Obama’s health care plan – Reimbursing physicians for discussing end of life treatment

As a hospice palliative care nurse I was eager to hear about Obama’s health care plan regarding end of life issues. I was naively surprised to read media reports suggesting Obama was going to bring in “death panels”, and “push the elderly to early death”. From my read, the bill simply allows physicians to be reimbursed for discussions with patients about end of life issues, and advanced directives.

Stewart Florsheim, a board co-chair of Compassion & Choices of Northern California, an organization that helps the terminally ill make end-of-life decisions wrote:

“… Section 1233 simply ensures Medicare reimbursement for voluntary consultations about end-of-life treatment between patients and their medical practitioners every five years, or more often in the case of a life-threatening change. The consultations might include discussions about hospice, options for treatment (including pain management) and the importance of having an advance directive. The bill would help validate and support the work of palliative care doctors whose services are often subsidized by the rest of the hospital because they do not generate much revenue.” See
http://www.jweekly.com/article/full/39774/cruel-rumors-about-death-panels-have-no-place-in-health-care-debate/ for the complete article.

Physicians are in a unique relationship, and have the opportunity to provide valuable information and to support individuals to make informed decisions. Without advanced discussion people may not have the blessings of: discussing their illness, understanding possible outcomes of exacerbations of their illness, and making informed decisions in advance. Rather, they may die “unexpectedly” (or so it seems) in emergency departments/specialty care units/acute care wards - all too often in crisis mode.

I hope that the National Hospice Palliative Care Organization and those working in Hospice and Palliative Care in the USA will help the Americans understand that discussion and preparation is part of excellent health care. This may also lead to the discussion that death in the ICU or other acute care settings, with all the bells and whistles may not be best “end of life care”!

I also hope that Canada will follow Obama’s lead and reimburse our physicians for discussing end of life care and advanced directives with our elderly and with others whose physical condition is unstable!

Kath