advance care planning consultations

A controversial provision of H.R. 3200 (one of the unpassed health care reforms bills introduced in 2009 prior to the Affordable Care Act) would have paid physicians to provide counseling to elderly or terminally ill Medicare patients who requested the counseling. 

The provision – ultimately not included in the Affordable Care Act – would have paid for one counseling session at least every five years, during which patients could discuss advance care planning, advance directives, living wills, palliative care and hospice and possible life-sustaining treatments for the terminally ill. Critics said the proposal would create “death panels” and described its intent as “guiding you in how to die.” The concept of “death panels” in the ACA was named PolitiFact’s “lie of the year” in 2009.

Although advance care planning consultations were not included in the Affordable Care Act, the government continued to address the issue, as end-of-life consultations are an important part of the services provided to Medicare beneficiaries, and there was no provision to allow Medicare to pay doctors for providing this service. Starting in 2016, under new HHS regulations that were finalized in 2015, Medicare did begin paying doctors for end-of-life consultations.