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Group Proposes Strengthening Medicare Plan to Pay Docs for End-of-Life Care Conversations

Conversations Should Start Early, Take Place At Least Once a Year on As Needed Basis

(Washington, DC – Sept. 4, 2015) Compassion & Choices today suggested two ways to improve a proposal by the Centers for Medicare & Medicaid Services (CMS) to reimburse doctors for communicating with patients about whether and how they would want to be kept alive if they become too sick to speak for themselves.

Compassion & Choices offered the following recommendations to strengthen the CMS proposal:

  1. The initial conversation about a patient’s healthcare treatment preferences should take place during the “Welcome to Medicare” preventive visit to ensure an early start to these conversations, before the diagnosis of a terminal illness.
  2. CMS should give physicians the flexibility and autonomy to engage in additional conversations as needed. Ideally, these conversations should take place at least once a year as a part of a patient’s annual medical review. However, the patient and physician should be given the autonomy to engage in these conversations as needed. For example, they may need additional conversations based on a patient’s disease diagnosis, prognosis and trajectory.

The suggestions are in response to a Sept. 8 deadline to submit comments to the Federal Register about a July 8 proposal to make advance care planning a separate payable service under Medicare codes 99497 and 99498 starting in 2016.

“Funding these two Medicare advance planning codes removes a barrier for doctors to initiate and engage in conversations that ensure healthcare providers honor patients’ treatment goals, preferences and values,” wrote Kimberly Callinan, Chief Program Officer for Compassion & Choices, a national end-of-life choice advocacy organization. “We encourage CMS to enact this regulation, provide the necessary funding, and continue to look for and address other potential barriers to these critically important discussions between patients and healthcare professionals.”

“These conversations can help patients understand their treatment options, recognize the need to plan ahead for the care they choose, avoid unwanted medical treatment and better ensure their end-of-life healthcare wishes are carried out if they are unable to speak for themselves,” Callinan concluded. “Evidence-based research overwhelmingly shows the need for more and higher-quality doctor-patient conversations about the patient’s healthcare goals, preferences and values.”

The evidence-based research supporting the CMS proposal includes: