The 90-year-old woman in the San Diego-area nursing home was quite clear, said Dr. Karl Steinberg. She didnât want aggressive measures to prolong her life. If her heart stopped, she didnât want CPR.
But when Steinberg, a palliative care physician, relayed those wishes to the womanâs daughter, the younger woman would have none of it.
âShe said, âI donât agree with that. My mom is confused,ââ Steinberg recalled. âI said, âLetâs talk about it.ââ
Instead of arguing, Steinberg used an increasingly popular tool to resolve the impasse last month. He brought mother and daughter together for an advance-care planning session, an end-of-life consultation thatâs now being paid for by Medicare.
In 2016, the first year health care providers were allowed to bill for the service, nearly 575,000 Medicare beneficiaries took part in the conversations, new federal data obtained by Kaiser Health News show.
Nearly 23,000 providers submitted about $93 million in charges, including more than $43 million covered by the federal program for seniors and the disabled.
Use was much higher than expected, nearly double the 300,000 people the American Medical Association projected would receive the service in the first year.
Thatâs good news to proponents of the sessions, which focus on understanding and documenting treatment preferences for people nearing the end of their lives. Patients and, often, their families discuss with a doctor or other provider what kind of care they want if theyâre unable to make decisions themselves.
âI think itâs great that half a million people talked with their doctors last year. Thatâs a good thing,â said Paul Malley, president of Aging with Dignity, a Florida nonprofit that promotes end-of-life discussions. âPhysician practices are learning. My guess is that it will increase each year.â
Still, only a fraction of eligible Medicare providers â and patients â have used the benefit, which pays about $86 for the first 30-minute office visit and about $75 for additional sessions.
Nationwide, slightly more than 1 percent of the more than 56 million Medicare beneficiaries enrolled at the end of 2016 received advance-care planning talks, according to by health policy analysts at Duke University. But use varied widely among states, from 0.2 percent of Alaska Medicare recipients to 2.49 percent of those enrolled in the program in Hawaii.
âThereâs tremendous variation by state. Thatâs the first thing that jumps out,â said Donald Taylor Jr., a Duke professor of public policy.
In part, thatâs because many providers, especially primary care doctors, arenât aware that the Medicare reimbursement agreement, , has taken effect.
âSome physicians donât know that this is a service,â said Barbie Hays, a Medicare coding and compliance strategist for the American Academy of Family Physicians. âThey donât know how to get paid for it. One of the struggles here is weâre trying to get this message out to our members.â
There also may be lingering controversy over the sessions, which were famously decried as âdeath panelsâ during the 2009 debate about the Affordable Care Act. Earlier this year, the issue resurfaced in Congress, where Rep. Steve King (R-Iowa) introduced the , which would halt Medicare reimbursement for advance-care planning appointments.
King said the move was financially motivated and not in the interest of Americans âwho were promised life-sustaining care in their older years.â
Proponents like Steinberg, however, contend that informed decisions, not cost savings, are the point of the new policy.
âItâs really important to say the reason for this isnât to save money, although that may be a side benefit, but itâs really about person-centered care,â he said. âItâs about taking the time when people are ill or even when theyâre not ill to talk about what their values are. To talk about what constitutes an acceptable versus an unacceptable quality of life.â
Thatâs just the discussion that the San Diego nursing home resident was able to have with her daughter, Steinberg said. The 90-year-old was able to say why she didnât want CPR or to be intubated if she became seriously ill.
âI believe it brought the two of them closer,â Steinberg said. Even though the daughter didnât necessarily hear what she wanted to hear. It was like, âYou may not agree with your mom, but sheâs your mom, and if she doesnât want somebody beating her chest or ramming a tube down her throat, thatâs her decision.â
KHNâs coverage of end-of-life and serious illness issues is supported by .
Ńîšóĺú´ŤĂ˝Ňîl Health Newsâ coverage of aging and long-term care issues is supported in part by .