November 01, 2015

New Medicare rule provides for advance care planning consultation

A new rule issued this fall by the Centers for Medicare and Medicaid Services (CMS) authorizes reimbursement to physicians providing advance care planning services – an action supported by the ABA to help ensure that patients receive the support they need to make informed decisions about their treatment and care.

The rule, which sets Medicare physician payment fees for calendar year 2016 and goes into effect Jan. 1, creates two reimbursement codes. The first code would pay approximately $86 for the initial 30-minute ACP consultation in a doctor’s office and $80 for consultation in a hospital. The second code would pay approximately $75 for each additional 30-minute conversation.

The ABA, which has a long history of strongly promoting the value of advance care planning and use of advance health care directives, supports meaningful planning services as a regular component of care for Medicare beneficiaries. The consultations under the new rule will include an explanation of various advance care planning options, and the process can begin at any time and become more specific when health status changes.

Health care advance directives, documents that provide instructions about a patient’s health care wishes, include living wills, which normally address preferences about end-of-life medical treatments, and durable power of attorney, under which someone is appointed by individuals to make medical decisions for then when they are unable to make them for themselves.

Another protocol is Physicians’ Orders for Life-Sustaining Treatment (POLSTs), a set of medical orders in a standardized format that are designed to facilitate shared, informed medical decisionmaking and communication between health care professionals and patients and are designed to be portable so that the appropriate care may be given across care settings.

A recent Kaiser Family Foundation report revealed that while nine out of 10 adults say doctors should discuss end-of-life care issues with their patients, only 17 percent of adults say they have had such discussions.

Earlier this year, the ABA expressed the association’s support for S. 1549, the Care Planning Act of 2015, sponsored by Sens. Mark R. Warner (D-Va.) and Jonny Isakson (R-Ga.). The legislation, in addition to authorizing Medicare to reimburse health care professionals who provide health care planning consultation, would amend the Public Health Service Act to require the Department of Health and Human Services (HHS) to give priority to the development of quality metrics to assess the effectiveness of advance care plans in regard to patients’ stated goals, values and preferences. The HHS secretary also would be authorized to awards grants for training, disseminating resources, and conducting a national public education campaign to raise public awareness of advance care planning and advance illness care.

Additional legislation was introduced Nov. 18 in the Senate and House to encourage Medicare beneficiaries to create electronic advance directives by offering a one-time financial incentive to them. The bills, S. 2297 and H.R. 4059, also would provide beneficiaries with access to a website displaying model advance directives.

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