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Senate Finance Expected to Kill House's End-of-Life Care Provision

Janice Simmons, for HealthLeaders Media, August 14, 2009

When the Senate Finance Committee unveils its healthcare reform bill in several weeks, one idea that will most likely not be included is the much-debated end-of-life provision that is in the House bill.

Sen. Charles Grassley (R-IA), the ranking minority member on the panel and a member its “gang of six" senators that has been working on the bill's provisions, slammed the House bill (HR 3200) on Thursday as "so poorly cobbled together that it will have all kinds of unintended consequences." In particular, he took aim at the section on end-of-life care.

"There's a big difference between a simple educational campaign, as some advocates want, and the way the House committee passed bill pays physicians to advise patients about end-of-life care and rates physician quality of care based on the creation of and adherence to orders for end of life care," he said in a statement.

The issue came under the spotlight this week in part when former Alaska Gov. Sarah Palin suggested that Obama and other Democrats wanted to set up "death panels" to decide who will or will not get medical services. The issue has come up repeatedly in town hall meetings this week with President Obama and congressional representatives.

The current language in question in the House bill (Section 1233) stated that it would amend how Medicare is paid for providing end-of-life counseling. In 1990, language was inserted in the Social Security Act, which governs Medicare, that defined an "advance directive" to be "a written instruction"--such as a living will or durable power of attorney--recognized under state law and "relating to the provision of such care when the individual is incapacitated."

The 1990 language called for healthcare providers and organizations to "maintain written policies and procedures with respect to all adult individuals receiving medical care by or through the provider or organization." The provision also required legal documents, such as advance directives, to be kept "in a prominent part of the individual's current medical record" and to provide "education for staff and the community" on advance directives. This was done without payment to providers.

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