Week Six 2/18/16 – 2/25/15 Public Sector Influence on Healthcare Policy : Efforts to Aid the Uninsured, Underinsured, Disabled, and Decrease Health Disparities

Recent Public Sector Influences

Hello and welcome to the discussion about public sector’s influence on healthcare policy. Last week, we discussed the Affordable Care Act (ACA) 2010. The ACA was responsible for expanding healthcare coverage for millions of Americans; and accomplished the following

  • Lowered healthcare costs
  • Ended pre-existing exclusions for children
  • Kept young adults (under the age of 26) insured under their parent’s healthcare plan
  • Provided preventive care at no cost, and allows people to seek emergency services outside their plan (US Department of Health and Human Services, 2015).

The goal behind the ACA is to provide quality healthcare to all Americans, regardless of social, economic, or environmental factors.

Public Sector Influences on Death With Dignity

Since no aid in dying law exists in Arizona, let’s look at how the public sector influences the Death With Dignity law and efforts to protect the uninsured, underinsured, disabled, and those with any other health disparities.

A great place to start was a guidebook for medical professionals written by an Oregon task force to improve the care for terminally-ill patients. In the guidebook it covered many areas including patient’s rights and responsibilities, mental health consultations, and financial issues.

Here are some statements I found important for this topic:

  • Patients have the right to their medical condition and prognosis to order to make informed decisions regarding treatment options
  • Patients have the right to know if their healthcare provider, healthcare plan, or system participates in the Death With Dignity Act
  • If a patient should change physicians in order to obtain a prescription from a participating physician, human and skilled care must continue until the transfer is complete.
  • Patients only deemed mentally-competent can participate in the law.
  • A Depression screening is recommended for all patients wanting a lethal prescription. If the screening is positive, a referral to a psychiatrist or psychologist is warranted.
  • If perceived patients are choosing lethal prescriptions due to financial burdens should be explored
  • Physicians, hospitals, or others involved in care who are perceived to have a direct or indirect financial interest should be disclosed during discussions about treatment options (Oregon Health and Science University, 2008).

I found the financial points interesting. It never states who exactly pays for lethal prescriptions, but through some more investigation I discovered that the Death With Dignity Act does not specify who pays for the services, but it is decided upon individual insurers (and under the Act it is not deemed suicide so insurers cannot view as such upon determination). Also, no federal funding can be utilized for services, so if Medicaid is the insurer only state funds can be utilized (Oregon Public Health Division, 2014).

Recent articles report how President Obama would like Medicare to reimburse providers for end-of-life counseling. Obama wanted to include this in the ACA, but opposition quickly followed. Remember Sarah Palin’s death panel discussions? Since 2010, Medicare did mandate coverage for advance care planning during wellness visits; and private insurance companies, like Blue Cross/Blue Shield of Michigan, are reimbursing  $35 for end-of-life discussions (Compassion & Choices of Washington, 2014).

Since aid in dying state’s decision, it will be up to the state government to influence healthcare policy; and protect the under served in it’s decision making process.

Below is a video about the ACA…do you agree with these stances? Are seniors and those with disabilities be targeted for these ‘death panels?’

See you in Week Seven!

References

Compassion & Choices of Washington (2014). Coverage for end-of-life talks. Retrieved from http://compassionwa.org/news/coverage-end-life-talks-gaining-ground/

Oregon Health and Science University (2008). The Oregon Death with Dignity Act: A guidebook for healthcare professionals. Retrieved from http://www.ohsu.edu/xd/education/continuing-education/center-for-ethics/ethics-outreach/upload/Oregon-Death-with-Dignity-Act-Guidebook.pdf

Oregon Public Health Division (2014). FAQs about Death with Dignity Act. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf

The Big Picture (2014, May 22). Sarah Palin was right: There are death panels in America. Retrieved from https://www.youtube.com/watch?v=6mD7iYFovdk

United States Department of Health and Human Services (2015). About the law. Retrieved from http://www.hhs.gov/healthcare/rights/

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7 thoughts on “Week Six 2/18/16 – 2/25/15 Public Sector Influence on Healthcare Policy : Efforts to Aid the Uninsured, Underinsured, Disabled, and Decrease Health Disparities

  1. SHEllis

    I think it’s great that insurance companies are starting to reimburse for end-of-life discussions and advance care planning. Studies show that most patients typically expect the provider to bring up the topic of advanced directives (Spoelhof & Elliott, 2012). However, in addition to lack of time, one of the provider barriers to advance directive completion is billing (Spoelhof & Elliott, 2012). With increased insurance coverage for end of life discussions, hopefully we will see a rise in the number of individuals well informed regarding end-of-life care.

    After doing some research, I found that the Veteran’s Administration (VA) healthcare system prohibits physicians from participating in the Death with Dignity Act as a term of employment (Oregon Public Health Division, 2014). Therefore, a veteran patient would need to seek care from an out-of-network physician to partake in the Death with Dignity Act. This would result in higher out-of-pocket expenditure, especially considering the fact that federal funds cannot be used for services rendered. It seems that there is still work to be done even in those states with a Death with Dignity Act to ensure equal access for all patients.

    References

    Oregon Public Health Division. (2014). FAQs about the Death with Dignity Act. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf

    Spoelhof, G. D. & Elliott, B. (2012). Implementing advance directives in office practice. American Family Physician, 85(5), 461-466.

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  2. jennweitman

    I read an article in the New York Observer the other day, about how Brittany Maynard’s story has inspired New York lawmakers to write a bill allowing death with dignity. The Albany State Senate introduced the bill called New York End of Life Options Act, which would allow physicians to prescribe a lethal dose of life ending medications to patients with terminal illness (Jorgensen, 2015). It will be interesting to see how the bill proceeds through the legislative process. If a death with dignity law is passed in Arizona, will nurse practitioners be allowed to participate in this practice?

    I watched the video you included at the end of your blog and it was eye opening. The story about the single mom who fell into Florida’s “Medicaid/ ACA doughnut hole” was heart breaking, but also a little dramatic. The argument made by the announcer states that had Republicans allowed the ACA to extend coverage to this state, it would save lives. Who’s to say that this woman would have sought healthcare for her heart condition had she had ACA health coverage? Who’s to say that treating her condition would have prevented her sudden death? What type of medical history and social history did she have that could have played a part in her health? To me, the idea of “death panels” is sensationalized. I agree that Medicaid and ACA have their fall outs, and unfortunately some people will be left out of certain parts of the bill. But I don’t believe that anyone/ any socioeconomic class/ any group of people are being targeted. It’s just the way the cookie crumbles.

    References

    Jorgensen, J. (2015). Death with dignity legislation inspired by Brittany Maynard introduced in Albany. New York Observer. Retrieved from http://observer.com/2015/02/death-with-dignity-legislation-inspired-by-brittany-maynard-introduced-in-albany/

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    1. dignitydiscussion Post author

      All great points, Jennifer. Definitely points to ponder. I, too, believe the whole death panel conversation is a way to put fear into our community (especially the elderly population). Thank you for your thoughts!

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  3. herendirav

    Leslie,
    I am truly fascinated by your topic. I had never made the distinction between Palliative Care, the end-of-life discussions that are held with patients receiving this service, and now, the new conversations that will be reimbursed through Medicare. Through the review of literature, I found a great article outlining the new codes developed by the American Medical Association (AMA) for advance care planning services. The current procedural terminology (CPT) codes to be implemented by Medicare will include a billing code for the first 30 minutes of face-to-face time with the patient, family member, and/or surrogate, to explain and discuss advance directives, and an additional code is provided for each additional 30 minutes of planning (Pullen, 2014). I believe that the Death with Dignity Act is powerful, and although Arizona is not a current participant, I hope that this may be an option for AZ residents in the future. From my clinical experience in the ICU, and other high acuity areas, I have cared for many patients who would have preferred this option, over continuous suffering/treatments/procedures imposed by family. Overall, I think that it is always important to remember that patients have diagnoses, emotions, fears, and spiritual needs. As providers, we should be able to find a way to respectfully have these discussions with patients, and assess each individuals goals/ needs.

    Pullen, C. (2014). New End-of-Life Discussion Codes a Step Toward Reimbursement? Medscape. Retrieved from http://www.medscape.com/viewarticle/832017

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  4. jhmardnp

    I recently read the Oregon Death with Dignity Act Guidebook. Do the other states that have legalized assisted suicide have similar policies or are they different in any significant way? JHM

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    1. dignitydiscussion Post author

      Actually some states such as Washington, Oregon, and New York have used (or are using) the Death with Dignity bill passed in Oregon as a guide to draft their bills. Per the Death with Dignity website, these states utilize Oregon’s law due to its longevity (since 1997); and there is years of data to substantiate how safe the practice has been (Death with Dignity, 2015).

      Reference

      Death with Dignity (2015). Death with Dignity around the U.S. Retrieved from http://www.deathwithdignity.org/advocates/national

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