Advocacy works! Medicare proposes payments for advance care planning!

by Phil Rodgers

One of the most valuable things I’ve learned over my 15+ years as a palliative care physician is the importance of gratitude. I’ve learned this from my mentors, my interdisciplinary colleagues, my students, and—most importantly—my patients and their families. Each day that I remember how grateful I am for the privilege of doing what I do, is a better day both for me and for those I work with.

Today I am especially grateful, but for a different reason. Late this afternoon, CMS announced that it will begin reimbursing physicians and qualified practitioners for providing advance care planning (ACP) services to Medicare beneficiaries, starting January 2016. In the proposed Medicare Physician Fee Schedule (MPFS) for 2016, two new CPT codes (99497 and 99498) can be used to bill for more complex advance care planning conversations, whether or not any other services are also provided during the same encounter (detail on pages 246-7). These codes will also allow CMS to track delivery of ACP services, and their impact on care for Medicare beneficiaries.

Many Pallimed readers will be familiar with the growing body of published evidence that ACP leads to care more consistent with individual preferences, higher patient and family satisfaction, fewer unwanted hospitalizations, and lower rates of caregiver distress, depression and lost productivity. But most of you probably didn’t need to read those studies, because you see these deeply valuable, patient- and family-centered outcomes every day in your practices. You already know that capable advance care planning is essential to delivering the best care possible.

So I am grateful that CMS has now recognized this value. And they are in good company: the IOM’s report Dying In America: Improving Quality and Honoring Individual Preferences Near the End of Life cites payment for ACP services among its key recommendations; numerous private insurers and some state Medicaid programs already reimburse practitioners for delivering ACP services; and a broad coalition of ACP supporters—including specialty societies representing the vast majority of US physicians, the AARP, the American Cancer Society LiveSTRONG, the Alzheimer’s Association, the National Council on Aging, and many others—has publicly urged CMS to begin paying CPT codes for ACP services.

I am also grateful to the many HPM professionals and friends who submitted comments to CMS late last year in support of ACP services. Some of you may even have submitted in response to synchronized posts on Pallimed, GeriPal and AAHPM last December—and my gratitude extends to all three host sites for their generosity. Those comments really do matter, and CMS received overwhelmingly positive support for the ACP codes.

There is work yet to be done, as the MPFS proposed rule will not be finalized until late fall, and we’ll need to understand together how and when to use the new codes, so stay tuned in coming weeks and months.

But for today, there is much gratitude. I hope you feel at least some of it with me.

For more info, see the post on GeriPal by Paul Tatum on this same subject, with a different focus.

Phil Rodgers, MD, FAAHPM is co-chair of the American Academy of Hospice and Palliative Medicine Public Policy committee.