Medicare Plans to Pay Physicians for End-of-Life Discussions

hospice palliativeThe Centers for Medicare and Medicaid Services (CMS) announced Wednesday that physicians will soon receive reimbursement for providing end-of-life care advice to their patients.

The proposed rule to pay doctors, nurse practitioners and PA’s for this service is set to take effect January 1, 2016. The final rate will be determined November 1, 2015 following a brief period of public comments to the proposal.

“We think that today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team,” said Dr. Patrick Conway, the chief medical officer for CMS.

Medicare tucked away the proposal in the middle of a massive 800 page update to the physician fee schedule.  The ‘Advanced Care Planning Services’ rule will create CPT code 99497 for “when the described service is reasonable and necessary for the diagnosis or treatment of illness or injury.”

According to the proposal, “in addition to discussing the patient’s short-term treatment options, the patient expresses interest in discussing long-term treatment options and planning, such as the possibility of a heart transplant if his congestive heart failure worsens and advance care planning including the patient’s desire for care and treatment if he suffers a health event that adversely affects his decision-making capacity.”

The announcement came with quick support by physicians and medical groups.

“The proposed Medicare payment rule affirms the need to support conversations between patients and physicians to establish and communicate the patient’s wishes in responding to various medical situations,” said Andrew W. Gurman, M.D., President-elect, American Medical Association. “This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional.”

“Patients deserve assistance with advance care planning and it’s essential that these conversations take place before a crisis happens,” said J. Donald Schumacher, president of the National Hospice and Palliative Care Organization. “We are pleased that CMS recognizes the value of these meaningful discussions between physicians and their patients.”

The announcement of the proposal settles a debate on end-of-life planning that became a firestorm in 2009 when former vice presidential candidate Sarah Palin claimed that such proposals amounted to “death panels” that would cease care for sick and elderly patients.

The “death panel” phrase became synonymous with President Obama’s proposal for health care legislation and resulted in the removal of end-of-life care reimbursement from the Affordable Care Act.

With Medicare’s announcement this week, doctors will now be reimbursed for discussing with patients living wills and other end-of-life options for their patients.

“More and more Americans are facing advanced illness and are aging with multiple chronic health conditions, so it’s now more important than ever to have these vital conversations,” said Schumacher.

By Brad Broker

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