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Rare Bipartisan Health Legislation Pushes Advance Care Planning

Rare bipartisan health care legislation is gaining momentum in Washington that would reimburse doctors and teams of providers to help patients suffering serious illness with advanced care planning.

The legislation, called The Care Planning Act of 2015, was introduced in the U.S. Senate by Mark Warner, a Virginia Democrat, and Johnny Isakson, a Georgia Republican. The bill would for the first time provide reimbursement under Medicare to health professionals to consult with patients about end of life care, including advanced directives.

“This (legislation) is not intended for the advanced care planning process to be static,” said the National Hospice and Palliative Care Organization’s Jonathan Keyserling in an interview with Life Matters Media. “It should be dynamic. This should help the patient and family to better understand the disease trajectory about their health care goals and convey those goals to all of the relevant medical care providers.”

Jonathan Keyserling
Jonathan Keyserling, NHPCO

It is believed to be the first major push in Congress behind legislation to reimburse medical providers for consultations since Sarah Palin, the former 2008 Vice Presidential candidate, contributed an avalanche of demagoguery on an effort to include payment for advanced care planning early in President Obama’s first term.

Amid the health reform debate of 2009, Palin accused the Obama administration and Democratic proponents of creating “death panels.” Meanwhile, John Boehner, then the House Republican leader, said Medicare coverage of advanced care planning would lead to “government encouraged euthanasia.”

Though neither Boehner nor Palin were accurate in their allegations, Medicare reimbursement for consultations was stripped from the legislation.

This time, there is bipartisan support and momentum for what lawmakers are calling a “voluntary and structured discussion about the goals and treatment options for individuals with serious illness, resulting in a documented care plan that reflects informed choices,” a memo from Warner’s office describes.

Sens. Warner and Isakson already have several Republican and Democratic sponsors to the legislation. Supporters include Democratic Sens. Tammy Baldwin of Wisconsin and Amy Klobuchar of Minnesota, as well as Republican Sens. Shelley Moore Capito of West Virginia and Susan Collins of Maine.

Sen. Mark Warner
Sen. Mark Warner

“In the last several years, some have deliberately chosen to misrepresent the purpose of care planning services to frighten people to score cheap political points,” Sen. Warner said in a statement. “It’s about making sure that your doctors, your hospital, and your family know what choices you have made about your care. If a patient prefers to explore every possible treatment option, that choice will be respected.”

Under current law, doctors can receive Medicare reimbursement for “medically necessary” care during their annual wellness visit. This care can include discussions about end of life care or advanced care planning and directives. However, consultations about end of life care cannot be the only reason for reimbursement to physicians, according to the Centers for Medicare and Medicaid Services.

The proposed legislation would create a new benefit under Medicare for “planning services” for those with advanced illnesses that would not only reimburse doctors, but include payment to an entire team of providers such as nurses, social workers and spiritual counselors.

“This (legislation) doesn’t create an opportunity for a physician alone to bill for advanced care planning,” Keyserling told Life Matters Media. “The Senators have taken a different tack, envisioning an interdisciplinary approach. It brings more accountability, better care coordination and better alignment of what the family desires being delivered to them.”

NHPCO_logoTo be sure, the legislation calls on the U.S. Department of Health and Human Services to develop a set of quality metrics that will measure, among other things, whether the patient’s stated goals are in sync with the documented care plan. Also measured will be the treatment that is delivered and what the outcome of the treatment was on the patient.

Providers of medical care say the reimbursement and related aspects of the legislation will fill a void in patient care.

“This legislation closes a gap in the health care system, and will strengthen our ability to comprehensively and appropriately address complex care needs that are core to our mission: to care for the whole person,” said Dr. David DiLoreto, chief executive officer of Presence Health Partners, a large network of Chicago area doctors and other providers. “We want to enhance the patient experience by truly allowing their voices to be heard in a way that is meaningful for them and for their loved ones.”

Medicare, like most private health insurers, is increasingly moving from a fee-for-service model of health care that rewards volume of care delivered to a value-based approach. This shift is designed to better ensure that patients are getting the right care, in the right place and at the right time.

“If an individual prefers a different approach after informed consultations with their health team, their families and others, those choices should be documented and honored too,” Warner said. “The important thing is being able to make that decision and trust that it will be respected.”

Several Senators backing the legislation have issued a parade of statements in the last week talking about their personal stories. Those stories come with a common thread about how lost they were when it came to advanced care planning.

“Having recently lost both of my parents, I speak from personal experience when I say how important it is for families, loved ones and medical care providers to have clear direction when making decisions about treatment in their final days,” Senator Capito said. “Sadly, Medicare will not currently pay doctors to have this conversation.”

The legislation provides five million dollars in fiscal 2016, beginning Oct. 1 of this year. The funding directs the Center for Medicare and Medicaid Innovation to create an “Advanced Illness Coordination Services” pilot program to reimburse “wrap-around, home-based services” to Medicare beneficiaries and for testing other care-coordination models.

There is also a consumer outreach portion of the legislation that will involve launching a national campaign designed to encourage advanced care planning as well as funds for a web site with information about advanced care planning, palliative care and hospice. The information will also be included in the popular “Medicare & You” handbook, sent annually to millions of seniors and considered a senior citizen’s Bible to Medicare benefits.

More than 40 groups in recent weeks have touted their support for the program.

“This legislation would help respect individuals’ goals, values and preferences for care and treatment,” Joyce Rogers, senior vice president of government affairs for AARP said in a statement. “This legislation recognizes and supports the critical role that family caregivers often play in providing and coordinating care or their loved ones.”