NRHI Welcomes CMS Advance Care Planning Payment Proposal

NRHI members have long advocated for end-of-life care discussions as an important component of patient centered care

Portland, Maine – As part of its annual Medicare physician fee schedule rule, The Centers for Medicare and Medicaid Services (CMS) proposed to reimburse physicians for advance care planning with patients. The rule allows doctors to bill Medicare for counseling patients on end-of-life or palliative care medical choices. The Network for Regional Healthcare Improvement and its membership strongly support this proposal.

On the heels of the IOM report Dying in America and with support from dozens of medical associations and other groups representing patients and caregivers, advance care planning payment is likely to come to fruition. If the proposal remains unchanged, payment will begin January 1st, 2016 and will pay for the service for any patient every five years.

“NRHI and its membership applaud CMS for this long-needed, patient-centered proposal. Advance care planning has been widely mischaracterized in years past. We hope this time the focus will be on what advance care planning is really about, a patient’s end-of-life wishes and the benefits to patients and their families,” said Elizabeth Mitchell, President and CEO of the Network for Regional Healthcare Improvement. She added that “this type of counseling would help patients understand their options, also potentially avoiding invasive medical interventions that may not add time or quality to their lives. The point is that decisions would be based on patient choice.”

A number of NRHI member organizations, all Regional Healthcare Improvement Collboratives, have worked on initiatives that assess and promote the value of end-of-life care and planning, advance directives, and palliative care.

Nancy Zionts, Chief Operating and Program Officer for the Jewish Healthcare Foundation, an NRHI member, runs the Coalition for Quality at the End of Life in Pennsylvania. Through the Coalition, her organization engages the community in improving and helping to remove barriers to quality end-of-life care. Citing research by the California Healthcare Foundation, she said “80% of people say they’d want to talk with their doctor about end-of-life care if faced with a serious life limiting problem, but only 7% actually do.” To combat this, her organization also offers Closure, an initiative that empowers consumers and healthcare professionals through information and resources to facilitate educated decisions about end-of-life care.

Zionts said that one thing she often explains is that advanced care planning is not a one-time process. “It’s not like a tattoo. It’s a series of conversations that allow for review of care options as circumstances change.” She lastly stressed that along with reimbursement, there must also be an increase in education and training in end-of-life care decision-making for providers, patients, and families.

For example, as a partner in the Advance Care Planning Coalition, Cincinnati based NRHI member The Health Collaborative is working with regional partners to increase the number of older adults with an advance care plan, specifically an advanced directive. “One of the outcomes of this Coalition is the training of over 70 employees within the various healthcare settings across our region to facilitate conversations about end-of-life planning,” said Craig Brammer, The Health Collaborative’s CEO. He added that the CMS proposal would bolster their goal to see that 75% of the defined Coalition population have a documented advance care plan.

In Colorado, NRHI member the Center for Improving Value in Healthcare (CIVHC) has a long history of work in this area. CIVHC President and CEO, Ana English said, “advance care planning is a crucial piece of comprehensive palliative care which helps to achieve the Triple Aim by improving patients’ quality of life and by reducing utilization and costs by matching treatments to goals. We’ve been working in this space for many years and are currently using the Colorado All Payer Claims Database to quantify the impact these types of services have on health care utilization and costs.” In a recently released study her organization found both reimbursement and cultural misperceptions have created barriers to more widespread implementation of palliative care. English feels that this proposal from CMS is an encouraging step to start eliminating those barriers. See the full report here.

Mitchell added that while there are many other changes that must be made to ensure universal access to advanced care planning, reimbursement is a foundational first step. “As the largest insurer for Americans at the end-of-life, this move by CMS should prompt expansion of both delivery and payment of this type of care across the continuum.”


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