The Centers for Medicare and Medicaid (CMS) announced last week that it will reimburse health care providers for conversations with Medicare patients about advance care plans starting January 1. These are the end-of-life discussions that were so controversial when first proposed as part of the Affordable Care Act and were subsequently removed because of opposition. Remember the term “death panels?”

It is interesting to me how public sentiment shifts on matters such as this. End-of-life discussions are clearly a sensitive topic, and maybe Americans just needed to “think about it awhile.” What I mean is eight in 10 Americans now believe that Medicare and private insurance should pay for end-of-life discussions, according to a recent poll by the Kaiser Family Foundation.

As a quick side bar, have you heard of a concept called the “Overton Window”? It was put forth by Joseph Overton and basically says that in the public policy arena, such as health care, only a relatively narrow range of potential policies are politically acceptable or in the "window" of options. New options come into the window as society moves and then politicians sense what is acceptable. I think that is what is happening here. But, let me get back on topic.

When we talk about advance care plans we are generally talking about advance medical directives, a term that refers to treatment preferences and the designation of a surrogate decision maker in the event that a person should become unable to make medical decisions on her or his own behalf. This usually means a living will, power of attorney and health care proxy.

If you are interested in more information on any of these items, a simple Google search will provide you with plenty of material. Social workers at UMC (or any hospital) would also be an excellent resource. Hospitals know about this because the federal government passed a law in 1991 called the Patient Self-Determination Act. It says that all hospitals receiving Medicaid or Medicare reimbursement must determine whether patients have or wish to have advance directives.

In conclusion, why is CMS making this change? There are likely two reasons. One, is the American people now say that they want it. Two, the cost of end-of-life care is particularly expensive for Medicare. CMS estimates that more than 25 percent of Medicare spending goes towards the five percent of beneficiaries who die each year. I think these changes represent an opportunity for Texas Tech Physicians to better serve our patients and furthermore, believe it would be a good topic for an in-service or Continuing Medical Education session. We will also need to determine how to bill for the service.