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Reimbursing Doctors For End Of Life Discussions

Medicare could soon begin reimbursing physicians for end of life conversations with patients, almost five years after similar proposals were taken out of the Affordable Care Act.

Bypassing the political process, some private insurers have already started reimbursing doctors for time spent helping patients complete advance health care directives, The New York Times reports. Interest in doctor-patient communication has risen as the millions of baby boomers age.

Sessions for some 50 million other Americans could be covered by Medicare if recent requests from the American Medical Association, the nation’s largest association of physicians and medical students, are approved. The AMA recently created codes for end of life conversations and submitted them to the Centers for Medicare and Medicaid Services (CMS).

“Each year, the AMA provides CMS with revisions to the CPT (Current Procedural Terminology) coding system that is used to price thousands of physician services. In a typical year, there are hundreds of codes that are either new, revised or deleted,” according to a CMS statement sent to Life Matters Media. “Advanced care planning was among the codes sent to us by the AMA.”

CMS may choose to establish payment and cover the sessions as described by the code; not pay for the specific code, but cover the sessions as part of another code; or deny payment. A decision is expected this fall.

“We think it’s really important to incentivize this kind of care,” Dr. Barbara Levy, chair of the AMA committee that sends codes to CMS, told the Times. “The idea is to make sure patients and their families understand the consequences, the pros and cons and options so they can make the best decision for them.”

The signature of President Obama on the Affordable Care Act. Courtesy WikiMedia Commons and whitehouse.gov
The signature of President Obama on the Affordable Care Act. Courtesy WikiMedia Commons and whitehouse.gov

When health care reform was signed into law in 2010, many Democrats wary of being identified with “death panels” dropped all proposals associated with end of life planning, despite support from many medical professionals, caregivers and ethicists.

According to Politifact, a Pulitzer Prize-winning fact checker, comparing end of life counseling to “death panels” was 2009’s “Lie of the Year.” Former vice presidential candidate and Alaska governor Sarah Palin was the first to coin the term “death panels” on her Facebook page after the release of an early draft of the bill. Some conservatives charged that vital care would be cut off to the aged and ill if doctors recommended they receive less aggressive treatments.

Karen N. Long, president of the Chicago End-of-Life Care Coalition, said she believes patients will benefit from one-on-one conversations with doctors about their “goals of care.”

“Everyone in this field has been working on this for a long time. It’s very much needed, because it helps patients think about what’s important to them, what they consider a ‘good’ quality-of-life,” Long told LMM. “I think most of the controversy goes back to the conflated issue of ‘death panels,’ where some individuals misquoted and misunderstood what was in the proposed law.”

An advance health care directive may take the form of a living will, power of attorney or the Five Wishes collection. The overall purpose of such forms is to help ensure that one’s end of life wishes are carried through in case of illness or incapacity.