V I E W P O I N T

Voluntary Advance Care Planning Consultations for Medicare Beneficiaries

Some opponents of health care reform are scaring seniors by reporting that Congress is considering legislation to require Medicare beneficiaries to participate in mandatory consultations on how they want to die. This information is NOT correct.

Health Care Reform Legislation and Medicare Reimbursement for Voluntary Advance Care Planning Consultations

H.R. 3200, America 's Affordable Health Choices Act, which is being considered in the House of Representatives, includes a provision to improve the Medicare program by authorizing reimbursement for one Advance Care Planning Consultation every five years. The consultation is not mandatory; rather, Medicare would provide reimbursement if beneficiaries voluntarily chose to meet with a health care practitioner for information about advance directives, including living wills and durable powers of attorney; the continuum of end-of-life services and supports available, such as palliative care and hospice; and orders regarding life sustaining treatment. Consultations could be conducted more frequently if there is a significant change in the health condition of an individual.

The purpose of Sec. 1233, page 425, of H.R. 3200 is to help people discuss their views regarding end-of-life care with their families and health care providers before the need for such care arises and to learn what they must do to ensure that their wishes are carried out if they become incapacitated. The Advance Care Planning Consultation, which would be paid for by Medicare, is intended to improve the quality of end-of-life care provided to beneficiaries. These meetings between patients and their doctors would be completely voluntary and no one would be required to complete an advance care directive or living will. The requirement in the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) requiring physicians to provide an advance care planning consultation as part of the Welcome to Medicare physical exam is not considered as one of the advance care planning consultations available to beneficiaries every five years.

H.R. 3200 also requires the inclusion of quality measures on end-of-life care in the Physician's Quality Reporting Initiative, and the inclusion of information on advance care planning in the paper and electronic versions of the Medicare & You handbook.

Support for Advance Care Planning Consultations

Supporters of the Advance Care Planning Consultation provision in H.R. 3200, and related legislation that has been introduced in Congress, believe it is very important for people to discuss their views regarding end-of-life care with their families and health care providers before the need for such care arises and to learn what they must do to ensure that their wishes are carried out if they become incapacitated. In addition, it is very helpful for people to know about the wide range of options that are available to them for end-of-life care, from very aggressive treatment to palliative services and hospice care.

Opposition to Advance Care Planning Consultations

The Advance Care Planning Consultation provision of H.R. 3200 is in the news because several conservative commentators have highlighted it in the media. Some have stated that the bill recommends palliative and hospice care when, in fact, it says that the consultation must include an explanation that these services are available. A questioner at President Obama's July 28 town hall meeting said, "I have been told there is a clause in there (health care bill) that everyone that's Medicare age will be visited and told to decide how they wish to die. This bothers me greatly and I'd like for you to promise me that this is not in the bill." (It is NOT in the bill.)

NATIONAL COMMITTEE POSITION

• The purpose of the Advance Care Planning Consultation provisions in health care reform legislation is to improve the Medicare program for beneficiaries. The consultations are completely voluntary.

• It is important for individuals to make known their wishes about end-of-life care, both for themselves and for their family members and health care providers, so that their wishes can be carried out without dispute if they become incapacitated.

• Having information about the wide range of services available to those with advanced illnesses can help improve the quality of care they receive as they near the end of their lives.

Government Relations and Policy, August 2009