Bill calls for more informed choices at end of life
Longer coverage, counseling, better planning
Health reform legislation introduced by Sen. Mark R. Warner (D-VA) strengthens the quality and availability of counseling, support services, and care management for patients with life-limiting illnesses. The legislation addresses unorganized care planning that might result in tests, treatments, and hospitalizations that many individuals might not choose if presented with options, such as palliative care or hospice.
The legislation, which is expected to be incorporated into comprehensive health reform legislation currently being considered by Congress, has been endorsed by several leading organizations, including the National Hospice and Palliative Care Organization and the National Association for Home Care and Hospice.
"This legislation will not deny health care to patients and families that want it," Sen. Warner said in a released statement. "But I firmly believe that any comprehensive health reform should include more information, counseling and resources that will allow patients, their families, their caregivers, and others to consider and discuss decisions about when and how long to pursue treatments at the end of life."
By some estimates, 27% of Medicare costs occur in the final year of life. Studies suggest that the nationwide application of the enhanced care planning tools included in Sen. Warner's legislation could reduce Medicare spending by an estimated $15 billion over 10 years, even as it provides more structured information and planning services that will better support the patient's wishes and improve their quality of life.
Sen. Warner's Senior Navigation and Planning Act of 2009 includes the following items that directly affect hospice:
Enhanced Medicare and Medicaid coverage of advanced illness care management services.
Beginning in 2011, individuals diagnosed with a life expectancy of 18 months or less will have access to a new advanced illness care management benefit administered by hospice providers. The current Medicare Hospice benefit only applies to individuals diagnosed with a life expectancy of six months or less, and it requires patients to give up curative treatment.
A requirement for physicians to provide certain Medicare beneficiaries with information on advance directives and other planning tools.
Beginning in 2014, Medicare reimbursements will not be provided until physicians provide individuals with information on advanced care planning for patients specifically diagnosed with end-stage cancer, renal disease, congestive heart failure, progressive neurodegenerative disorder, oxygen-dependent chronic pulmonary disease, or any other condition with a similar level of medical necessity determined appropriate by the secretary of the Department of Health and Human Services (HHS).
Incentives for providers to achieve accreditation and certification in hospice and palliative care.
If an eligible inpatient hospital, inpatient critical access hospital, or skilled nursing facility has an accredited palliative care program and meets utilization criteria, the hospital or skilled nursing facility would receive a Medicare bonus payment of 2% for fiscal years 2011 through 2016 and a bonus payment of 1% for fiscal years 2017 through 2020. After fiscal year 2020, if an eligible hospital or skilled nursing facility does not have in place an accredited palliative care program, the hospital would see reimbursements decreased by 1%.
More comprehensive discharge planning for facilities.
By Jan. 1, 2013, discharge procedures for hospitals, skilled nursing facilities, and home health agencies and admission procedures for hospice programs must include a discussion with patients and their families about the general course of treatment expected, the likely impact on the length of life and function, and the procedures they should use to secure help if an unexpected situation arises.
Increased public awareness about the importance of end-of-life planning.
HHS will design and implement a national education campaign to raise public awareness of the importance of planning for care near the end of life. This grant-funded campaign will focus on the need for readily available legal documents that clearly express an individual's wishes through advance directives, including living wills, comfort care orders, and durable powers of attorney for health care.
"Overall health reform should include a thoughtful process that informs patients, their families, and caregivers on how to navigate and think through decisions about when and how long to pursue treatments at the end of life," said Warner. "This will allow us to foster a culture in which all of us will have the ability to age well, with dignity, based on our own wishes and in the setting of our choosing."
Health reform legislation introduced by Sen. Mark R. Warner (D-VA) strengthens the quality and availability of counseling, support services, and care management for patients with life-limiting illnesses.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content