Backing Off Advanced Care Planning

Remember the 2009 outcry over “death panels,” when some Republicans seized on the idea of voluntary advanced care planning in health reform as a sure sign that the bill would lead to rationing? Well, the advanced care planning provision didn’t make it into the final bill, and the idea hasn’t been too much discussed since, except as comedy fodder. Now the Obama administration is taking heat on this issue once again for covering advanced planning under Medicare and then rescinding that coverage.

Without too many people noticing, the administration added voluntary advanced care planning as an element of the Medicare annual wellness visits. The provision was buried in a much larger regulation published in the fall and didn’t draw too much notice. Around Christmas, the New York Times highlighted the provision in an article. The report noted that many advocates were thrilled that advanced planning would be covered under Medicare, but even staunch supporters were hoping the victory wouldn’t stir up another death panel debate.

"Death panels" remain a source of comedy and politics. Image via Flickr user MarkWallace by Creative Commons License.

The advanced care planning coverage would have gone into effect on Jan. 1, but the Obama administration rescinded the provision. In a final rule that strips advanced planning from the larger Medicare regulation, the administration wrote that there hadn’t been enough opportunities for the public to comment on the idea. Advanced care planning was included in the final rule, but not in an earlier proposal that was issued for public comment. But the administration also defended the decision to include it in the first place, saying that some people who commented on the proposal had suggested its inclusion.

The controversy came up during a White House press briefing Jan. 5 when reporters suggested that the White House was lending credibility to the false notion of death panels by removing advanced care planning. White House Press Secretary Robert Gibbs denied that and said the administration still supports the idea of advanced care planning and sees it as a bipartisan issue. Do you think advanced care planning can be discussed without being politicized? Share your thoughts.  

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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Filed under Geriatric Medicine, Health Policy, health reform, Hospice and Palliative Care, IMNG, Physician Reimbursement, Practice Trends, Primary care

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