Public Strongly Favors Medicare Funding for End-of-Life Talks, Poll Finds

Americans strongly support doctors having conversations with patients about end-of-life care, and almost as many say Medicare should pay doctors to do this, according to a new poll released today from the Kaiser Family Foundation.

Today’s findings come as CMS is poised to finalize a rule to pay doctors to discuss end-of-life treatment options, and more than 6 years after attempts to include such a provision in the Affordable Care Act (ACA) was inaccurately derided as the creation of a “death panel” by former Alaska Governor Sarah Palin, causing it to be dropped from the bill as it made its way through Congress.

The Kaiser Health Tracking Poll found that 89% of the public believes that doctors should discuss end-of-life issues with patients and 81%, including a similar share of seniors, support paying doctors with Medicare dollars to carry out this task. A similar share of Americans (83%) says that commercial insurers should compensate doctors for counseling patients on their options.

This same share reports being very comfortable discussing treatment choices with a medical provider, but very few have. Only 17% report having had such a conversation, but these percentages rise among seniors (27%) or among those with a debilitating or chronic condition (31%). A third of Americans (33%) say they have had such a talk with a doctor to report a relative’s wishes about end-of-life care.

Fewer Americans describe their healthcare providers as willing to take part in such talks (57%). Not as many are comfortable having these conversations with their children (55%) their close friends (51%) their parents (51%) or a minister, priest or spiritual adviser (50%).

Medicare reimbursement policy was among the factors identified a year ago in a major report from the Institute of Medicine (IOM), now the National Academy of Medicine, called Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, which found that the way that the medical system in the United States handles end-of-life care often does not work well for patients, for families, for medical staff, or for insurers; the system ends up spending huge sums in the final weeks on care that patients often do not want.

While changing reimbursement policy by itself was not seen as a cure-all, it was seen as an important step, along with working with professional medical societies to set better standards for end-of-life care and to promote better training of physicians to handle these conversations.

The IOM report urge reform because of rapidly changing demographics: while the number of Americans over age 85 stood at 5.5 million, or 1.7% of the population, in 2010, that number is projected to rise to 19 million, or 4.2% of the population, by 2050. By that year, persons age 65 or older will make up 19.8% of the US population.