November 18th will mark the 11 year anniversary of the day I ended my grandmother’s life.
I did it with an ink pen. To sign documents to give to hospital permission to remove her from life support, to give permission to harvest her organs.
My family was fortunate. We all agreed that it was wrong to keep her on life support. No one thought a prayer circle of unusual size would undo the damage of the stroke. Imagine the exact opposite of the freak show that was going on in Florida at the time. That was my grandmother’s death. So we were lucky. And it encouraged several people to create advance care directives.
Five years later, “Death Panels” entered the national conversation and hung around like … well … like Sarah Palin. CMS (Medicare to youse) tried to include advance care planning in a new annual wellness visit benefit and the usual rejects didn’t like that.
At the start of the year, CMS declined to cover the new advance care planning visit to appease the people who were still yelling about Death Panels. At that point I thought “O.K., this time for sure we’ve started the final battles in a war that will end with medical care in the U.S. reduced to laying on of hands, colloidal silver enemas and stoning.”
In July, when the agency proposed covering the visits in 2016, I assumed the shouts of a handful of irrational attention-mongers would (again) be given more weight than the hundreds of individuals and organizations that support advance care planning.
Occasionally I am wrong, and this time I don’t mind. The final rule came out last week. As of Jan. 1 doctors and other health care providers will be able to talk to their Medicare patients about what they (the patients, not the doctor or The Government) want to do if they can no longer make decisions about their health care. From the final rule:
Some commenters were concerned that patients might change their decisions once care was actually needed and be unable to override previous advance directives; or that the government would be making healthcare decisions instead of patients, physicians, and families.
We note that while some public commenters were opposed to Medicare paying for ACP services, the vast majority of comments indicate that most patients desire access to ACP services as they prepare for important medical decisions.