In an effort to curb health care spending and provide a better quality of life to terminally ill patients, U.S. Sen. Mark Warner has introduced legislation aimed at changing how end-of-life care is provided.

The legislation is not without controversy as it seeks to provide more patients with options for symptom management instead of more aggressive treatments and procedures.

While Warner said he is most interested in bringing the conversation about end-of-life planning to the forefront, the legislation also seeks to reduce medical costs, specifically those of Medicare. Researchers suggest that 27.4 percent of Medicare costs come in the final year of life.

"As I looked into it more, this is really more about the quality of aging," Warner, D-Va., said in a phone interview. "This is not about limiting anybody's health care. You may make the decision that you want it all and want to stay in the hospital to the very last moment. But a lot of families may make a different decision."

The bill, which was submitted Thursday, has gained the endorsement of several groups including the Alzheimer's Foundation of America. It will likely become part of a larger health care overhaul bill and debate.

And Roanoke-area palliative care specialists say there is a need to raise awareness of end-of-life issues not only among patients and families but also among physicians and hospital administrators.

"Allowing someone to die well is just as important to help someone live well," said Dr. Joan Fisher, a Carilion Clinic pediatric oncologist and one of two Carilion palliative care specialists. "I can keep someone in the hospital alive for weeks. I can extend their life. Or I can send them home and keep them alive for less time, sometimes more time, but keep them alive in a way that is more meaningful."

The specialists said they support government taking a leading role in educating the public and medical community about end-of-life care.

"Hospice doesn't mean that you stop treatment. Palliative care doesn't mean that you leave them to die," said Dr. Syed Raza, a physician at Valley Internal Medicine Associates in Salem and a board-certified palliative care doctor. "What it means you don't put them through a lot of misery and you let them make some decisions with the dignity that they should have. And you let them control the symptoms and you get them the best quality of life that they have for their time on this earth. I think people need to hear this part."

Neither Fisher nor Raza were connected to or familiar with the specifics of Warner's efforts.

A key piece of Warner's Senior Navigation and Planning Act of 2009 seeks to address the educational and awareness gap when it comes to end-of-life care. Besides directing the Department of Health and Human Services to implement a national educational campaign on planning for care at the end of life, the bill requires physicians to share information on advance directives, or "living wills," and other planning tools with patients who have certain terminal diagnoses such as end-stage renal disease, cancer or congestive heart failure.

Under the bill, beginning in 2014, Medicare reimbursements would be withheld from physicians who did not follow this requirement.

Additionally, hospitals, skilled nursing facilities, home health agencies and hospice programs would be required to provide information to patients concerning the general course of treatment expected and the likely effect on the length of life of various treatment options.

Besides requiring providers to give information to patients, the bill sets up an incentive of bonus Medicare payments for hospitals and other facilities that become accredited in hospice and palliative care. After 2020, facilities that aren't accredited would see Medicare reimbursements trimmed by 1 percent.

Accrediting facilities is something that those in the palliative care field have been pushing for, Fisher said.

At Carilion, Fisher and another physician have been slowly educating their peers and administrators since October 2007 about the importance of embracing a palliative care program.

"It's still in its infancy," she said. "But this year we have pushed to consolidate it as a service, and we're starting to open palliative care beds."

Since they've implemented the program, Carilion doctors have seen the length of time their patients spend in hospice extended. That's a good thing, Fisher said, because most people are typically in hospice for less than a week before they die.

"The earlier you get someone in hospice, the longer they live," she said. "It's very well established. Also, they help the family process the death of their loved one, and that's huge."

At Lewis-Gale Medical Center, Raza said he and his colleague have also tried to bring palliative care education and programming to the hospital. But he said it is sometimes hard to accomplish.

"The problem is it is not a very lucrative field," he said. "I think it is a great service to the community. There are 1,000 medical conditions that we see in the old age and one person who at 85 or 90 years old may have a heart condition and another doesn't, but every one of them is going to need an end-of-life care."