Sunday, August 16, 2009

HR 3200 ~ and its the provision for End-of-life planning (Section 1233

HR 3200 ~ and its the provision for End-of-life planning (Section 1233)

August 16th, 2009

I am a conservative Mennonite, parent of 3, grandmother, former ER nurse, currently a professional midwife and appointed member of the Midwifery Advisory Council for the Medical Board of California.

After 4 decades as a healthcare professional and patient advocate, its obvious to me that America can’t afford not to reform the way we provide and pay for healthcare. Rarely has a robust public discourse been so important to the welfare of Americans as the debate on health care reform. In order to fix the long-term deficient, we must fix health care. For American business to successfully compete in the global economy, we must fix health care. In order to live with ourselves, we must fix health care.

However, news programs and cable talk shows opine 24-7 w/o ever actually providing the facts.

Since an intelligent debate requires the facts, I downloaded HR 3200, printed it out, put it in a 3-ring notebook and read all 1,100 pages with my handy yellow highlighter in hand. I now have an informed opinion about the House of Representative’s bill, including the Advance Care Planning Consultation provision (Section 1233).

My husband and I are both retirement age and both covered by Medicare and my mother-in-law in 87. Like every other American, we’d be highly offended by any hint of duplicity in HR 3200.

People need to know that there is absolutely nothing sinister in sec 1233 — no ‘death panel’ for mentally or physically handicapped children, no scheme to save Medicare money by paying healthcare professionals to hand out hemlock to octogenarians. Not a single word in sec. 1233 (or anywhere else in the House bill 3200) even remotely hints at a government-sponsored plan to kill off the elderly or disabled, manipulate medical care providers or force doctors to rat on the end-of-life decisions made by Medicare patients to the government.

It would also be helpful if the public understood that Section 1233 is a provision to amend the Social Security Act written by a Republican Congressman from Georgia. As you know, the law has required hospitals to ask all patients being admitted to a hospital if they have an Advanced Directive for the last 20 years. However, the older provision does not reimburse medical providers for spending their professional time to help people to develop an advanced directive.

Section 1233 would simply permit medical practitioners (physicians, physician assistants and nurse practitioners) to be reimbursed for helping Medicare patients develop a plan for end-of-life care that suits their needs and that of their families. The provision identifies the very broadest range of option, stating that: “treatment … may range from an indication for full treatment to an indication to limit some or all or specified interventions.” It is always the patient that decides what kind of care they want, not the practitioner. Sec 1233 includes training for health care professionals “about the goals and use of orders for life sustaining treatment”. The only role of physicians or practitioners is to provide factual information on the full spectrum of possible choices and how to best achieve those goals, including necessary legal information.

The only thing being tracked and reported by sec 1233 is the level of compliance by the health care professional with their obligation to inform the patient about advance directives and life-sustaining treatments. Exactly how this information is to be measured and tracked is not mandated by HR3200 but comes instead from a “consensus-based organization”. A further safe guard in the bill is a requirement that criteria proposed by the consensus-based organization be published in the Federal Register and a period of public comment provided before it can be adopted.

The facts about the House bill are simple, and straightforward and should be communicated that way in the media:
The Advance Care Planning Consultation provision is thoughtful and well-written
It carries forward the intent of Social Security Medicare legislation of 20 years ago in a professional and effective way
Sec 1233 reimburses health care professionals for helping Medicare patients deal effectively with end-of-life issues thru a process of advanced planning
The information imparted by medical practitioners is to be developed or endorsed by a consensus-based organization and includes a feedback process before being implemented
Since it only amends the Social Security Act, so there is nothing hidden, either in the Sec 1233’s own text or elsewhere in HR 3200.
To make that a bit easier, I posted a plain language version of Section1233 and also included the original uncut version of the same provision for direct comparison. Freed from distracting details and legalese, this plain language text makes it possible to understand what Sec 1233 does and doesn’t say.

Go to and read it for yourself.
Faith Gibson, LM, CPM
Palo Alto, Ca

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