Medicare proposes to pay for advance care planning

In a newly released proposed rule, Medicare is proposing to pay for individuals to talk to their doctors and care teams about their health care wishes as part of their advance care planning. Medicare already pays for advance care planning under people’s Welcome to Medicare visit. But, the agency wants to give people additional opportunities and greater flexibility to have a conversation about end-of-life decisions with their doctors.

For their peace of mind and for the comfort of their family, an increasing number of people are planning ahead for their care and creating advance directives even before they enroll in Medicare.  Some are ready to discuss end-of-life planning with their doctors when they first enroll in Medicare, and others would prefer to wait.  People also might want to start the conversation at the onset of a serious illness or as an illness progresses.

Making decisions about the kind of care you would want when you cannot speak for yourself takes some serious thinking.  There are a number of factors to consider, including Medicare coverage options and who you would want to make decisions on your behalf.  The proposed rule would allow Medicare to cover patient conversations with providers about the kind of care patients desire—from every treatment possible to minimal intervention–along with a range of other issues, when the patient wishes to have them.

In May 2015, 66 organizations sent a letter to Sylvia Burwell, head of the Department of Health and Human Services, urging that Medicare pay for advance care planning discussions with medical providers. “Published, peer‐reviewed research shows that ACP [advance care planning] leads to better care, higher patient and family satisfaction, fewer unwanted hospitalizations, and lower rates of caregiver distress, depression and lost productivity.”

And, there is a bi-partisan Senate bill, the Care Planning Act of 2015, from June 11, 2015, that would authorize Medicare to pay physicians to counsel patients on end-of-life decisions.

A proposal to cover advance care planning was taken out of the Affordable Care Act before it was passed, after Sarah Palin called these voluntary discussions to plan for end-of-life care “death panels.”