In the Dec. 28, 2010 NAMSA Newsletter, the group headlined a story about the "death panel," or end of life planning that was quietly being added back into Medicare-paid-for physician services as part of the free annual wellness benefit now available from Medicare. We included five quotes that the New York Times had used as examples of the clandestine way the rule was supposed to be quietly slipped into the wellness visit. It didn't stay quiet for long.
The bubble burst within a few days of NYT article. There must have been some real shouting going on at CMS, Medicare, and the White House, but by Jan. 3, the Obama administration had reversed the rule. In case you don't remember, there was so much hullabaloo about the issue during the health care reform debates that it was removed from the PPACA language in order to find a few more votes for its passage.
Well, the New York Timesrevived the issue by reporting the administrative method that had been used to sneak it back in: It had been included in a Medicare regulation that sets payment for physician services, published in the November Federal Register, and had the approval of CMS administrator Dr. Donald Berwick.
The commotion was brief, and, here's how it ended – at least for now: "An administration official, authorized by the White House to explain the mix-up, said Tuesday, 'We realize that this should have been included in the proposed rule, so more people could have commented on it specifically. We will amend the regulation to take out voluntary advance care planning'," The New York Times reported on Jan. 4. " 'This should not affect beneficiaries' ability to have these voluntary conversations with their doctors.' "
No, it shouldn't, and we have always referred to the need, but not what many people regard as a "death panel." In the Dec. 28 letter, I reviewed the fact that many of our members have, from time-to-time, been asked about end-of-life advance directives and have had the sense to defer it to the clients' doctors, attorneys, other family members, etc. I left out two main ingredients in the stable of where to go: I should have included family ministers and religious relationships, which are the backbone of end-of-life concerns for many people, and I should have included hospice workers, on whom many people rely in such matters.
So, for now, the issue seems to be closed, and who knows where the House repeal legislation will go. As we've said before, this could take years if the Supreme Court is to be relied on to give an answer, in which case it may be too late to back off all the rule and regulation writing going on at the moment.
In other news
In late December, the Centers for Medicare and Medicaid Services announced its new doctor directory site. The site, Physician Compare, was activated for the beginning of 2011. Being the Web junkie that I am, I decided to investigate it myself. CMS says the Physician Compare site is similar to the existing Hospital Compare site, after which it was modeled.
I went to the site, and searched for family practice physicians within 15 miles of my ZIP code. I shouldn't complain, because this is a new site, and CMS should be allowed to have some time to refine its rendering. But I think the agency may have been in a hurry, because over half of the family physicians were as far away as 250 miles – a pretty long drive to see a GP. Although many of the GPs in my ZIP code were included, not all of them were, so an update is clearly needed.
The site is little more than a directory, which I suppose is sufficient, and the most common "additional info" is a line that says, "Accepts Medicare-approved amount on all claims." I reckon that's to be expected, because Medicare is always looking for those who accept assignment. Other boxes are available for "specialty," with a section on "specialty definitions," "gender," "Medicare assignment (or no preference)," and "language (spoken)."
Some journals threw rocks at the site, calling it "deeply disappointing," but I disagree. It is a new site, and should be allowed to grow and improve. The intent is noble, and may save you in answering questions. Take a gander at it for your own opinion; I'm content, as long as the site updates and grows in value.
Ron Iverson is president of the National Association of Medicare Supplement Advisors Inc. He can be reached at 406-442-4016. This article was adapted from a piece that ran in the Jan. 4 edition of the NAMSA newsletter.
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