In a major change of policy, Medicare will now pay for end-of-life counseling for terminally-ill patients.
Amy Berman is a former nurse who now works at a health policy foundation. So five years ago, when diagnosed with a rare form of breast cancer, she knew to do her homework.
"It's the worst form of breast cancer to get," she explained. "Nobody survives it."
We asked Berman if doctors asked her what she wanted when they first began discussing her treatment plan.
"One doctor was perfection. She said we can try to hold back the cancer, but not do things that are unnecessary," Berman explained. "I went to another doctor and this other doctor wanted to do the complete opposite kind of care, wanted to throw everything at the cancer, even though it wasn't going to change the outcome."
Berman chose only those treatments that ease pain.
"I really wanted to focus on living the best possible quality of life," she said.
Dr. Diane Meier directs the Center to Advance Palliative Care, an emerging field of medicine that focuses on a patient's quality of life.
"At the outset of a serious illness it's very important to talk with patients and families about what they can expect what is the natural history of this disease course, what is the time frame," said Dr. Meier.
Now that Medicare will reimburse doctors for advance care planning and end of life discussions, there should be more time for those discussions.
"Without those conversations, somebody else is making all the decisions for us," said Berman.
And Berman agreed, for her, that decision was less aggressive care. For somebody else, it might be more aggressive care.
"It's whatever it is that that person is hoping to do for their health," she said.
The cancer has spread, but she is continuing to work and play. Berman is living the best life she possibly can.
Studies suggest patients who receive the kind of specialized care that focuses on quality of life and pain management have fewer hospital and office visits, and may even live longer.