Richard Sorian, assistant secretary of Public Affairs for HHS, said the regulation does not require that the doctor say anything, but merely defines what advance-care planning is.
“The conversation between a patient and a doctor is a) voluntary and b) confidential. It is up to the patient and doctor to determine what that conversation is, or whether to have the conversation in the first place,” he said.
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The decision about end-of-life discussions is entirely in the hands of the patient, Sorian said. It is up to the Medicare patient to decide. “Do I want a discussion about end-of-life care? And then, it’s up to the patient about what they want to discuss.”
Sorian also clarified that it was the Bush administration that first implemented regulations regarding end-of-life counseling. The wellness visit began as a “Welcome to Medicare” exam, which was created by the Republican-led Congress in the Medicare Modernization Act of 2003. In 2008, when Democrats held the majority, Congress passed the Medicare Improvements for Patients and Providers Act, which modified the exam to include end-of-life planning. The Bush administration first implemented regulations that included the end-of life planning as part of the wellness visit created in MIPPA.
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Radulovic said the regulation will be the springboard for patients to make use of an important benefit. “We feel this gives a patient or Medicare beneficiary the opportunity to become an informed consumer and make their own choices that reflect their own beliefs,” he said. As patients age, he said, their views on hospice or palliative care might evolve and the regulation allows for that.
“This is not about rationing care or saving money, it’s about making sure patients understand what options are available before there is a health care crisis,” he said.