News Briefs – MARCH 2022

MAiD UPDATE   |  MEDICARE PAYING TWICE  |  VETS HEALTH BETTER AT VA

 

States Continue to Struggle With Implementing MAiD Laws

Medical aid in dying continues to be a controversial issue across the United States. Only 11 states and the District of Columbia have authorized MAiD through legislation, ballot measures, or the courts. Yet in a Gallup poll conducted in May 2020, 74% of people agreed that: “When a person has a disease that cannot be cured…doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it.” Majority support in that poll included every demographic group measured, including men, women, White people, people of color, every age category from 18 to 55+, political party designation, and education level.

Here are the latest efforts of note to pass medical aid in dying laws in various states:

• The Washington State House Committee on Health & Long Term Care heard testimony in February from Compassion and Choices and others urging the passage of a bill to improve access to the state’s Death With Dignity Act. The bill would reduce the time a person has to wait between making an official request to use the medication from 15 days to 72 hours. The bill would also allow advanced practice registered nurses and physician assistants to act as one of the two medical providers for a person who wants to access medical aid in dying.

 

• Advocates for MAiD in Maryland are pushing to resurrect the End-of-Life Options Act that died in the state senate in 2019. They pin their hopes on a new survey showing that 69% of Maryland voters support people’s right to access medication to end their life if they have an incurable terminal illness with six months or less to live. Only 20% of those surveyed opposed such legislation. Nonetheless, the state senate remains divided and may not be inclined to consider the legislation before elections in November.

 

• A bill allowing medical aid in dying in Delaware can now move on to possible consideration by the full house after it passed by a single vote in the House Health and Human Development Committee. This is the latest effort to pass legislation that was first introduced in 2015 but has never been voted on. In 2015 there were no cosponsors of the bill, but the current bill has 11 cosponsors. Another clear sign that opposition to the bill is eroding: The Medical Society of Delaware went from opposing the legislation to declaring neutrality.

 

• The Virginia Senate Committee on Education and Health defeated a proposed Death With Dignity Act. Those legislators in favor of a medical aid in dying law for Virginia have tried to pass such a law since 2018. Although it has failed in the senate, there is still an option to move forward with legislation in the house. A bill has been assigned to a subcommittee, but it appears unlikely to be heard in the current session.

 

• A medical aid in dying bill in the Utah House Health and Human Services Standing Committee failed by a vote of 9-2 after hearing emotional testimony from people on both sides of the issue at a public comment session. Utah lawmakers began introducing death with dignity legislation in 2015. The bill that was just defeated was modeled closely on Oregon’s Death with Dignity Act.

 

Medicare Paying Twice for End-of-Life Care Services  

In the period of 2010 through 2019, Medicare paid $6.6 billion to nonhospice providers for services to patients who were enrolled in hospice care. The causes of the duplicate payments aren’t entirely clear, which is why the U.S. Department of Health and Human Services Office of the Inspector General has recommended that the Centers for Medicare and Medicaid Services study the question of hospice reimbursement reform.

Nearly two-thirds of the nonhospice payments were related to “physician/suppliers” services. When a patient is on a hospice program, hospice medical directors and nurses typically take over the medical care, removing the need for involvement by most nonhospice physicians. However, it has been considered appropriate for a nonhospice physician to bill for medical services unrelated to the terminal diagnosis of a patient on hospice. Aside from this appropriate billing, one cause of the duplicate billing may be that some nonhospice clinicians do not know their patients are on hospice.

Further study of these payments might help to clarify how much of the $6.6 billion relates to acceptable nonhospice care. Such an investigation would have to consider that the Centers for Medicare and Medicaid Services has a longstanding position that all the care of a terminally ill patient should be covered through the hospice benefit, except in rare or unusual circumstances. There are no triggers in the physician billing system to alert providers that a patient has elected hospice. The hospice may also be unaware that the patient has gone to an outside physician. The study suggests that greater transparency with patients about what is and isn’t covered by hospice might help to reduce duplication of services and payments.

Another factor impacting the great increase in Medicare payments identified in the study may be the increase of for-profit hospices. During the study period, the number of for-profit hospices increased by 78%, while nonprofit hospices decreased by 12%. The Office of the Inspector General indicated that 62% of the payments to nonhospice providers related to patients in the care of for-profit hospices.

 

Veterans Survival Rates Better in VA Hospitals

Veterans transported by ambulance to Veterans Affairs hospitals had a 20% lower mortality rate at 30 days than veterans taken to non-VA hospitals. This result was consistent across men and women, patient age groups, and different types of pre-existing conditions. However, Black and Hispanic patients, and those patients taken to a VA hospital where they had been treated in the past, had the most pronounced mortality advantage.

The study was conducted by researchers at Carnegie Mellon University, the University of California, Berkeley, and the Department of Veterans Affairs. Researchers examined emergency visits of more than 580,000 veterans taken by ambulance to 140 VA and 2,622 non-VA hospitals in 46 U.S. states and the District of Columbia from 2001 to 2018. The results of the study appear contrary to well-publicized concerns about the quality and capacity of the VA hospital system.

The authors of the study noted that there were some limitations to the study. For one thing, it did not eliminate entirely the mixing of confounding variables, even though the design of the study attempted to reduce such risk. Also, the study focused on older veterans, so the results may not apply to younger veterans or to episodes of care that were not initiated by emergency treatment.