Proposed Advance Care Planning Coverage For Medicare Beneficiaries

The Centers for Medicare & Medicaid Services (CMS) took a step toward improving care for Medicare beneficiaries with serious illnesses by proposing to adopt new service codes for advance care planning (ACP) as part of the 2016 Medicare Physician Fee Schedule proposed rule which was welcomed by healthcare professionals specializing in palliative care as well as patient advocates.

In May, the American Academy of Hospice and Palliative Medicine (AAHPM) joined 65 organizations representing patients, health professionals, caregivers, faith-based healthcare systems, and other advocates in sending a letter urging CMS to include payment for voluntary ACP in the Medicare Physician Fee Schedule.

“Understanding and prioritizing individuals’ care goals and preferences is a cornerstone of hospice and palliative medicine practice and represents the standard of care all of us should expect,” said AAHPM President Christine S. Ritchie, MD MSPH FACP FAAHPM, Professor of Medicine at the University of California, San Francisco. “We are pleased that CMS, by proposing to implement separate billing codes for advance care planning services, has recognized that Medicare beneficiaries’ values and goals are critical for guiding decisions about care and treatment. This will greatly improve our patients’ ability to make sure their voice is heard and, with the assistance of their health care provider, establish and document their individual wishes in the event of a serious illness.”

Peer-reviewed research shows that ACP leads to care more consistent with an individual’s wishes, higher patient and family satisfaction with that care, and fewer unwanted hospitalizations. Such planning also yields lower rates of caregiver distress, depression and lost productivity. In fact, a 2014 Institute of Medicine (IOM) report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, cited coverage for ACP among its five key recommendations. Federal agencies, including the Centers for Disease Control and Prevention and the Veterans Health Administration, also support ACP.

“A majority of Americans want to discuss advance care planning, and AAHPM remains committed to ensuring all individuals have the opportunity to establish their health care preferences with their doctor and have them documented, should they choose to do so,” said AAHPM Chief Medical Officer Joe Rotella, MD MBA HMDC FAAHPM. “We urge CMS to finalize its ACP services proposal. Once implemented, CMS should monitor how ACP services are being delivered and assess their impact on beneficiary quality of life and effectiveness of care.”

The Medicare Physician Fee Schedule proposed rule will be open for public comment through Sept. 8, 2015, after which time CMS will finalize policies to take effect beginning in 2016.


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