Six years after end-of-life planning nearly derailed development of the Affordable Care Act amid charges of “death panels,” the Obama administration has revived a proposal to reimburse physicians for talking with their Medicare patients about how patients want to be cared for as they near death.

The proposal, contained in a large set of Medicare regulations unveiled Wednesday, comes amid growing public discussion about the need for medical care that better reflects patients’ wishes as they get older.

Two months ago, former Florida Gov. Jeb Bush, one of the front-runners for the Republican presidential nomination in 2016, suggested that Medicare patients should sign so-called advance directives that spell out the care they want if they become incapacitated.

The American Medical Assn. has recommended the Medicare billing change.


The new proposal from the Department of Health and Human Services would not require Medicare patients to sign any order or even to talk with their physicians about end-of-life care.

Rather, the proposed regulation would allow medical providers to bill Medicare for “advance-care planning” should a patient want to have the discussion.

Such a session could include “the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed) by the physician or other qualified health professional,” according to the proposed rule.

Despite the growing consensus that better end-of-life planning is needed, the new regulation threatens to revive the “death panel” campaign that Republicans successfully used to demonize the federal health law as it was being debated.


Popularized by former Alaska Gov. Sarah Palin, the charge that the health law included a death panel provision, though universally discredited, became a popular GOP talking point, even though the idea of reimbursing physicians for talking with their patients about advance care directive had been supported by Republicans and Democrats.

Medicare currently provides coverage to more than 50 million mostly older Americans and is projected to grow steadily as baby boomers retire.

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