Healthcare News & Insights

Payments on the horizon for advance care planning?

178400371A controversial topic — advance care planning — is being broached again despite opposition from certain groups. 

The topic was first brought to light in the Affordable Care Act (ACA). Amid cries of outrage, the provision was taken out of the law. However, advanced care planning is being quietly brought back for consideration through a regulatory procedure instead of legislation, reported USA Today.

The Illinois State Medical Society recommended that the American Medical Association (AMA) create specific medical codes for advance care conversation reimbursement. And that’s exactly what an AMA panel did.

And soon, the AMA will make recommendations on what physicians should be paid for advance care planning, which includes living wills and end-of-life treatment options.

This will be just one of the reimbursement recommendations the AMA makes this year to the Centers for Medicare & Medicaid Services (CMS) on a broad range of procedures and services.

Issue at hand

As the country’s largest health insurer, Medicare has 50 million beneficiaries, most of whom are over 65.

As our nation ages, advance care planning becomes more and more important.

In fact, many oncologists, geriatricians, internists and other medical specialties who treat and care for the elderly and critically ill say “it’s crucial to elicit a patient’s wishes for treatment and other pastoral or psychological supports in a dire medical situation,” according to USA Today.

Physicians need to know if patients want every measure possible taken to prolong their lives even though there is little hope, or if they just want their caregivers to alleviate pain. These conversations are delicate and should not be rushed.

“It may take up to two hours to bring everyone to an understanding of the situation and the various options,” Thomas Smith, an oncologist and director of palliative care at Johns Hopkins Medicine, told USA Today.

Currently, physicians who are having these conversations with patients have to squeeze them in during other visits and can’t give the time and attention that the topic requires.

Also, if physicians were paid for these discussion like they are paid to examine patients, they would be more apt to take place.

Ahead of the curve

Under Medicaid, it’s up to the state to determine what medical services will be covered. Currently, two states reimburse their doctors for advance care planning — Oregon and Colorado.

According to the USA Today report, Colorado pays their physicians $80 for a 30-minute conversation on advance care planning.

Even some private carriers, such as Excellus Blue Cross Blue Shield of New York, are seeing the value in providing coverage for these services. It ensure that the medical community is providing care based on patients’ wishes.

And if Medicare approves reimbursement for advance care planning conversations, it would give patients control over their care as their options narrow.

Opposition speaks out

Of course not everyone thinks advance care planning is a great idea.

There are those who think that paying for end-of-life conversations is swimming in dangerous waters, because it’ll lead to rationing care or withholding it altogether.

“It is one thing genuinely to determine what people’s treatment wishes are but the danger is very grave that efforts to pay for advance care planning sessions [under] Medicare will turn into subtle efforts to pressure some of the most vulnerable patients to surrender their right to live,” said Burke Balch, director of the Powell Center for Medical Ethics at the National Right to Life Committee.

And according to USA Today, House Republican leader John Boehner, referring to the original provision in the ACA said, “This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law.”

That, along with former Republican vice-president candidate Sara Palin’s ranting about President Barack Obama proposing “death panels” brought the original provision to an end.

More legislation

U.S. Rep Earl Blumenauer of Oregon, a Democrat, is sponsoring a bill that would require reimbursement for advance care planning. And he’s hopeful the bill will get a hearing without a lot of opposition.

He’s optimistic because he has 30 co-sponsors among whom are a bunch of Republicans. And while they are against the ACA, they know it’s not about that.

“I don’t care if you’re for the ACA or against it or don’t care one way for the other. This is legislation that is supported by 90% of the public,” said Blumenauer.

And while reimbursement for advanced care planning with patients is a good start, it has to be taken a step further.  Phone consultations with relatives who don’t live in the vicinity need to be covered, as well as getting reimbursement for patients who aren’t gravely ill but still want to discuss advance directives.

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