The Centers for Medicare & Medicaid Services has tabled plans to reimburse medical practitioners for end of life conversations with seriously ill and elderly patients, despite broad support within the medical community. CMS is accepting public comment on the decision through December 31.
The 2015 Medicare Physicians Fee Schedule, an 1,100 page document, incorporates billing codes that serve as a guide to how Medicare will reimburse various services. Two billing codes for advance care planning services submitted by the American Medical Association were acknowledged but not approved for payments.
For example, billing code 99497 would have reimbursed practitioners for 30-minute advance care planning sessions with patients and families, during which advance health care directives would be explained, and even completed. The 2015 code does not authorize payment for the discussion. CMS declined to comment.
Similar proposals were removed from the Affordable Care Act in 2010 after political opponents associated advance care planning sessions with “death panels,” a widely discredited accusation.
The decision to delay reimbursement was met with disappointment from end of life care advocates and some medical organizations. The American Academy of Hospice and Palliative Medicine is circulating a petition and urging practitioners to voice support for end of life conversation reimbursement.
“It seems like a short-sighted omission on the part of CMS,” said Dr. Porter Storey, executive vice president of the AAHPM. “It seems to me that there are a lot of important discussions that need to take place as people get sicker to help them get the care they want. I have every intention of submitting a comment personally.”
The AMA delayed commenting on the matter, as future coverage remains under consideration by CMS.
Thaddeus Pope, director of the Hamline University Health Law Institute, said the CMS delay could be due to implementation issues or politics.
“They are seeking comments and are planning to roll it out – presumably now in 2016,” he said. “After decades of inadequate reimbursement, we can wait one more year. Fortunately, many private insurers are already reimbursing well for advance care planning.”
The hope among supporters is that doctors will encourage more seriously ill patients to complete advance health care directives and identify “goals of care” if they are reimbursed for their time. As millions of baby boomers age, interest in advance care planning has grown. However, according to the Institute of Medicine’s newly released Dying in America, most Americans lack basic understanding about end of life care choices.
“We know a lot of things about how physicians behave, and they respond to incentives,” said Dr. Ziad Obermeyer, an emergency medicine physician at Brigham & Women’s Hospital in Massachusetts. “Currently, physicians are discouraged against having these discussions, because they have to take time from things that are reimbursed, and these conversations are also really difficult to have.”