Telling McCaughey to Get Real.

The American Association of Hospice and Palliative Medicine responds to Betsy "euthanasia" McCaughey's recent article in the Wall Street Journal that erroneously raises alarms about medical practitioners guidelines in the health care bill.

From the superb PalliMed:

Betsy McCaughey, champion of the hyperbolic 'death panel' myth, published an op-ed in the Wall Street Journal this week detailing concerns she had in the House version of the Health Care Reform Bill (aka HR 3962, aka Affordable Health Care for America Act). The one concern regarding hospice and palliative care reads as follows:

Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.

Here is what the bill actually says:

SEC. 1114. PERMITTING PHYSICIAN ASSISTANTS TO ORDER POST-HOSPITAL EXTENDED CARE SERVICES AND TO PROVIDE FOR RECOGNITION OF ATTENDING PHYSICIAN ASSISTANTS AS ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS.

(a) Ordering Post-hospital Extended Care Services- Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) is amended--

(1) in paragraph (2) in the matter preceding subparagraph (A), is amended by striking `nurse practitioner or clinical nurse specialist' and inserting `nurse practitioner, a clinical nurse specialist, or a physician assistant'.

(2) in the second sentence, by striking `or clinical nurse specialist' and inserting `clinical nurse specialist, or physician assistant'.

(b) Recognition of Attending Physician Assistants as Attending Physicians to Serve Hospice Patients-

(1) IN GENERAL- Section 1861(dd)(3)(B) of such Act (42 U.S.C. 1395x(dd)(3)(B)) is amended--

(A) by striking `or nurse' and inserting `, the nurse'; and

(B) by inserting `or the physician assistant (as defined in such subsection),' after `subsection (aa)(5)),'.

(2) CONFORMING AMENDMENT- Section 1814(a)(7)(A)(i)(I) of such Act (42 U.S.C. 1395f(a)(7)(A)(i)(I)) is amended by inserting `or a physician assistant' after `a nurse practitioner'.

(3) CONSTRUCTION- Nothing in the amendments made by this subsection shall be construed as changing the requirements of section 1842(b)(6)(C) of the Social Security Act (42 U.S.C. 1395u(b)(6)(C)) with respect to payment for services of physician assistants under part B of title XVIII of such Act.

(c) Effective Date- The amendments made by this section shall apply to items and services furnished on or after January 1, 2010.

So does it 'replace' or 'allow'? I guess it is open to interpretation, but I have to agree with the letter written by Sean Morrison and Gail Cooney to the Wall Street Journal Editors.

This portion of the bill allows nurse practioners and clinical nurse specialists the same rights as physician assistants where state laws allow. With the shortage of qualified specialists in palliative care, all disciplines need to work together to provide the most comprehensive care for the most patients.

Hospice and palliative care workers know death. It's their business. And they know a wrong - and politicized - assertion when they see one. Hospice facilities often hold bake sales to raise funds and palliative care has been famously neglected by hospitals, medical schools, and the medical industry for the more lucrative and edifying "aggressive care" methods of end of life treatment. With limited resources and attention, hospice and palliative care will finally and rightfully get more attention under the new health care bill.

Neglect of end of life care has up to now caused a shortage of specialists, care-givers and facilities across the country, right at the time when we face a larger greying population. As the medical industry works to catch up on their neglect of end of life issues, something's got to give to fill in the gap.

When the AAHPM says McCaughey's not for real, we would best serve our seniors needs by listening to them.