Advance care planning could become a more routine part of care

AMA Wire
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Making decisions ahead of time about how they are cared for at the end of life soon could become a more routine part of medical care for Medicare patients under a proposed rule from the Centers for Medicare & Medicaid Services (CMS) that would adopt physicians’ calls to pay for end-of-life counseling.

The proposed 2016 Medicare Physician Fee Schedule would establish two new codes to be used to cover early conversations about care options between patients and their physicians, as recommended by the AMA/ Specialty Society Relative Value Scale Update Committee. This advance care planning would include discussions before an illness progresses and during the course of treatment so the patient can decide on the type of care that is right for him or her. One code would cover the first 30 minutes, and the other would cover additional 30-minute blocks.

Physicians at the 2015 AMA Annual Meeting collectively passed policy urging insurers to pay for such counseling, which would include goals of care, living wills and durable powers of attorney for health care. CMS cited the AMA’s recommendations in its fact sheet about the proposed rule.

“The proposed Medicare payment rule affirms the need to support conversations between patients and physicians to establish and communicate the patient’s wishes in responding to various medical situations,” AMA President-Elect Andrew W. Gurman, MD, said in a statement. “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.”

The proposed rule also is the first to address provisions of the Medicare Access and CHIP Reauthorization Act (MACRA), which repealed the sustainable growth rate formula.

The agency is seeking comment from the public on how it proposes to implement certain provisions of MACRA, including the new merit-based incentive payment system. The proposed rule also includes updates to payment policies, the Physician Quality Reporting System and the value-based payment modifier. CMS will accept comments on the 815-page document until Sept. 6 and will publish its final rule this fall. The AMA is reviewing the proposed rule in detail and will submit comments.

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