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Sunday, September 6, 2015

Death Panels Back from the Dead: Take Action Immediately!

You have until Tuesday at 5:00 p.m. to make your opinions known about Medicare funding for end of life discussions that will encourage patients to refuse life-sustaining care. Read about it here.

And here are instructions for commenting.

FEDERAL REGS COMMENT DEADLINE IS SEPT 8 AT 5PM   (Who needs legislation? Death Panels Back By Government Fiat!)

September 3, 2015  

Dear all,

It has been almost five years since I wrote you about the effort of the federal government to impose EOL consultations on us through the use of a carrot and stick.

That alert apparently made its way to the desk of Robert Pear at the NY Times, their healthcare expert.  He was interested in LifeTree's investigative work and ran a story on Christmas Day titled "Obama Returns to End-of-Life Plan That Caused Stir."

On January 4, 2011, the Obama administration withdrew the EOL portion of the new regulation, just 10 days after the NY Times article.  The story had captured the news over the holidays. 

Since then the Big Death lobby, a.k.a. the Third Path Movement, has been patiently at work getting ready to come at this problem again!   

A "Notice and Comment Rulemaking" period is currently under way with a deadline of September 8, 2015, 5pm Eastern.  After that deadline next Tuesday, an important change in how medicine will be practiced will take place unless CMS (Centers for Medicare and Medicaid Services) receives serious negative comments from the general public.   

Here is what has happened.  Please continue to read.  This is important!!

Two new CPT Codes (Current Procedural Terminology Codes, registered trademard of the American Medical Association) can be used by healthcare professionals starting Jan 1, 2016 to record Advance Care Planning Services and apply for reimbursement from the federal government for these "services." 

These Advance Care Planning talks will record wishes pertaining to medical treatment and record them in an advance care document such as 1) healthcare proxy, 2) healthcare power of attorney, 3) living will and 4) POLST/MOST/POST/MOLST form.  (You know, the POLST form that become doctor's orders!)

These codes are 99497 for the first 30 minutes of advance care planning discussion and form completion with the patient by the physician or other qualified health professional, and 99498 for any additional minutes spent with the patient for that purpose. 

PLEASE, take a moment right now to tell the federal government that you oppose this regulatory change.  (See the list of suggested points which you could make, below) 

You can submit comments electronically, by regular mail, or by express or overnight mail.   Use only one method.  Please comment IMMEDIATELY. 


1. By electronic mail.  Here are two direct links:

Info & instructions:

Comment form:

2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1631-P, P.O. Box 8013, Baltimore, MD 21244-8013.
NOTE:  Please allow sufficient time for mailed comments to be received before the close of the comment period which is Sept 8, 2015 at 5pm.

2. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1631-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
If the comment period goes according to the Big Death lobby's hopes and aspirations these codes will become "active" which means that the new codes can start being used and the government will start paying for these End-of-Life consulting "services" in the near future.  (Reference is in the Federal Register of Wednesday, July 15, 2015, Vol 80, No. 135, p. 41773)

Diane Meier of the Center to Advance Palliative Care is crowing that this time the change is happening without any fanfare, without any cries of death panels or media attention.   WE NEED TO MAKE SOME FANFARE!!!

At the end of this email are suggested discussion points you can make in your individual letters.  In summary, expect these ACP talks to be conducted using a one-size-fits-all framework of boxes to check which will become doctor's orders, the POLST form!

Prayers to the Holy Spirit and to St. Joseph,

Elizabeth D. Wickham, PhD
PO Box 17301
Raleigh, NC, 27619

 Here are some suggested points to make in your letter:

  • These 2 codes (99497 and 99498) are not about paying for traditional medicine. They encourage End-of-Life (EOL) discussions.    Most doctors do not go to medical school to learn how to conduct EOL discussions.  These codes are for a new type of medicine called palliative medicine.  Palliative medicine is a vehicle of the Right to Die movement to legitimize the hastening of death. 
  • Use of these 2 codes means that only EOL discussions occurred, not diagnosis or curative treatment. 
  • These two can be used over and over.  This rule change will encourage those who are trained to persuade the patient to choose life limiting choices to come back again and again so long they don't "succeed."   What right does the patient have to say, "Go away!" 
  • These Advance Care Planning (ACP) "talks" that are paid for by these 2 codes are recommended for all adults, not just seniors.  The culture of death wants to bring death awareness into every fabric of healthcare. 
  • These 2 codes will pay for talks not only with physicians but also with "other qualified professionals."   Who are these "other qualified professionals"?   It is not hard to figure this out.  The Affordable Care Act (Obamacare) funds training of POLST "facilitators."  High on that list of groups who funded by Obamacare are the Respecting Choices conversation specialists who trained using a curriculum developed by Bud Hammes in LaCross, WI.  Respecting Choices professionals are emerging members of the palliative care team.
  • The government will have the power to set quality measures for Advance Care Planning "talks."  Use of these 2 codes will imply use of a standardized approach to Advance Care Planning. The conversation language will be to motivate the patient to participate in the ACP "process" and to fill out the POLST form. 
  • After the advance care wishes are known and recorded (electronically) non-compliance with those wishes will be considered a "safety issue" and will need to be "investigated." 
  • The long run plan for these 2 codes is to give government power to decide what constitutes an "acceptable discussion" about EOL decisions.  Doctors will be penalized if they do not conform.    Socialized medicine for sure. 
  • Doctors will be pressured to make their quota of patients with advance directives. 
  • These 2 codes will override doctors who want to protect their patients.  The "facilitators", i.e. "other qualified professionals", will quickly be given control over most of the ACP talks. 
  • We know already that some private insurers are paying for ACP talks.  These 2 codes will be supported by most private insurers because by paying for these end-of-life discussions private insurance companies can cut the costs they might have to spend later on for the sickest patients.
  • These 2 codes will encourage the use of the POLST form across all states, even those who do not have a developed POLST program.   See the letter written by the National POLST Paradigm Task Force to CMS about this rule change a couple weeks ago here. 
  • With access to Electronic Health Records, computers can be taught to recognize who doesn't have an Advance Care Plan. Then comes the nurse manager to call you up and offer a community healthcare worker to spend time with you and get paid using these 2 codes. 
  • Having the Advance Care Plan talk may cause moral distress for some providers, clinicians and patients.  After all, we are taught to make decisions about our health care at the moment and with the knowledge that we are obligated to preserve and protect our life which is a gift from God. 
  • The Gunderson Health System has been training Respecting Choices (RC) facilitators for decades.   There are other "facilitators" being trained by community organizations.  Community Conversations on Compassionate Care (CCCC) offers group discussions by trained lay and health professionals.   Both RC and CCCC define "success" in ACP talks as the choice to prevent unwanted life-sustaining treatment.  

In summary, Respecting Choices and Community Conversations on Compassionate Care people will become clinical micro systems integrated into routine care through these 2 codes to shape physician behavior.

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