Medicare and Medicaid to reimburse doctors for death counseling


The Centers for Medicare & Medicaid Services (CMS) is on-track to begin allowing physicians to bill for “end of life discussions,” or “advance-care planning” – counseling sessions that sound nice in theory, but carry the baggage of dark precedent.  In our state since 1999, for example, the Texas Advance Directives Act has seen the nation’s most draconian results spawn from this seemingly innocuous agenda; instead of putting more control into the hands of patients as the law’s name suggests, the legislation awarded doctors and hospitals a frightening and untouchable right to supersede patient wishes and impose death at will.

Indeed, the innocent-sounding language used to describe such physician-to-patient counseling shrouds the darker, overarching mindset that propels economic utilitarians and the healthcare industry alike to take active steps to convince patients that the value of their Lives should take a backseat to the convenience of everyone else.  According to Medscape Medical News, CMS revealed on Wednesday that they propose to begin reimbursing doctors for such counseling beginning in 2016:     

CMS introduced two CPT billing codes for end-of-life discussions, also called advance-care planning, in its physician fee schedule for 2015, but did not make them payable.  CPT code 99497 covers a discussion of advance directives with the patient, a family member, or surrogate up to 30 minutes.  The add-code of 99498 covers an additional 30 minutes of discussion.

Medscape notes that these discussions cover issues such as advance directives, hospice care, and other so-called “end-of-life” matters.  What is often blurred from the conversation about preparedness for the medical nature of one’s final days, however, is evidence that the federal government has an anti-Life agenda in promoting these conversations.  As such, federally-funded conversations about the issues are likely to be tainted by an agenda that downplays dignity and the Right to Life in favor of pragmatic considerations such as the cost of healthcare.

The Affordable Care Act initially sought to pay physicians for advance-care counseling in first drafts of the legislation, but whistleblowers pointed to precedent that suggested an impure motive in this provision.  One specific example dates back to the Clinton Administration’s “HillaryCare” – ObamaCare’s precursor.  As Texas Right to Life noted in January, HillaryCare researchers estimated the health care costs that the average American incurs at the end of his Life by comparing the medical expenses incurred in the last year of Life with the costs incurred during his entire Life.  They found that the last year of Life is by far the most expensive for the vast majority of Americans.  The logical extension of that research is that curtailing the period of high-cost care at the end of a person’s Life would reap greater economic prosperity for the nation.

But the approach to medicine that seeks to quantify a person’s value based on the medical costs they incur is incompatible with Pro-Life ethics.  Sadly, however – as we see in Texas every single day – this approach is precisely what bolsters the push for so-called “advance-care planning,” a central focus of which is the creation of advance directives – legal documents through which patients surrender their right to  lifesaving intervention in the case of emergencies that will otherwise lead to their demise.  Cha-ching.  The federal government just pocketed months’ or even years’ worth of medical costs that would have been incurred in helping to prolong the Life of the ailing patient.

The golden ticket for unfeeling pragmatists to get away with this behavior is to ensure that the patient’s demise was freely chosen under the direction of his physician.  Enter physician counseling: if a trusted doctor tells his patient that an advance directive is a good idea, and the patient freely and willingly opts to draft such a document, then the persons driving the movement to curtail medical treatments slither away scot-free.  We are not suggesting that patients be left in the dark about the decisions and circumstances they will face as their lives progress.  Rather, we are suggesting that patients deserve Life-affirming approaches free of slimy economic agendas and veiled politics.


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