Right-to-die group wants Medicare to pay for health care house calls

One news release this week, about a federal bill to provide primary care services at home for Medicare patients, caught my attention because it was from Compassion & Choices, a group that does not conceal its origins with the Hemlock Society.

Compassion & Choices was a chief advocate for California’s right-to-die law that went into effect June 9. The group supports a bill that was introduced Wednesday in the U.S. Senate that would convert the Affordable Care Act’s home-care pilot program for people with debilitating diseases to a permanent Medicare program.

Under the Independence at Home Act of 2016, Medicare would implement primary care teams to see patients at home with an aim “to reduce expenditures and improve health outcomes.” Eligible beneficiaries would include seniors or disabled people with two or more chronic illnesses, such as congestive heart failure, diabetes or Alzheimer’s disease.

Those primary-care teams making house calls could be directed by physicians, nurse practitioners or physician assistants, according to the bill’s text.

One suspects the proposal could catch on, with the government trying to move expensive care out of hospitals to rehabilitation facilities or to homes. Under the bill, Medicare would provide incentive payments to home medical practices if expenditures over a year are less than an estimated spending target.

Other groups supporting the bill are the American Academy of Home Care Medicine, the Alzheimer’s Association and the Family Caregiver Alliance’s National Center on Caregiving, a San Francisco group that assists families and friends who provide challenging long-term care for loved ones at home.

Representatives for Denver-based Compassion & Choices, which claims 450,000 members nationwide, said the legislation is consistent with its federal agenda to put patients in charge of their health and prevent unnecessary and unwanted treatments for people with irreversible medical conditions.

“People think we are just about advocating for medical aid-in-dying,” spokesman Sean Crowley said. “We are part of a coalition that is trying to change the medical system so it is patient-focused and not doctor- and medical-system focused.”

Mark Dann, federal affairs director for Compassion & Choices, said providing care at home for patients with debilitating diseases naturally leads to conversations about advanced care planning.

Dann said the organization would not reap any federal funds from the bill or provide services for Medicare patients. He said the group wants to improve end-of-life care, whether it is hospice care, pain control, or medical aid-in-dying in states where that is legal.

Fewer than 1 percent of patients choose medical aid-in-dying in the five states where it’s allowed, the group says.

According to the nonprofit, too many people who are terminally ill are given costly, pointless, invasive tests and treatments, and too often their advanced care directives and do-not-resuscitate orders are ignored in hospitals.

Disability rights advocates, who fear the state’s right-to-die law is a danger to adults with mental illness and severe disabilities, declined to comment on Compassion & Choices’ support for the federal bill.

The sponsors are Democratic Sens. Edward Markey of Massachusetts and Michael Bennet of Colorado and Republican Sens. John Cornyn of Texas and Rob Portman of Ohio.

Kathleen Kelly, director of the Family Caregiver Alliance, said the Affordable Care Act’s home-based care pilot projects showed that participating patients received high-quality care in their homes. She said family caregivers are better able to cope with increasing care demands when they have qualified health partners.

Crowley acknowledged that Compassion & Choices has received a large amount of funding from billionaire George Soros, though the investor and political activist is not the group’s largest donor.

The Hemlock Society, a right-to-die organization founded in 1980, became an organization called End-of-Life Choices before a 2005 merger with another group created Compassion & Choices.

This story was originally published July 7, 2016 at 5:41 PM with the headline "Right-to-die group wants Medicare to pay for health care house calls."