should have made those decisions ahead of time. HOW does having a Medicare doctors visit change any of that? You see we agree. People SHOULD be responsible. Families SHOULD force the issue and have the discussion. We simply disagree about having to pay for this decision with tax dollars.

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                        C.J. Wrightposted 13 years agoin reply to this

                        Doug, I'm not arguing for euthanasia, you are. It's a self directed euthanasia, but euthanasia none the less. It's telling people, "Do the right thing, don't be a burden" I personally don't see a problem with it. However I don't support tax dollars being spent on it.

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      classicalgeekposted 13 years agoin reply to this

      End-of-life planning should be a basic part of everyone's health care. Therefore it should be covered. The reason a doctor is paid for it is: a) doctors exchange time for money; b) a doctor's expertise is required to answer some questions patients may have about the efficacy of certain treatments and their alternatives. The only thing new about this is now insurance pays for it.

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         C.J. Wrightposted 13 years agoin reply to this

         I just don't see it. It's ridiculous and it opens the door to some pretty scary stuff. First, if your doctor has this conversation with you when your 18, don't you think you opinions and views may change by 25, 55 OR 60? Would your views change once death is imminent? That's my point. However, now your going to have an extra appointment to discuss this YEARLY? Really. That's going to make cost go down right?

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         Uninvited Writerposted 13 years agoin reply to this

         Exactly. Everyone should do this. So many of us put it off until it's too late. I'm sure some things change. However, I do know and would have known at 18 that I do not want to live as a vegetable. I'm sure things can be changed as often as you wish, no one is going to force to do something you do not want to do.

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            C.J. Wrightposted 13 years agoin reply to this

            I agree with all of that. My point is that MEDICARE has a horrible reputation for fraud. If a patient comes in for a visit who is eligible for Medicare, Medicare WILL be billed once a YEAR regardless of whether the "discussion" takes place. That's just a reality.

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               SomewayOuttaHereposted 13 years agoin reply to this

               i get that...when i go to the dentist i verify the work that was done by signing documents each visit....maybe that would help deter fraudulent claims

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                  C.J. Wrightposted 13 years agoin reply to this

                  In nursing homes, hospice care and large doctors groups there is what's called a "MEDICARE" Nurse. He/she is an expert at billing. They make sure that EVERY billable line item is added to that person's account so that it may be billed to MEDICARE. It doesn't really matter to some if the patient needs this care or even if they get it. Just as long as it is "charted" and BILLED.  This is a system loaded with FRAUD. This "end of life" discussion is just another vehicle.

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               Ralph Deedsposted 13 years agoin reply to this

               Sounds like you don't believe in Medicare. And, of course, the fraud is committed, not by Medicare, but by doctors and other providers. Medicare needs to do a much better job of controlling fraud, perhaps by sending a few providers to the slammer.

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                  C.J. Wrightposted 13 years agoin reply to this

                  I don't believe in Medicare as it exist today. Thats for sure. I also can't see the benifit of this provision. It will only lead to more waste. Every year ONE of your doctors visits will be written off as an "END OF LIFE" planning visit. We are now at the point where the average American believes that his/her medical expenses are someone elses burden to bare.

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         psycheskinnerposted 13 years agoin reply to this

         Exactly.  It will reduce stress, confusion and average costs.  I am all for it.  It will also probably help with organ donation shortages.

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      Ralph Deedsposted 13 years agoin reply to this

      All they're saying is that Medicare will pay for the voluntary consultations. Seems to me like a good idea to me because it will help insure that individual's wishes will be observed. Perhaps more important, it may help reduce the incredible amount of cost incurred during the final months of life. Several years ago my uncle had a severe stroke and despite the fact that he had executed a living will indicating he didn't want his life prolonged unless the chances of full recovery were good (he was in his late 70s) the doctors went ahead with brain surgery which didn't help, and the hospital kept him alive in a coma for a year during which time he didn't speak a word or communicate in any way. This was against his wishes and over the objections of his wife, at great cost.

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      Jeramiposted 13 years agoin reply to this

      I read the article and all that I could tell from this is that now doctors get to bill the insurance for things that are already going on.
      
         Do not Resuscitate Orders, are a right that we have had for quite some time.
         The right to refuse treatment also.
         Home Hospice care saves taxpayers billions of dollars each year.
      
         Also Hospice caregivers are grossly underestimated.
      
         There are many patients that are given 6 months to live and sent home under Hospice care.
         Hospice cares' objective isn't to help the patient die with dignity.
      
         It is to extend the "quality and value"     of the patients'
      life. 
        There are cases that the patient had they taken the recommended treatment probably would have died at the time appointed.
      
        BUT instead they are out playing golf,...(maybe not as great of a score that they usually would, but at least they are playing) ...  and playing with their grandchildren long after their expected time of death had passed.
      
         Home Hospice care is way greater of a thing than people give it credit for. 
         And it is cheaper on the taxpayers than a long drawn out hospital treatment and care. 
         And better for most terminal patients.
      
        Just my opinion along with the highest admiration for the work that these people do.
      
        So now this bill pays the Dr. to have this discussion with the patients.  Good!
        I think they should have to in an honest manner when appropriate.

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   lovemychrisposted 13 years ago

   My mom had this discussion with me. We made it official. Good to have the gvt involved, in case a group of Morons comes around telling me I am committing murder for letting my mom die in dignity.

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   SomewayOuttaHereposted 13 years ago

   ...the concept is a good one...how it is administered is another issue...just went through watching my friend die...if she hadn't made her plans in advance...someone could have misunderstood why there was no 'care' to keep her alive...it happens...people sometimes don't understand what they are witnessing because they are not used to thinking that way...we are used to helping people stay alive...helping someone die is a completely different thought process....and sometimes it takes folks abit of time to get their head wrapped around it....

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   Hugh Williamsonposted 13 years ago

   End of Life Options Planning isn't linked with rampant Medicare fraud, which needs to be addressed on it's own.
   
   I don't see why someone would protest giving an ill patient all of the information necessary to set up intelligent treatment plan, or non-treatment end of life plan.
   
   No one will be forced to do such a plan, but they would be able to opt for it if they choose. Today, our pet poodles usually die more humanely than grandma does.
   
   My thoughts.

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   Evan G Rogersposted 13 years ago

   Let's be totally honest with ourselves.
   
   Choosing to NOT accept health-care that has vast potential to save your life is a decision that can ONLY be made by the patient. It's THEIR responsibility to look for the best price in health care; it's the PATIENT'S responsibility to decide when enough's enough; it's THEIR decision to save up the money needed to stay alive as best they can.
   
   Having the government step in and reward doctors for, essentially, asking the patient to choose to NOT accept life-saving health care is UTTERLY DISGUSTING.
   
   And it's a DIRECT result of government failure and government interference with the market.
   
   Please, let's just be honest on this one:
   
   "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."
   
   ...doctors are being PAID to ask their patients to not receive care that they might want.
   
   Imagine that: deciding ahead of time if you want to be on a breathing machine when you're perfectly healthy... and then having a heart attack a month before your grand-daughter gets married.
   
   These discussions would NORMALLY be happening - at no extra cost to taxpayers - if the government just stepped out of the entire health-care system entirely.
   
   PS - why is Obama legislating? I thought he was the head of the Executive....
   
   PPS - it's disgusting to hear legislatures actually trying and BEGGING to keep this information out of the hands of the public...

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      I am DB Cooperposted 13 years agoin reply to this

      This is an absolutely ridiculous spin of the issue at hand. Allow me to quote part of what you said: "Choosing to NOT accept health-care that has vast potential to save your life is a decision that can ONLY be made by the patient." That's exactly right. The problem is far too many patients never get around to making this decision one way or the other. That's why we currently have a system where patients who have never told their loved ones or medical care providers how far to go to save them end up unconscious in the ICU getting pumped full of drugs to keep their heart beating for the final month of their life, at a cost of hundreds of thousands of dollars.
      
      Patients will still have the option to have this kind of care if they want, but surveys have shown that most people do not want to die this way, but they never sit down and plan for their own death so that's just the way they end up going. Life-sustaining treatment is not the same as life-saving treatment. Many times it's impossible to bring a patient back to a point where they are aware of their surroundings and their situation, but it's relatively easy (at a great expense) to keep their heart beating. It's sort of a limbo between living and dying, and I think a lot of people would argue that it's this limbo state that's disgusting.
      
      Doctors will be paid for these consultations, but I wouldn't expect them to push for people to have the plug pulled on themselves early. Remember that hospitals make a lot of money from end-of-life care. Giving a doctor a few hundred bucks for a consultation is probably not going to sway him away from the thousands of dollars that can be made if a patient decides to cling to life until the very end.

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      C.J. Wrightposted 13 years agoin reply to this

      "...doctors are being PAID to ask their patients to not receive care that they might want."
      
      That's the key. It's crazy. I guess I shouldn't be surprised that most don't see this. American's have COMPLETELY divorced themselves from healthcare cost.

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   psycheskinnerposted 13 years ago

   All that is clear to me is that some people won't give credit where it is due and just have to find a way to make anything initiated by a party they didn't vote for "evil".

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   SomewayOuttaHereposted 13 years ago

   ...this is a huge topic...good one...
   
   a couple of other thoughts come to mind....when does end of life care kick in - who makes the decision and how do they determine when?
   
   ...it'd be interesting to see the financial picture - the data on how much money is spent keeping folks alive and the age group that most money is targeted at...it'd give me a better idea of why this is being looked at...i figure i know the answer but would want to see the stats...
   
   ....without the data...the next question for me is why put 'new' money into end of life...when dollars are no doubt needed at the front end (prevention and/or health care in general) rather than the back end...back end dollars i figure need to be used better...

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      C.J. Wrightposted 13 years agoin reply to this

      EXACTLY. If you want "universal coverage" you must have rationing. Rationing based on statistics. In the end it doesn't matter what you WANT. It only matters what is most cost effective. Thats the cold hard facts. You can't get away from it. Not even the all knowing government can be all things to all people.

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         Doug Hughesposted 13 years agoin reply to this

         "If you want "universal coverage" you must have rationing."
         
         SAYS WHO???????????????????????

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            C.J. Wrightposted 13 years agoin reply to this

            MATH

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            C.J. Wrightposted 13 years agoin reply to this

            There is rationing when people pay for their care. What makes you think Universal Care won't have rationing.

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      Doug Hughesposted 13 years agoin reply to this

      To address the question
      
      "When does end of life care kick in - who makes the decision and how do they determine when?"
      
      There's a set of medical criteria - When I inquired with Hospice, they referred me to Dr. Kenneth Doka, who has written books on the subject. Basically, unless and until your medical condition meets certain guidelines, neither the living will or end-of-life directives can 'kick in'.  Otherwise, you could order your own medical suicide.
      
      You define in your living will or medical directives what you want to have happen if and when certain conditions are met.  You decide.
      
      The doctor will measure if the conditions you describe meet the ethical criteria.. and as long as they do, he will do what you request, whether it's take you off life-support or withhold nutrition.  Or leave you on life support no matter what - if that's your directive.

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         SomewayOuttaHereposted 13 years agoin reply to this

         ..yea i understand all that....in some cases, some die at home...and the dr. isn't there...family handles it....there are so many scenarios around this subject i find....
         
         ...i believe in living wills, etc....some don't get a chance to put one together or express their wishes....i figure adults do get the choice if they are able to...i figure children/youth don't...wonder what the plan is for children/youth.....

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   psycheskinnerposted 13 years ago

   This will be folded into visits that are already occuring--for the very reason that their end of life is now foreseeable.
   
   Funny how you object to the government asking people to think and plan for themselves.

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      C.J. Wrightposted 13 years agoin reply to this

      Maybe so, maybe they will be folded in. So let's just wait and see what the billable rate is for this folded in benefit.

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      C.J. Wrightposted 13 years agoin reply to this

      I don't want to pay for the government to ask the patient to think.

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         Doug Hughesposted 13 years agoin reply to this

         C.J. - You don't want to pay for the government to do ANYTHING.
         
         This makes sense. It empowers the patient. The doctor gets paid for doing an important job medical job - giving medical information about what the patient can and can not ask for in a living will and medical directives - and how those directives would be carried out. If an MD won't get paid for answering these questions, why should he? There are other patients waiting with billable conditions.
         
         It serves the public interest by reducing the enormous cost of end-of-life care BEYOND the point that the patient would choose to eliminate life-support.

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            C.J. Wrightposted 13 years agoin reply to this

            "C.J. - You don't want to pay for the government to do ANYTHING."
            
            Completely untrue. The government is responsible for defense, the roads and general welfare. It's the general welfare where we find most of the disagreements.
            
            "It serves the public interest by reducing the enormous cost of end-of-life care BEYOND the point that the patient would choose to eliminate life-support."
            
            No it doesn't it only provides another vehicle for Medicare fraud. You see Doug, I have no problem with the government funding vaccinations. I have no problem with the government providing general health clinics to help the poor. What I have a problem with is fooling a willing public into believing they can completely divorce theirselves from mecical care cost and still be a part of the decision making process.

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   habeeposted 13 years ago

   I think these decisions are better made with a doctor than with a lawyer, so this could be a good thing. I just hope no elderly individuals feel pressured into making decisions they aren't comfortable with.
   
   My only problem with this "law" is that they tried to keep it hidden from the public.

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