Bioethics Blogs

Medicare Coverage of Advance Care Planning – a Real Seward’s Folly

Exactly 150 years ago, in March 1867, U.S. Secretary of State William H. Seward signed a treaty with Russia for the purchase of Alaska for $7 million. 

Despite the bargain price of roughly two cents an acre, the Alaskan purchase was ridiculed in Congress and in the press as “Seward’s folly,” “Seward’s icebox,” and President Andrew Johnson’s “polar bear garden.”

I am concerned that another huge federal purchase might similarly be ridiculed as “folly.”  As I blogged a few weeks ago, Medicare coverage of advance care planning has cost $35 million for advance care planning (ACP) conversations for about 223,000 patients from January through June 2016.

But Medicare does not require the use of any recognized tool or decision aid as a condition of payment.  Indeed, Medicare specifies no quality standard whatsoever.  While it is surely desirable that patients engage in ACP.  But more ACP is not necessarily better, unless it satisfies minimum standards.

Hopefully, the purchase of all these ACP discussions will turn out, like the Alaska purchase, to be a great bargain.  But we certainly have not done enough to at least mitigate the risk of waste.  

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.