Congress and the administration are taking steps to help patients plan for end-of-life medical care
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The reimbursements are included in a rule announced last fall by the Centers for Medicare and Medicaid Services that sets physician payment fees for calendar year 2016. The rule created two new reimbursement codes. The first code pays approximately $86 for an initial 30-minute advance care-planning consultation in a doctor’s office and $80 for consultation in a hospital. The second code pays about $75 for each additional 30-minute consultation.
The consultations include an explanation of various advance care-planning options, including health care advance directives, which are documents that provide instructions about a patient’s health care wishes. Those documents include living wills, which address preferences about end-of-life medical treatments, and durable powers of attorney, in which patients appoint family members or others to make medical decisions for them when they are unable to do so themselves.
Another protocol is the physician orders for life-sustaining treatment, aka POLST, a set of medical orders in a standardized format designed to facilitate shared, informed medical decision-making and communication between health care professionals and patients with advanced illnesses. The orders address key critical-care decisions and are designed to be portable so that the appropriate care may be given across care settings.
The ABA has a long history of promoting the value of advance care planning and patient self-determination. Since 1986, the association’s House of Delegates has adopted nine policy positions developed primarily by the Commission on Law and Aging. The most recent policy, adopted last February, supports legislation promoting access to and financing of high-quality, comprehensive long-term supportive services for individuals with advanced illnesses, including advance care planning through counseling, disclosure and meaningful discussion of prognosis, goals of care, personal values and treatment preferences.
The process of advance care planning can begin at any time, and can be made more specific as a person’s health status changes.
TOO LITTLE TALK
A recent study conducted by the Kaiser Family Foundation revealed that, while nine out of 10 adults responding to a foundation survey said doctors should discuss end-of-life care issues with their patients, only 17 percent of the respondents said they have had such discussions.
The ABA supports the Care Planning Act of 2015 (S. 1549), sponsored by Sens. Mark R. Warner, D-Va., and Johnny Isakson, R-Ga. The legislation, in addition to authorizing Medicare to reimburse health care professionals who provide planning consultations, would amend the Public Health Service Act to require the Department of Health and Human Services to give priority to the development of quality metrics to assess the effectiveness of advance care plans. The HHS secretary also would be authorized to award grants for training, disseminating resources, and conducting a national public education campaign to raise awareness of advance care planning and advanced illness care.
Other pending legislation would encourage Medicare beneficiaries to create electronic advance directives by offering them a one-time financial incentive.
Sen. Richard Blumenthal, D-Conn., is expected to introduce a bill this Congress to enhance public and professional education in advance care planning, provide support for POLST programs, and implement studies on the feasibility of a national uniform policy on advance directives, including creation of a national registry.
Summing up the impact of these developments, Charles P. Sabatino, director of the ABA Commission on Law and Aging, says, “The growing willingness of Congress and the administration to support advance care planning reflects a realization that meaningful discussions between patients and health care professionals are absolutely essential to ensuring that patients understand their options, and that care plans are made that respect the patient’s personal values, wishes and goals of care.”
This article originally appeared in the February 2016 issue of the ABA Journal with this headline: “Healthy Actions: Congress and the administration are taking steps to help patients plan for their end-of-life medical care.”
This report is written by the ABA Governmental Affairs Office and discusses advocacy efforts by the ABA relating to issues being addressed by Congress and the executive branch of the federal government. Rhonda McMillion is editor of ABA Washington Letter, a Governmental Affairs Office publication.
