Wednesday, January 5, 2011

In again, out again: CMS Reimbursement for Advance Care Planning

In a disheartening and aggravating (to me, anyway) reversal, the Obama Administration has announced that the recent approval (for reimbursement purposes) of time spent counseling patients on advance directives will not go in to effect after all (see today’s New York Times article).    As the administration spokesman pointed out, this change does not prevent patients and providers from having these important conversations, but it means that this continues to be a non-billable service under CMS (Medicare) regulations.

Just a month ago a “final” Medicare rule was announced that would provide reimbursement to physicians who offer counseling on advance care planning during a routine annual well-care visit.  It was met with excitement and praise from CAPC and other organizations that advocate for patient-physician discussions about the patient’s wishes should they become incapacitated and unable to make health care decisions. As the NHPCO web site pointed out, these discussions are strictly voluntary.  It also makes sense from the perspective of advocating individual rights and strengthening patient, family, and patient-physician communication and relationships.

I’m having trouble figuring out why the administration would reverse this decision.  I have not heard anything from the “death panel” scaremongers that would give them the willies as they go into a new Congressional era in which House Republicans have pledged to repeal the health reforms enacted less than a year ago (have you heard the headlines that use the phrase “Republicans plan to repeal health care”?—that’s weird in itself).  The rather lame excuse given is that a procedural lapse caused the new rule to be omitted in an earlier, proposed, set of rules, so this part of the rule did not have adequate time for public comment.  The result, of course, is confusion at all levels and very mixed messages coming from the administration.

In the grand scheme of things, this was (and is) a relatively small bit of the overall health care conversation and policy decision-making.  It is also highly symbolic (and, as we have seen, open to highjacking and distortion by those who are opposed to any government involvement in health care reform).  Advance care planning and end-of-life care have been largely missing from thoughtful conversation about health reform in Congress.  I suppose this might be a trigger to try to jump-start that conversation again, but, as I said in my opening sentence, it is disheartening.

(Note this post written by Thomas Quinn, but posted by Christian Sinclair)

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