Human Exceptionalism

Insuring End-of-Life Talk Not Death Panels

Sarah Palin started the idea that paying doctors to discuss end-of-life care with patients were death panels. She soon corrected herself to properly note that health care rationing boards under Obamacare would be the death panels. Ever since, even those who support rationing call them death panels. 

But to the subject at hand: I have never understood why paying doctors to hold these conversations was a big deal–either way. It seems to me that such discussions are a basic part of the physician’s job, whether they get paid separately for it or not. 

In any event, Obamacare doesn’t cover such conversations, and currently neither does Medicare. But insurance companies are beginning to. From the NYT story:

We are seeing more insurers who are reimbursing for these important conversations,” said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade association. The industry, which usually uses Medicare billing codes, had created its own code under a system that allows that if Medicare does not have one, and more insurance companies are using it or covering the discussions in other ways.

This year, for example, Blue Cross Blue Shield of Michigan began paying an average of $35 per conversation, face to face or by phone, conducted by doctors, nurses, social workers and others. And Cambia Health Solutions, which covers 2.2 million patients in Idaho, Oregon, Utah and Washington, started a program including end-of-life conversations and training in conducting them.

What? Evil insurance companies did something of which the New York Times approves? Snow in August!

Snark aside: Let’s think about this. Will $35 really make the difference between a doctor doing and not doing her duty to the patient? I don’t think so.

Moreover, it isn’t as if these talks are one-offs: Rather, such matters should be the subject of a continuing dialog: A patient is diagnosed with a serious illness. Doctor and patient discuss what should or should not be done. Patient’s condition improves or worsens. Often, that will spark another conversation–and then another.

Now, if insurers want to pay for this, fine with me. If Medicare pays for it, fine too--depending on the details.

For example, I opposed legislation to have Medicare cover such conversations, not because I oppose the talks, but because the authors larded the bill with tons red tape–complete with a Care Planning Advisory Board.  Good grief.

And, of course, we wouldn’t want the conversation to become a push toward no treatment to save money. Well, most of us wouldn’t.

For some reason, the Times made this relatively minor matter a front page story. It doesn’t warrant that kind of coverage. It isn’t really that big a deal.   


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