Medicare doctors soon will start getting paid for end-of-life counseling, under a final rule the Obama administration issued late last week.
Beginning in January, doctors can get reimbursed for advising terminally ill patients on what types of interventions they may want to accept or reject. Under the rule, Medicare will pay $86 for the first 30 minutes of “advance care planning” if it takes place in a doctor’s office and slightly less if it takes place in a hospital.
Paying for end-of-life counseling was once a highly controversial topic, with former vice presidential candidate Sarah Palin getting widespread attention for her allegation that including it in the 2010 healthcare law would lead to “death panels.”
But when the Centers for Medicare and Medicaid Services announced in July it was considering the matter, and then issued a final rule on Friday, there were virtually no objections from Republicans, reflecting a major shift in views of end-of-life counseling. Health policy experts have long noted that such counseling can help reduce unnecessary medical costs that quickly mount up at the end of many patients’ lives.
Andy Slavitt, acting administrator for CMS, said his agency received a “large number” of comments supporting the proposal.
“Establishing separate payment for advance care planning codes to recognize additional practitioner time to conduct these conversations provides beneficiaries and practitioners greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families,” CMS said.
Rep. Earl Blumenauer, an Oregon Democrat who has championed allowing physicians to bill for counseling for the terminally ill, called it a “turning point” for end-of-life care, although he added that providers need training in offering such counseling and need to be able to easily add it to a patient’s medical records. He originally tried to get it included in the Affordable Care Act.
“The decision by CMS to create a benefit for advance care planning is a turning point in end-of-life care. However, our work is far from done … ultimately, the care provided must align with the patient’s stated goals, values, and informed preferences,” Blumenauer said.
The American Hospital Association and other medical societies also have praised the decision.
