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Medicare's potential reimbursement for end-of-life discussion: A big step forward


Guest post from Jonathan H. Burroughs, M.D., president and CEO of The Burroughs Healthcare Consulting Network

Dying in America is big business. It is estimated that most Americans spend almost half of their total lifetime healthcare expenditures in the final year of their lives. Almost half of all Americans die in hospitals and 1 in 5 die in intensive care units despite the futile nature of their conditions and the ambivalence that many family members have of letting a beloved relative go.

The numbers are pretty staggering. According to a Congressional Office of Technology report, 2 million Americans are confined to nursing homes, 1.4 million require feeding tubes for survival, and 30,000 are kept alive in comatose or permanently vegetative states. Death also creates a huge financial toll on the living, with up to one third of families losing their lifetime savings in order to pay for end-of-life care (despite having primary insurance coverage).

In July, CMS finally announced plans to reimburse physicians, advanced practice nurses and physician assistants to have end-of-life conversations with patients. A final decision will be made Nov. 1, following a 60-day comment period. Major medical organizations support the measure, and third-party payers are already beginning to offer coverage for these conversations with many more planning on adding this coverage once the final CMS measure is approved.

There still is opposition, though. According to the National Right to Life Committee, there is concern that patients will be encouraged to avoid potentially life-saving treatments in order to cut healthcare costs. And others would like the proposal expanded to include social workers and palliative care experts.