[EDITOR’S NOTE: This article has been clarified from its original form to better describe the American Medical Association’s process of giving the Centers for Medicare & Medicaid Services information, which the government agency then considers before it sets reimbursement rates.]
The American Medical Association is expected to submit information to the Centers for Medicare & Medicaid Services soon about resources needed for end-of-life medical consultations. The physicians group regularly issues comments to CMS, which then uses the input, along with other aggregated information, to set provider reimbursement rates.
CMS action could re-ignite the “death panel” rhetorical storm that ensued after the Affordable Care Act was introduced several years ago, according to a published report in Stateline, the online news service from the Pew Charitable Trusts. The report said a proposal to set pay rates could gain better traction this time since it is being pursued on regulatory grounds instead of legislative efforts; CMS uses AMA information in forming its pay-rate rules 70% to 90% of the time, acknowledged AMA Media Relations Manager Robert Mills.
“Other groups’ comments aren’t as comprehensive,” Mills explained. “We bring in 31 different specialty societies, asking physicians in the field how much time it takes to do a service, what type of equipment is needed, and put all this information into spreadsheets. After our recommendations on resources are made, the [AMA committee] has no idea what the rates will be from CMS.”
At issue is what physicians should be paid for advance care planning, which is designed to facilitate critical end-of-life decisions like wills and treatment options once patients become terminal or too ill or incapacitated to make them alone, according to Pew.
Some private insurers already reimburse physicians for providing advanced care planning services, according to the Stateline article. Palliative care clinicians told the group that end-of-life conversations between doctors and their patients have largely been forced into the shadows to avoid scrutiny, adding that reimbursable advanced care planning as proposed would avoid this.
Meanwhile, U.S. Rep. Earl Blumenauer (D-OR) recently introduced The Personalize Your Care Act, bipartisan legislation that would provide Medicare and Medicaid coverage for voluntary consultations about advance-care planning. The bill also provides grants to states to establish or expand Physician Orders for Life Sustaining Treatment (POLST) programs, and ensures that an individual’s electronic health record is able to display his or her current advance directive and/or POLST form.
Blumenauer said studies have shown that more than one in four elderly Americans lack the capacity to make their own medical care decisions at the end of life. A New England Journal of Medicine article noted that advance directives have little impact on much of the costs incurred at the end of life.
