CMS would pay for end-of-life counseling under new rule
The decision comes amid growing discussion about a sick patient’s right to forego medical treatment that would keep them alive.
Stock image of a doctor treating a patient.
The Centers for Medicare and Medicaid Services on Wednesday proposed a new rule that would reimburse doctors for end-of-life counseling, the very kind of practice that led to the heated “death panel” debate before the Affordable Care Act was passed.
According to CMS, the new payment model would pay doctors for having discussions with patients about what should happen if they are too sick to speak for their own medical treatment, which includes whether they should be resuscitated.
“Consistent with recommendations from the American Medical Association and a wide array of stakeholders, CMS proposes to establish separate payment and a payment rate for two advance care planning services provided to Medicare beneficiaries by physicians and other practitioners,” the agency wrote in a fact sheet about the proposal.
The decision comes amid growing discussion about a sick patient’s right to forego medical treatment that would keep them alive or on life support.
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Scrutiny over similar end-of-life planning language in the Affordable Care Act set off Conservative pundit and former Alaska Gov. Sarah Palin in 2009, who suggested officials would set up “death panels” to decide which patients get life-saving care. That claim was widely debunked.
“This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions. The AMA has long supported coverage of advance care planning and provided recommendations and input to help Medicare create a payment policy based on a full understanding of this medical service,” AMA president-elect Andrew W. Gurman said in a statement.
End-of-life advocacy group Compassion & Choices also backed the proposal.
"Nearly one out of four older Americans say that either they or a family member have experienced excessive or unwanted medical treatment,” said Daniel R. Wilson in a statement. “This CMS proposal is a positive step – but by no means a panacea – toward ensuring patients receive only the end-of-life care they want – no more and no less.”
Doctors are already reimbursed for advanced care planning when a patient first joins Medicare, but according to CMS many people do not need those services when they first enroll. The new rule would cover it under Medicaid and Medicare at any time.
CMS announced the proposal as part of a larger update to the physician fee schedule for 2016. In that rule, CMS outlined payments under the new Physician Quality Reporting System established in a law this year that replaced the controversial sustainable growth rate. Physicians will have to report clinical data in 2017 or risk a 2 percent reimbursement cut in 2018.
[Also: Obama signs SGR repeal as Fitch says bill raises need for physician engagement]
CMS also proposed finalizing the number of measure physicians must report, which would hit 300 if the proposal is approved.
Also in the proposal, the Medicare and Medicaid administrator outlined plans to publish data on physician performance through a Physician’s Compare tool, similar to the agency’s Hospital Compare database on hospital ratings.
Lastly, CMS in the rule said it will solicit feedback from providers on certain issues related to the Medicare Shared Savings Program, which allows participating accountable care organizations to earn savings, or face penalties, based on quality outcomes.
For example, CMS wants feedback on how it can better handle how physicians reporting under the PQRS when they are already part of an ACO that is reporting under the shared savings program.
CMS said it will gather public comment on the proposal for 60 days.
“We seek comment on this proposal, including whether payment is needed and what type of incentives this proposal creates,” CMS said. “In addition, we seek comment on whether payment for advance care planning is appropriate in other circumstances such as an optional element, at the beneficiary’s discretion, of the annual wellness visit.”
Here's the full proposal:
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