- The Centers for Medicare and Medicaid Services on Wednesday released a draft of Medicare's first physician payment rule that would reimburse physicians for providing end-of-life counseling.
- The proposal creates two new codes that would pay for the time a physician spends discussing advance directives with patients and filling out forms. One code covers a 30-minute block; the second would cover any additional 30-minute periods. The agency said it is not assigning a value to these codes at this time.
- The agency may also make advance care planning "an optional element" of annual wellness visits for Medicare beneficiaries.
As Huffington Post put it, this is the proposal that "will make Sarah Palin's head explode"—the creation of the so-called "death panels" that, critics claim, remove patient agency and could result in the rationing of care.
Proponents—which includes most provider organizations—say advanced care planning both lowers systemic costs and provides higher patient satisfaction and better care. Atul Gawande's best selling "Being Mortal" dramatically underscores this philosophy, as does the 2014 Institute of Medicine report "Dying in America: Improving Quality and Honoring Individual Preferences Near End of Life," which indicated that without an advanced directive, patients and their families face prolonged hospitalization, soaring medical bills and avoidable pain and suffering.
Meanwhile, appropriately-delivered hospice care can shrink costs and mitigate suffering. According to a 2007 Duke University study published in Social Science & Medicine, hospice care reduces Medicare expenditures during the last year of life by an average of $2,309 per patient.
"Published, peer‐reviewed research shows that ACP [advance care planning] leads to better care, higher patient and family satisfaction, fewer unwanted hospitalizations, and lower rates of caregiver distress, depression and lost productivity," a group of organizations including the AMA wrote in a letter to HHS secretary Sylvia Burwell. "ACP is particularly important for Medicare beneficiaries because many have multiple chronic illnesses, receive care at home from family and other caregivers, and their children and other family members are often involved in making medical decisions."
Other bits and pieces from the new rule:
- The agency denied requests to pay for telehealth evaluation and management, tele-rehabilitation services, palliative care, pain management and patient-navigation services for cancer patients, according to Modern Healthcare.
- The proposal does add certified registered nurses to the list of qualified telehealth providers for some services, including evaluation and management.
- The new draft also makes some changes to the Physician Quality Reporting System in advance of its incorporation into the new Merit-based Incentive Payment System and proposes the addition of some new elements to the Physician Compare site (like a green check mark next to providers who received an upward adjustment for cost and quality).
- The agency is soliciting feedback on whether to expand the Comprehensive Primary Care Initiative and how to reimburse care consultations between primary-care docs and specialists that require "extensive discussion, information-sharing and planning."
CMS will be accepting feedback until September 8.