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Another Voice: Medicare on the right path with end-of-life planning

By Patricia Bomba

Medicare, the federal program that provides health insurance coverage to 55 million older and disabled Americans, plans to reimburse physicians for having conversations with patients about the care they receive in their final days when they may not be able to speak for themselves. The proposal is expected to take effect in January. Univera Healthcare endorses Medicare’s efforts and strongly urges everyone to support the plan.

Patients nearing the end of their lives often worry about having their wishes honored regarding the level of medical care they want to receive or avoid. These patients fear that if they can’t speak for themselves, well-meaning family members or health care professionals may authorize extraordinary medical interventions that may slightly prolong life, but not its quality. That’s why it’s important for physicians to initiate conversations with their patients who are seriously ill or frail to discuss and appropriately document care goals and individual preferences. For patients and their loved ones, making end-of-life wishes known can be one generation’s gift to the next.

Since 2001, Univera Healthcare has been training physicians and other health care providers how to initiate these conversations and complete the required documentation. Since 2009, our health plan has reimbursed them for conducting these discussions. We believe reimbursement incentivizes providers to incorporate end-of-life discussions into regular practice for appropriate patients.

Our health plan’s program supports New York State’s Medical Orders for Life-Sustaining Treatment protocol, an eight-step process spanning multiple sessions that allows seriously ill or frail patients who are likely to die within the year to specify the level of health care they want and don’t want. The physician then completes a MOLST form, a legal document that physically travels with the patient throughout all levels of care and/or uses the electronic eMOLST to complete the form online and ensure the patient is included in the New York’s eMOLST Registry, which can be accessed by medical professionals across the state.

We are proud of our involvement in creating New York’s MOLST protocol and prouder still that in the next few weeks we’ll be meeting with Medicare to discuss its interest in our reimbursement model and eMOLST platform as a best practice template for use nationwide.

Medicare’s plan to reimburse physicians for initiating end-of-life discussions will result in even more people avoiding unwanted interventions by writing their own final chapter. We urge everyone to support this plan.

Patricia Bomba, M.D., is vice president and medical director/geriatrics for Univera Healthcare. She served on the Institute of Medicine’s Committee on Transforming End-of-Life Care.