End of Life issue in the HC bill; No so innocuous as obama makes it out to be

[jojajn]

Originally Posted by sanrene

washingtonpost.com

The House Bill Skews End-of-Life Counsel



These are the kind of questions that democrat should be answering, but they refuse and that is why TH participants engage in the moaning and groaning and calling them on their vagueness.

This is the same thing as this bill which was passed in 1990 and is still a Federal law today.

The Patient Self-Determination Act (PSDA) is a federal law passed by Congress in 1990 which requires providers to inform all adult patients about their rights to accept or refuse medical or surgical treatment and the right to execute an "advance directive." An "advance directive" is a written instruction such as a living will or durable power of attorney for health care recognized under state law relating to the provision of health care when the individual is incapacitated.

The PSDA and the final rule require you to:

Give written information to all adults receiving services of their rights under State law to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and to formulate advance directives. In November, 1991, the Minnesota Department of Health (Department) provided a uniform description of Minnesota law on advance directives entitled "Questions and Answers Regarding Minnesota Law on Advance Directives" to be used by providers in meeting the requirement to provide a description of state law concerning advance directives. This mailing includes a revised description based on 1998 Minnesota law.

You must begin using this revised description no later than January 1, 1999. ALL MEDICAID PROVIDERS MUST DISTRIBUTE THIS WRITTEN DESCRIPTION OF STATE LAW. You may reprint or reformat the material and you may supplement it with written material of your own. YOU MAY NOT CHANGE THE CONTENT OF THE WRITTEN DESCRIPTION OF THE WRITTEN DESCRIPTION OF STATE LAW.

The PSDA and the final regulations specifically mandate the use of the State-developed description of state law to be distributed by Medicaid providers. Medicare-only providers are also required to provide a description of state law but may provide their own description instead of the one provided with this bulletin. The Department suggests the use of the State-developed description by Medicare-only providers for uniformity among providers.

The written information must be provided to an individual upon each admission to a medical facility and each time an individual comes under the care of a home health agency, personal care provider, or hospice. If the patient is incapacitated at the time of admission and is unable to receive information or articulate whether he or she has executed an advance directive, the provider should give advance directive information to the patient's family or surrogate. The provider still must provide this information to the patient once he or she is no longer incapacitated or unable to receive such information.

Maintain written policies and procedures concerning advance directives for all adults receiving care or services and inform the individual, in writing, of these policies. The policies must include a clear and precise explanation of any objection a provider or provider's agent may have, on the basis of conscience, to honoring an individual's advance directive. The provider's statement of limitation, if any, should:

1.Clarify any differences between institution-wide conscience objections and those that may be raised by individual physicians;

2.Identify the State legal authority permitting such objection; and

3.Describe the range of medical

conditions or procedures affected by the conscience objection.

Federal Law Regarding Advance Directives

Also:

http://www.denbar.org/docs/psda.pdf?ID=1816

[evilnewbie]

Originally Posted by MovingForward

You do know, sanrene, that this provision was introduced into the bill by a REPUBLICAN senator: Johnny Isakson of Georgia? And that most doctors support it?

Being a physician, I do support it because it is an enormous drain on resources and money. I have very often seen expensive measures taken place to prolong someone's life be it a year or a week or even a month. They don't have a quality life during this time. But you know what... Its not an easy thing to do or say, especially at that moment.. I know how I feel about it and the costs are astronomical, most of which ranges in the hundreds of thousands to millions of dollars... Even though I see it as a large drain on resources and money, how can I influence people to do it? Personally, if it was my own family, I want everything done because as often as it fails, there is the twilight of success to save someone... It is perhaps hypocritical of me to ask others to die a bit more prematurely but not for my own family and friends... It is a touchy subject but one that should be broached with the patient...

[MovingForward]

From the Washington Post's Charles Lane:

Current HCR Proposals of Interest to the End-of-Life Care Community

The following proposals have been voted upon and agreed to during the legislative action on health care reform. Please note that the process is still in early stages and this does not represent what will be in the final package.

In the House Proposal, HR 3200, “America’s Affordable Health Choices Act of 2009”:

1. Hospice Annual Market Basket increase reduced by Productivity Factor Adjustment beginning in fiscal year 2010 (Sec 1103)

2. Extension of Moratorium on BNAF Rate Cuts (Sec 1113 – in Chairman’s Mark)

Extends the moratorium on the removal of the hospice budget neutrality adjustment factor through fiscal year 2010.

3. Advance Care Planning Consultations (Sec 1233)

Provides coverage for consultation between enrollees and practitioners to discuss orders for life-sustaining treatment. Consultations would be provided every 5 years, or more frequently if the enrollee is diagnosed with an advanced illness.

It also instructs CMS to modify the “Medicare &You” handbook to incorporate information on end-of-life planning resources and to incorporate measures on advance care planning into the physician’s quality reporting initiative. Read the legislative analysis of this provision.

4. Programs to Increase Awareness of Advance Care Planning Issues (Agreed to – Baldwin/Burgess Amdt)

Establishes a grants program to maintain an information phone line and clearinghouse for state-specific advance directive materials, and an additional grants program to fund an advance care planning educational campaign. Grants cannot be made to any government or non-government organization that promotes suicide, assisted suicide, or the active hastening of death.

In the HELP Committee Proposal, “Affordable Health Care Choices Act”:

1. Allows for utilization of CLASS Independent Benefit Plan for advance care planning (Agreed to – Isakson Amdt)

Within the establishment for a national voluntary insurance program for purchasing Community Living Assistance Services and Support (CLASS) available to individuals with functional limitations, program funds can be used for advance care planning.

Link: The Volokh Conspiracy - Washington Post's Charles Lane on Section 1233, Advance Care Planning Consultation:

And did you know that NHPCO, those COMMIES, support the amendment, as well?

Health Care Reform and Hospice - The National Hospice and Palliative Care Organization

Note, in particular:

In the HELP Committee Proposal, “Affordable Health Care Choices Act”:

Allows for utilization of CLASS Independent Benefit Plan for advance care planning (Agreed to – Isakson Amdt)
Within the establishment for a national voluntary insurance program for purchasing Community Living Assistance Services and Support (CLASS) available to individuals with functional limitations, program funds can be used for advance care planning.

And, finally, please note: Read the health care bill -- it won't kill you: Connie Schultz - cleveland.com

In particular:

"The doctor is not forced to bring it up, nor is the patient. In fact, an earlier version from Republican Sen. Johnny Isakson was rejected because it would have required an end-of-life consultation before a patient qualified for Medicare."

Gotta' hand it to you, though, sanrene: you sure earn your money for the right-wing.

[MovingForward]

Like I said, sanrene, when presented with the "evidence" you demand, you flee. Which is why I rarely bother to provide it.

Pitiful.

[Ibginnie]

Well since this one has turned into another bash fest...

Thread closed