Thursday, December 30, 2010

A Keepable New Year's Resolution!

Yes, you read that right. I believe I've found one. Little Miss Attila brought it to my attention, via Hillbuzz. LMA suggests, with help from Hillbuzz, that you, myself, and other fellow bloggers pick one "issue of our times" and become experts on it by reading and researching stories. After becoming experts on such stories, we report and blog about them throughout the year. Sounds like a great idea to me. I believe I might have found my issue, in the form of the new end-of-life provision that has been written back into Obamacare by way of the "secretary shall determine" language.

Since I can't find the link for the article, here it is in print, as I copied and pasted it to read later:

Remember the "death panel" scare in last year's health care debate? Sarah Palin and others served up ominous warnings that a House health care overhaul bill would give federal bureaucrats life-and-death power over medical treatment for people approaching the end of their lives.

Those fears were overblown. But the political furor forced Democrats to scrap a provision that would have paid doctors to give Medicare patients end-of-life counseling once every five years.

Now comes word of new Medicare rules that some critics say resurrect the "death panels."

Relax. These new rules are more Marcus Welby than Jack Kevorkian.

Right now, Medicare will pay a doctor for one end-of-life planning session with a Medicare patient. That may include help on how to prepare an "advance directive," a patient's instructions to his doctors about what to do if the patient becomes too sick to make his own medical decisions.


Chicago Shopping Overwhelming Offers: Always 50% off or more from your favorite brands >>


Starting Jan. 1, Medicare will pay for an annual session, if needed, as part of a broader "wellness" visit.

That's it. The counseling sessions are voluntary. The government won't tell doctors what to discuss with their patients. It won't pressure physicians to push patients into living wills or advance directives.

It's a smart move.

Research shows that end-of-life planning is valuable: A recent British Medical Journal study concluded it "improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives."

The study also noted that "patients welcome advance care planning and expect health professionals to initiate discussions."

That doesn't always happen, of course. Many patients don't have these conversations with their doctors, says Dr. Robert Berenson of the Urban Institute.

Reason One: Some doctors avoid starting end-of-life talks because it makes them uncomfortable.

Reason Two: Doctors are paid to deliver more aggressive treatment, even if it's futile. Berenson tells us that many patients are not fully informed about treatment options and the prognosis for success. Even if they choose a less aggressive treatment plan, some doctors ignore or overrule those preferences. "In other words, doctors are often more heroic than patients are," he says.

In a 2009 Urban Institute study, Berenson and his co-authors suggested a raft of ways to pay for health care reform. They estimated that the government could save $90 billion over 10 years, not by denying care but by better managing end-of-life care. That means helping terminally ill patients avoid futile treatment and manage their pain once they choose to stop treatment. It also means focusing on comfort and emotional support, not on exhausting every option technology offers.

Families, patients and doctors reach excruciating decisions every day about whether to extend treatment in the face of steep odds or to choose a less aggressive course. What families and patients decide is often guided not just by financial concerns, but by religious principles and deeply held moral beliefs.

The new rule changes none of that. But it does encourage doctors to open those tough conversations about death. To let patients know that they can largely control what is and is not done in the final days of their lives. That their families won't be forced to make agonizing decisions. That's a tremendous relief for many patients, and the families they leave behind.


Let me know what you think!