WASHINGTON — Six years after legislation to encourage end-of-life planning touched off a furor over “death panels,” the Obama administration issued a final rule on Friday that authorizes Medicare to pay doctors for consultations with patients on how they would like to be cared for as they are dying.
The administration proposed the payments in July, touching off none of the rancor that first accompanied the idea during debate on the Affordable Care Act in 2009.
Dr. Patrick Conway, the chief medical officer at the federal Centers for Medicare and Medicaid Services, said Friday that the final rule was similar to the proposal earlier this year.
Under the final rule, he said, “patients and families can have the discussions when and where they want” — before patients become ill, after they receive a diagnosis of cancer or other serious illness, or while they are receiving hospice or palliative care.
In such conversations, patients could discuss whether and how they would want to be kept alive if they became too sick to speak for themselves. Doctors can advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.
Under the rule, officials said, Medicare would pay $86 for the first 30 minutes of “advance care planning” in a doctor’s office and $80 for the service in a hospital. In both settings, they said, Medicare will pay up to $75 for 30 additional minutes of consultation. These standard amounts can be adjusted for differences in costs in different parts of the country.
The final rule, which takes effect in January, is consistent with recommendations from the American Medical Association. It creates new codes to pay for advance care planning under Medicare’s physician fee schedule.
The rule makes clear that advance care planning is to take place “at the discretion of the beneficiary.” This may allay the concern of people who feared that the government would decide whether to “pull the plug on Grandma,” as some members of Congress said in 2009. The term “death panels” was popularized by Sarah Palin, the 2008 Republican vice-presidential nominee, and took on a life of its own amid the controversies surrounding President Barack Obama’s push to enact major health care legislation.
