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End-of-life advice is good medicine

Updated: September 24, 2012 6:25AM



Death panels. Government-sponsored euthanasia. Pulling the plug on grandma.

Those were just some of the blatantly false terms conservatives threw around last year to scare Congress into stripping a provision out of the health-reform bill that would have allowed Medicare to reimburse doctors for providing voluntary, end-of-life counseling to their patients.

The scare tactics worked. Now, the Obama administration has issued similar Medicare guidelines authorizing payment to doctors who provide voluntary end-of-life counseling during annual check-ups.

Not surprisingly, critics of the new guidelines, which went into effect Saturday, wasted no time reviving alarmist rhetoric that these private doctor-patient conversations would be used to goad seniors into foregoing potentially life-sustaining care in their final days.

Nonsense.

Encouraging seniors to think about what, if any, life-sustaining measures they would want taken if they were gravely ill isn’t the same as encouraging them to forgo treatment.

Those who want every measure taken to save their lives will still be free to make that choice. Those who would prefer not to live in a vegetative state will have that option, too. And people won’t be forced to talk their doctors about their options one way or the other.

End-of-life counseling is simply a way to educate patients about their options, so they can take the next step of drafting a “living will” and appointing a health-care proxy who can make treatment decisions on their behalf when they are no longer able.

Only about one-third of Americans have a living will, which means critical end-of-life decisions are often delegated to family members in the midst of a crisis.

It’s no surprise, then, that people who make their wishes known in advance are more likely to receive the kind of end-of-life care they want than people who don’t.

End-of-life counseling also has the potential to lower health-care costs by reducing the likelihood that patients will receive costly treatment and tests they don’t want.

A 2009 study published in the Archives of Internal Medicine found that late-stage cancer patients who received end-of-life counseling incurred health-care costs that were 36 percent lower in the last week of life than patients who didn’t.

Those kinds of savings become critically important to driving down the nation’s escalating health-care costs. More than 25 percent of annual Medicare expenses, for example, are attributable to end-of-life care for the 5 percent of beneficiaries who die each year.

Many doctors would discuss advance planning with patients whether or not they were reimbursed for their time. But we see no harm in giving doctors additional incentives to initiate these important conversations, particularly when it could lead to more compassionate care for patients and significant cost savings for Medicare.



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