Despite increased media and public attention to end of life care, only 17 percent of adults say they have had such a discussion with their doctor or health care provider. In contrast, 9 in 10 adults (89 percent) say doctors should discuss end-of-life care issues with their patients. (Kaiser Family Foundation 2015)
In a fee-for-service medical environment, incentives to provide a wide array of services are driven by the ability to bill and collect for services performed. While roughly 60% of physicians, nurse practitioners, physician assistants, and others who perform billable patient care services are now “employees” and do not benefit directly from producing billable services (New York Times 2014), their organizations seek to make ends meet by billing under a fee for service model to collect fair compensation for what they provide to their customers.
Because of the Centers for Medicare and Medicaid’s 2016 activation of reimbursement for two codes under which end-of-life discussions between provider and patient can now be billed, and with active education to providers and patients of this, perhaps the earlier mentioned 89%/17% gap can soon be narrowed.
Officially issued by CMS on October 30, 2015, its press release states:
“Consistent with recommendations from the American Medical Association (AMA) and a wide array of stakeholders, CMS is establishing separate payment and a payment rate for two advance care planning services provided to Medicare beneficiaries by physicians and other practitioners… Establishing separate payment for advance care planning codes to recognize additional practitioner time to conduct these conversations provides beneficiaries and practitioners greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families. (Centers for Medicare and Medicaid 2015)
Dr. Patrick Conway, Medicare’s chief medical officer, was asked to comment on the new rule by the Associated Press after the CMS release. Conway stated, “As a physician and a son, I personally know how important these discussions are for patients and families. We believe patients and families deserve the opportunity to discuss these issues with their physician and care team.”
Although physicians and others who perform services billable under Part B Medicare will need to implement these payable codes within their organizations before offering these services, palliative care leaders and staff can be pivotal in providing the background and education of the code availability to their patients and their referring medical providers. For example, fact sheets including the following could be created, posted, distributed via email, or posted on the facility’s web site:
- A summary of the CMS rule, code numbers, relative value unit values (RVU), and time allowed;
- What an advance care planning meeting between a provider, patient, and family might address;
- Web links to tools for handling the difficult conversations or documenting advance care plans;
- Phone numbers or email addresses of local experts from whom additional information can be obtained.
The California State University Shiley Institute for Palliative Care offers resources which may assist palliative care program staff to more fully integrate palliative care services, and enable their clients to receive them. The What Every… Series of courses offers definitions and understanding of What Every Health Professional Needs to Know about Palliative Care. The series has courses directed at physicians, nurses, social workers, chaplains, and health care workers in general, with the goal of sharing the language and principles of palliative care across organizations. Learn more about the What Every… Series at http://csupalliativecare.org/organizations/what-every/.
To enable teams to more effectively document care, the CSU Shiley Institute for Palliative Care Excellence in Interprofessional Palliative Care Documentation can improve communication, teamwork, and strengthen provider relationships. Working With Physician Orders for Life-Sustaining Treatment (POLST) for Professionals is a fully online course, which helps providers learn more about who would benefit from having a POLST form, and where POLST fits in in the Advance Care Planning Continuum.
Additional resources on the codes and steps for implementation, can be sought on professional society, trade organization, regulatory body, and federal or state government web sites.
Centers for Medicare and Medicaid. 2015. CMS Newsroom. October 30. Accessed November 4, 2015. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-2.html.
Kaiser Family Foundation. 2015. 10 FAQs: Medicare’s Role in End-of-Life Care. October 1. Accessed November 4, 2015. http://kff.org/medicare/fact-sheet/10-faqs-medicares-role-in-end-of-life-care/.
New York Times. 2014. New York Times.com. February 14. Accessed November 4, 2015. http://www.nytimes.com/2014/02/14/us/salaried-doctors-may-not-lead-to-cheaper-health-care.html?_r=0.