CMS approves payment for voluntary end-of-life talks

Reimbursement for advance-care planning (ACP) will become a reality for physicians who accept Medicare in 2016, the Centers for Medicare & Medicaid Services (CMS) has announced six years after controversy swirling around "death panels" got a similar provision dropped from the Affordable Care Act.

As set forth in CMS' more warmly welcomed proposal released this summer, physician reimbursement will be available for discussions about matters such as advance directives, hospice care and other end-of-life issues. The final rule, released Friday, makes clear that advance care planning is to take place "at the discretion of the beneficiary."

Under the final rule, "patients and families can have the discussions when and where they want,"  Patrick Conway, M.D., CMS' chief medical officer, told the New York Times. "We received overwhelmingly positive comments about the importance of these conversations between physicians and patients. We know that many patients and families want to have these discussions."

Beginning in January, physicians will be able to use two new current procedural terminology (CPT) billing codes for ACP. CPT code 99497 covers a discussion of advance directives with the patient, a family member or surrogate for up to 30 minutes. An additional 30 minutes of discussion takes the add-on code of 99498. Medicare will pay a standard amount of $86 for 99497 in a doctor's office and $80 for the service in a hospital, and up to $75 for 99498. Beginning next year, physicians will be able to offer and bill for these ACP services as part of Medicare's annual wellness visit.

The American Medical Association and many other medical societies support paying for end-of-life counseling, although the Association of American Physicians and Surgeons contends that such fees would "create financial incentives to persuade patients to consent to the denial of care," Medscape noted.

Atul Gawande, M.D., the renowned surgeon, author and researcher, spoke on the topic of dying at the Medical Group Management Association annual conference in Nashville. He and his colleagues at Boston's Dana-Farber Cancer Institute turned on its head the assumption that end-of-life discussions would upset patients.

Helping patients navigate through a seven-question protocol helped both the patient and the care team get clear on what was important to the patient, according to Gawande, who recently wrote Being Mortal: Medicine and What Matters in the End. That could be a trip to Disneyland with their grandkids or time spent with their family around the dinner table. What matters is encouraging patients to talk about these wishes before it's too late.

Other policies finalized in CMS 2016 final rule--the first published since repeal of the sustainable growth rate formula--include beginning implementation of the Merit Based Payment Incentive System, payment incentives to dialysis facilities to improve the quality of dialysis care and a payment adjustment to the first year of the Home Health Value-Based Purchasing model, according to a CMS announcement.

To learn more:
- here's the final rule (.pdf)
- read the article from Medscape
- see the story from the NYT
- read the announcement