Call To See How I Can Help You 781-433-8665


Medicare may pay for advanced directive counseling by physicians

Posted by Sasha Golden | Jul 12, 2008 | 0 Comments

By a veto-proof majority, Congress has just passed an amendment to Patient Self-Determination Act of 1991 which would include counseling concerning advanced directives as part of the “initial preventive physical examination” (IPPE), a once-in-a-lifetime benefit given to all new Medicare beneficiaries under Part B. 42 U.S.C. 1395x(ww). In other words, physicians will get paid to raise the issues concerning the choices to be made where further efforts to cure disease in the course of the examination.

Sounds like a good idea… but as a practical matter, primary care physicians are economically pressured by both Medicare and private insurers to maximize the number of patients which they can see in the course of a day. Thanks to Ted Kennedy's unexpected vote last week, the Senate passed legislation replacing the 10.6% pay cut for primary care physicians that went into effect on July 1 with a 0.5% raise through December 31, 2008. (Payments will rise by another 1.1% for calendar year 2009.) This raise is miniscule compared with the payments Medicare makes to specialists. New doctors are avoiding going into geriatrics and primary care because they can make more money in radiology or plastic surgery or other specialties with higher reimbursement rates.

I have to wonder whether, even though physicans will get paid something for counseling about the end-of-life issues, if those discussions will get short-shrift in some cases. Further, these discussions have to be held again and again, as the older patient's attitudes about treatment and death frequently change as health deteriorates over time. I see no promise that physicians will get paid to raise these issues as the patients' needs change.

Further, will Massachusetts physicians counsel patients about what can happen if the health care agent or a nursing home or hospital ignores those directives? Massachusetts is one of three states in the US where advanced directives –giving specific directions for care outside a health care proxy — are NOT legally binding. Some physicians may not be aware that there is a procedure to enforce the health care proxy in the Probate Court. These issues concerning patient rights are legal as well as medical — are the doctors going to be encouraging their patients to see their friendly local elder law attorneys? I think not.


About the Author

Sasha Golden

Alexandra “Sasha” Golden received her undergraduate and law degrees from Boston College, and has been practicing law in Massachusetts since 1994. Attorney Golden is a long-standing member of the Massachusetts chapter of the National Academy of Elder Law Attorneys (NAELA) and of the Probate and So...


There are no comments for this post. Be the first and Add your Comment below.

Leave a Comment

Contact Golden Law Center Today

Golden Law Center is committed to answering your questions about elder law and estate planning issues in Massachusettes.

I'll gladly discuss your case with you at your convenience. Contact us today to schedule an appointment.

Golden Law Center
(781) 465-6078 (fax)
Mon: 09:00am - 05:00pm
Tue: 09:00am - 05:00pm
Wed: 09:00am - 05:00pm
Thu: 09:00am - 05:00pm
Fri: 09:00am - 02:00pm

Disclaimer: The materials appearing on this website are provided for informational use only and are in no way intended to constitute legal advice or the opinions of this law firm or any of its attorneys. You should never hire an attorney without first meeting with the lawyer, reviewing her qualifications, and carefully reading the fee agreement. The use of the material on this website does not create an attorney-client relationship, and you should not rely upon the information provided here without seeking the advice of an attorney. We also cannot guarantee that the materials appearing on this website are not guaranteed to be correct, complete, or up-to-date since the law is always changing.

This website must be labeled “advertising” according to the rules of professional responsibility established by the Massachusetts Supreme Judicial Court. This website may not meet the applicable laws or ethical rules in other states. Golden Law Center does not wish to represent persons living in those states who seek our representation as a result of viewing this website.

Links that may appear on this site are intended to provide additional sources of information and are not to be construed as being endorsements by the Golden Law Center or indications of affiliation. We do not imply that we are legally authorized to use any trade name, registered trademark, symbol, logo, or seal that may be reflected in any of these links.