CMS Proposes Support of End-of-Life Care Discussions

As the Centers for Medicare & Medicaid Services (CMS) continues to transform the Medicare program to a quality- and outcomes-based system, the agency is proposing to support patient- and family-centered care for Medicare beneficiaries by enabling them to discuss advance care planning with their providers.

“CMS is building on the important work of Congress to shift the Medicare program toward a system that rewards physicians for providing high-quality care,” Andy Slavitt, administrator of CMS, said in a statement.

The end-of-life proposal is one of a number of provisions on which CMS is seeking comments. The proposal cites recommendations from the American Medical Association (AMA) and other stakeholders that CMS establish separate payment for two advance care planning services provided to Medicare beneficiaries.

"Establishing separate payment for advance care planning codes provides beneficiaries and practicioners greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families," according to the proposal.

In March, the Institute of Medicine reported in Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life that advance care planning is essential to improve the quality of end-of-life care. However, as it stands, Medicare does not pay for advance care planning, and providers who assist beneficiaries with this process do so without compensation for their time and efforts.

"For Medicare beneficiaries who choose to pursue it, advance care planning is a service that includes early conversations between patients and their practitioners, both before an illness progresses and during the course of treatment, to decide on the type of care that is right for them," according to CMS.

Other provisions being considered include statutory adjustments to physician payments based on misvalued codes, updates to the Physician Quality Reporting System, updates to the Physician Value-Based Payment Modifier, and potentially expanding the Comprehensive Primary Care Initiative.

The AMA applauded CMS' proposal and has been a long supporter of covering advance care planning.

"This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional," Andrew W. Gurman, president-elect of AMA, said in a statement. "This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions.