Public Rallies Behind Medicare Payment for End-of-Life Talks

End-of-life care discussions between patients and doctors are getting major support from the public as the Centers for Medicare & Medicaid Services (CMS) weighs its proposal to include these talks as part of practitioner billing, a new poll revealed.

About eight out of 10 Americans support Medicare and private insurance coverage for advance care discussions, and nine out of 10 doctors say these talks should be conducted with patients, according to a study by the Kaiser Family Foundation.

The discussions allow patients and doctors to determine the type of care a person wants to receive toward the end of life. While it’s a topic that can make some feel uncomfortable—about half said they would feel comfortable talking with a doctor about this subject—there are many important decisions during the final stages of life for which a person’s preferences can be taken into account. For example, some people may choose to receive home care during their final weeks or make other advanced plans related to how care is delivered to them if they become unable to make decisions due to a chronic illness.


While most agree talking about end-of-life care is important, only 17% of respondents in the survey said they’ve discussed this type of care with a doctor or another health care provider, including 27% of seniors 65 and older, the study found.

CMS released its proposed changes in early July to the Medicare Physician Fee Schedule for 2016 that would allow practitioners to bill for end-of-life care discussions with Medicare beneficiaries. Experts have agreed for some time that end-of-life care has fallen short in terms of how it is coordinated and delivered.

“For Medicare beneficiaries who choose to pursue it, advance care planning is a service that includes early conversations between patients and their practitioners, both before an illness progresses and during the course of treatment, to decide on the type of care that is right for them,” the CMS proposal reads.


Involving patients in the process earlier—and allowing doctors to bill for these talks—could lead to improved patient care, studies have shown.

The American Hospital Association (AHA) and the American Medical Association (AMA) have voiced support for the measure.

“This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional,” the AMA wrote in a statement. “This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions.”

End-of-life decisions are not weighted by the cost of care in the CMS proposal, but this type of care does play a significant role in health care spending. End-of-life care is one of the priciest expenditures for Medicare and makes up about one-third of spending, according to the Dartmouth Atlas of Health Care.

There has been some opposition to the proposal, despite public majority support for these discussions to be a part of the health care billing system. Sarah Palin, former Governor of Alaska and one-time GOP vice presidential candidate, took to social media to compare end-of-life plans to “death panels,” resurrecting an inference that such talks would lead to panels that decide who would receive care.

GOP opposition could indicate that the decision, as part of health care changes brought on by the Affordable Care Act, will be an issue in the upcoming presidential election.

CMS will issue a final rule on the plan by Nov. 1. The discussions would be voluntary, and doctors could start receiving payments beginning Jan. 1.

The decision over these talks comes at the same time as a debate over palliative care in states such as California, where legislators are considering a bill that would allow patients in the advanced stages of a terminal illness to choose to end their lives.

Written by Amy Baxter

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