Death Panels Again (Palliative Care)

Sec 1233 of HB 3200 covers topics related to end-of-life care. Questions were immediately raised about it. The President of the AMA, J. James Rohack MD, said "...the bill would create a new Medicare benefit to pay physicans for time spent on advance-care planning consultations with seniors."

That raises two questions for me:

Was there legislation approving heart transplants or kidney dialysis?

Do doctors currently hold advance-care planning consultations with seniors?

Approval of such consultations is an administrative function and should not require legislation. Surely, doctors have such consultations and find some Medicare code to provide payment. Dr. Rohack's statement is misleading.

In a paper by National Quality Forum ( National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008 - Page 39) it is stated: "Patients receiving palliative care in the hospital who were discharged alive saw a net savings of nearly $1,700 in direct costs per admission and nearly $300 in direct costs per day." And "When palliative care patients die in the hospital, the savings are nearly $5,000 in direct costs per admission, and nearly $400 in direct costs per day..."

Sec 1233 is not about paying doctors for their services. It's about cutting costs. And that is a good thing.

We are concerned about the decision-making process. When do we, the patient and family members, lose control. If we want to continue our fight for life, will Medicare step in and demand that we switch into palliative care mode?