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New Medicare Policy Encourages Advance Care Planning (ACP)

Summary: Medicare will pay physicians to discuss advance care planning, such as end-of-life care, with patients and their families beginning in 2016. This policy change encourages patient autonomy and promotes better care because patients are more informed of all of the healthcare options available to them.

What is Advance Care Planning?

Starting January 1, 2016, Medicare will compensate physicians for discussing advance care planning with patients. What is advance care planning (ACP)? It is planning the type of care you would want to receive if you were unable to speak or make healthcare decisions for yourself in the future. Advance care planning includes conversations about end-of-life care, terminal diagnoses, hospice care, advance directives, and other health goals. The purpose of ACP is for patients to communicate their end-of-life wishes, as well as share these wishes with physicians and family members.

The Centers for Medicare and Medicaid Services (CMS) has established two billing codes for physicians to use to document advance care planning with Medicare beneficiaries. One code is for the first 30 minutes of the advance care planning conversation, and the second code is for additional 30-minute conversations. These codes give doctors and patients the flexibility and opportunity to have these difficult, but necessary conversations at the most appropriate time for all parties involved. Advance care planning discussion can now take place at any time during the course of a patient’s care, and doctors will be reimbursed for their time.

Through reimbursement, the CMS acknowledges that these important conversations regarding advance care planning require additional time from the physician. This new policy change not only encourages better physician-patient communication, but it is also an opportunity for patients to educate healthcare providers and family members about their wishes. Furthermore, documentation of these conversations ensures that a patient’s wishes and preferences are honored in the event of a crisis.

Prior to this policy change, doctors usually were not paid for their time and efforts in assisting patients in end-of-life and advance care planning. The only time physicians were reimbursed for advanced care planning discussion was during the “Welcome to Medicare” visit, which is available to all new Medicare beneficiaries. However, the majority of Medicare beneficiaries did not benefit from this because they were new to Medicare and likely did not need ACP at the time.

Plan for the Future with ACP

Advance care planning can take place at any time with your Medicare physician. This means you can start planning at any age or condition of health.

“Patients deserve assistance with advance care planning and it’s essential that these conversations take place before a crisis happens. We are pleased that CMS recognizes the value of these meaningful discussions between physicians and their patients.” –J. Donald Schumacher, president and CEO of the National Hospice & Palliative Care Organization

How You Can Benefit from ACP

For the Medicare patients who choose to participate in advance care planning with their doctors, they can discuss topics such as hospice care, advance directives which contains records of specific medical treatment preferences, living wills, and choosing a proxy decision maker.

According to the Pew Research Center, 4 out of 10 Americans ages 65 and up do not have advanced directives or have not written down their own wishes for end-of-life medical treatment. In an aging society, it is so important that our health care system can facilitate difficult conversations to support older patients as they transition into the next stage of their life.

“The conversations are certainly not easy, and there will need to be additional education for some physicians, but end-of-life discussions need to be part of the life cycle. We need to give patients and families much more control at this very important time of their lives.” –Daryl Cady, CEO of Hospice of Southern Maine.

The Advisory Board Company, a policies research and consulting firm, recommends using the “ABCDEs” when thinking about advance care planning.

  • Announce to the medical team that you have an advance directive.
  • Be clear to the medical team about your intentions for treatment.
  • Communicate and coordinate with family members to ensure everyone understands the treatment plan.
  • Discuss next steps.
  • Explore the benefits of palliative and/or hospice care.

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