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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

Expert hails Medicare proposal to reimburse end-of-life counseling

KU palliative care doctor says plan represents positive step, although details yet to come

By Andy Marso | July 09, 2015

Photo by KU Medical Center Dr. Christian Sinclair of the University of Kansas Medical Center says a Medicare proposal to reimburse physicians for end-of-life planning represents an important shift.

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This week’s announcement that the federal government is proposing Medicare reimbursements for doctors who discuss end-of-life plans with their patients was one Christian Sinclair has been waiting for.

Sinclair is a palliative care physician at the University of Kansas Medical Center who long has recognized the value of getting patients actively involved in planning the treatment they want when facing death before they get to that point.

He said he was “very excited” that the government is starting to formally recognize it as well.

“There’s still plenty of questions on how this is all going to shake out, but the fact that Medicare got behind this is really encouraging,” Sinclair said.

The government’s stance represents an important shift toward valuing physician-patient collaboration rather than just paying for treatment the physician orders, he said.

Sinclair is one of the leading U.S. authorities on palliative care and advance directives.

“There’s still plenty of questions on how this is all going to shake out, but the fact that Medicare got behind this is really encouraging.”

- Dr. Christian Sinclair of the University of Kansas Medical Center

He was on a national committee that last year produced a report called “Dying in America” and next year he will serve as president of the American Academy of Hospice and Palliative Medicine.

Some private insurance plans have started to reimburse for end-of-life planning and have found that patients who take advantage are more satisfied with their care, he said.

If Medicare follows through with its plan to cover advance care planning, other private insurers are likely to follow.

That’s important, Sinclair said, because Medicare primarily covers Americans age 65 and older. Making decisions about resuscitation and living on feeding tubes or ventilators is something everyone should do once they’re mature enough to understand the choices, he said.

“It’s not just for older Americans,” Sinclair said. “Advance care planning is something that 22- or 23-year-old people should do because they need to let people know what they would want in a medical emergency too.”

Sinclair said there are still a lot of details to be determined in the proposed Medicare rule, which also will undergo a public comment period.

For one thing, the level of reimbursement has not been outlined, which could limit which providers will find it worth their time. There’s also the question of who would be qualified to provide the advance care planning.

Sinclair said right now it’s the domain of only physicians, but others are qualified. The key, he said, is having standards that ensure providers are properly trained and respect patients’ individual decisions rather than “just anybody with a checklist.”

Proposals for reimbursement of end-of-life planning included in the federal Affordable Care Act became bogged down in political opposition that used the threat of government “death panels” to quash the idea.

Sinclair said he did not think that would happen this time. Those political debates, he said, spurred people to take a more serious, nuanced look at advance care planning.

Sinclair said it’s important to note that having a legally binding advance directive not only tells physicians which patients don’t want aggressive treatment, but also makes clear which patients want to be kept alive by any means necessary.

“They can really empower their own choices, whatever they are,” Sinclair said. “Sometimes I think people are afraid these are just very one-sided.”