The Spokesman-Review


Editorial: Reimbursing doctors for end-of-life plan laudable

The Obama administration is quietly imposing a new Medicare provision related to end-of-life care, and while we don’t condone the hush-hush nature of the change, we applaud the result.

New York Times reporter Robert Pear broke the news recently that the government will begin reimbursing doctors who confer annually with Medicare patients on their options, including advanced-care directives. Participation by patients is purely voluntary.

Congress was pondering a similar measure in the summer of 2009 before Sarah Palin and others swooped in and labeled this sensible idea “death panels.” After the misguided outcry, the measure was stripped from the bill. President Barack Obama is bringing it back via executive order and supporters are quietly celebrating so as not to arouse another round of demagoguery.

Quibbles over process aside, this change should help shrink health care costs at the precise point where they tend to balloon. Fully one-third of all health care spending occurs in the last year of a person’s life.

At present, Medicare does not pay doctors who take the time to have thoughtful conversations with patients about the kind of treatment they’ll want once they get gravely ill. However, it does pay them for any tests and procedures they might perform, regardless of whether they make a difference.

That is a costly trigger for medical inflation.

Keep in mind that this is not the same thing as bureaucratic bean counters coldly pulling the plug on Grandma.

Possible scenarios would include asking emphysema patients whether they’d want to be hooked up to life support one day, or discussing the wisdom of possible surgeries with heart disease patients, or seeking guidance on how much treatment terminal cancer patients desire. The idea is to have this planned out while patients are able to think for themselves, so they can get the care they want.

An excellent example of how this works takes place at Gunderson Lutheran Hospital in LaCrosse, Wis., where advanced-care directives are the norm. At this path-finding facility, 96 percent of patients sign off on comprehensive plans. But it costs the hospital millions of dollars a year, because workers are not reimbursed for their efforts under our nation’s fee-for-service model.

Paying for end-of-life discussions would lower costs. Spending on patients in the last year of life at Gunderson averages about $18,000. The national average is $26,000, according to a National Public Radio report. At one New York hospital it is $75,000. The savings come from avoiding unnecessary and unwanted care.

The national health care reform bill was disappointing, because it fell short on cost containment. But this change is a step in the right direction.

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