The Centers for Medicare and Medicaid Services has released the Medicare Physician Fee Schedule proposed rule that makes the two advance care planning codes established in FY2015 “active” and begins the process of allowing physicians to code and be paid for advance care planning discussions they have with their patients. “When there are not enough registered nurses and health care workers in our hospitals, patients and families suffer longer waits in pain for the care they need”, the letter says. Andrew Gurman, president-elect of the AMA, said that although previously this issue was mischaracterized, it’s high time to facilitate patients’ choices for advance care planning.
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The plan is expected to realize more than $150 million in savings over five years, according to Dr. Patrick Conway, deputy administrator for innovation and quality and chief medical officer at the Centers for Medicare and Medicaid Services.
Doctors are already reimbursed for advanced care planning when a patient first joins Medicare, but according to CMS many people do not need those services when they first enroll. In the third quarter of 2011, eight of 38 states reviewed failed to report encounter data from any managed-care entity to a national database called the Medicaid Statistical Information System by the required deadline.
Despite the growing consensus that better end-of-life planning is needed, the new regulation threatens to revive the “death panel” campaign that Republicans successfully used to demonize the federal health law as it was being debated. A disproportionate share of healthcare costs, especially in Medicare, come in the final months of life, despite surveys that show most Americans would prefer to die at home.
She added that the proposed changes represent an “important step to improve the quality of care for the hundreds of thousands of Americans who have hip and knee replacements through Medicare every year”. It suggests that what many doctors regard as a common-sense option is no longer seen by the Obama administration as politically toxic. It allows for an unlimited number of face-to-face counselling sessions about end of life issues, to be reimbursed.
End-of-life counseling covers everything from possible medical options aimed at prolonging a patient’s life to DNR (Do Not Resuscitate) indications and life support discontinuation for those uneasy about having to depend on machines in order to survive. “I would want any American who wanted to have this conversation with their clinician to have the opportunity to do so”. Researchers looked at 4 aggressive measures taken for patients with Stage IV or recurrence of cancer: intensive care, emergency room treatment, chemotherapy and hospitalization.
Balch said his organization was trying to find a congressional sponsor for a bill that would instead direct Medicare to produce materials about end-of-life decisions that reflect a range of views, including those “concerned with protecting people’s right to treatment”.
Advance directives simply guide family members, health care providers and emergency responders in the event a patient becomes incapable of making decisions or expressing his or her preferences.
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Information for this article was contributed by Matt Sedensky and Ricardo Alonso-Zaldivar of The Associated Press; by Zachary Tracer of Bloomberg News; by Pam Belluck of The New York Times; and by Noam N. Levey of Tribune News Service.
