McCaughey falsely claims Page 432 of bill makes end-of-life counseling “mandatory”

McCaughey: "[D]angerous" bill makes end-of-life counseling “mandatory” on Page 432, and doctors will be “penalize[d]” for not following advanced directives.

From the August 20 edition of Comedy Central's The Daily Show with Jon Stewart:

STEWART: Now, you have said that the conversation is mandatory.

McCAUGHEY: It is.

[...]

STEWART: Give me the part that says it is mandatory that you must --

McCAUGHEY: It's on Page 432.

[...]

STEWART: You showed me the page the did that.

McCAUGHEY: That's right. There it is.

STEWART: And so let me just read it very quickly. “In general, for purposes of reporting data on quality measures for covered professional services, the secretary shall include quality measures on end-of-life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.”

McCAUGHEY: And what's wrong about this -- it's one thing to pay doctors to spend time with their patients discussing this issue. I am not against this. But, putting pressure on doctors to require patients to go through a consultation that's prescribed by the government and then penalize them --

STEWART: Two -- two -- two things on that.

McCAUGHEY: Wait a second. Wait a second.

STEWART: All right.

McCAUGHEY: Just, just -- and then to penalize them if the patient or their family changes their mind about their living will --

STEWART: Two, two, two things about that --

McCAUGHEY: -- in a moment of crisis. That's really wrong.

STEWART: It would be really wrong if that was in any way what this said.

In fact, the language McCaughey cited provides incentives for doctors to report data

Bill language deals with “reporting data.” From Pages 431-432 of the House tri-committee bill, America's Affordable Health Choices Act:

(1) PHYSICIAN'S QUALITY REPORTING INITIATIVE. -- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w--4(k)(2)) is amended by adding at the end the following new paragraphs:

''(3) PHYSICIAN'S QUALITY REPORTING INITIATIVE. --

''(A) IN GENERAL. -- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

''(B) PROPOSED SET OF MEASURES. -- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.''.

“Physician's Quality Reporting Initiative” provides incentives for satisfactorily reporting data, not for outcomes. The initiative provides that an eligible health care professional can receive “incentive payments” if he or she “satisfactorily submits (as determined under this subsection) to the Secretary [of Health and Human Services] data on such quality measures in accordance with such reporting system for such reporting period.” The Department of Health and Human Services' Frequently Asked Questions page describes “satisfactory reporting for Physician Quality Reporting Initiative” as follows:

The statutory description of satisfactory reporting for Physician Quality Reporting Initiative (PQRI) depends on how many quality measures are applicable to the services furnished by the physician or other eligible professional (EP) during the entire reporting period. If there are no more than three quality measures applicable to the services provided by the EP, then each measure must be reported for at least 80% of the cases in which the measure was reportable. If there are four or more quality measures applicable to the services provided by the EP, then at least three measures, selected by the EP, must be reported for at least 80% of the cases in which each measure was reportable. EPs are encouraged to report on as many quality measures as are applicable to the services provided. Reporting on as many applicable measures as is practical will increase the opportunities to reach the 80% satisfactory reporting level.

McCaughey previously backtracked from claim that Page 425 of bill makes end-of-life counseling mandatory

McCaughey previously claimed Congress made end-of-life counseling mandatory on Page 425. McCaughey stated on July 16:

And one of the most shocking things I found in this bill, and there were many, is on Page 425, where the Congress would make it mandatory -- absolutely require -- that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner, how to decline nutrition, how to decline being hydrated, how to go in to hospice care. [FredThompsonShow.com, interview archives, 7/16/09]

PolitiFact: McCaughey has “pants on fire,” “spreading a ridiculous falsehood.” In response to McCaughey's claim that Page 425 made end-of-life counseling mandatory, PolitiFact.com said:

For our ruling on this one, there's really no gray area here. McCaughey incorrectly states that the bill would require Medicare patients to have these counseling sessions and she is suggesting that the government is somehow trying to interfere with a very personal decision. And her claim that the sessions would “tell [seniors] how to end their life sooner” is an outright distortion. Rather, the sessions are an option for elderly patients who want to learn more about living wills, health care proxies and other forms of end-of-life planning. McCaughey isn't just wrong, she's spreading a ridiculous falsehood. That's a Pants on Fire. [PolitiFact.com, 7/23/09]

McCaughey backpedaled on claim after it was debunked. After Politico asked McCaughey in a July 28 article to respond to criticisms of her claim, she backpedaled, telling Politico that the bill would make end-of-life counseling mandatory "[i]n so many words."

McCaughey softened rhetoric on other claims in the past. After McCaughey repeatedly claimed that provisions in the economic recovery act would permit the government to dictate treatment, she was confronted by CNN health care reporter Elizabeth Cohen, who reported: “I had a PDF of the bill up on my computer. I said, 'Show me where in the bill it says that this bill is going to have the government telling your doctor what to do.' And [McCaughey] directed me to language -- it didn't actually say that. But she said that it was vague enough that it would allow for that to happen in the future.”