Skip to main content

A Giant Thank You to CMS: Advance Care Planning Has Value

Today it is time to celebrate!

Today the Center for Medicare and Medicaid Services (CMS) announced that it is taking a tremendous step to improve the care of Medicare beneficiaries and ensure that patients receive care that matches their goals and values. CMS proposing to begin payment for advance care planning!!!

The advance care planning codes appear in the American Medical Association’s Current Procedural Terminology (CPT) manual as 99497 and 99498. These consultations are voluntary on the part of the patient and the patient’s preferences are key to the process. Look for more details about how to implement these codes soon. The CMS proposed rule for physician payment can be found here.

CMS states "For CY 2016, we are proposing to assign CPT codes 99497 and 99498 PFS status indicator "A," which is defined as: "Active code. These codes are separately payable under the PFS. There will be RVUs for codes with this status." The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service. ...We are proposing to adopt the RUC-recommended values (work RVUs, time, and direct PE inputs) for CPT codes 99497 and 99498 beginning in CY 2016 and will consider all public comments that we receive on this proposal.. "

Regular readers of GeriPal know the value of advance care planning (ACP). ACP leads to better care, higher patient and family satisfaction and it lowers caregiver distress.

In a call for ACP payments last year GeriPal cited:
  • There is now clear guidance to policy makers 
    • The Institute of Medicine (IOM) report, Dying In America, sends a clear message to policy makers by highlighting clinician-patient communication and advance care planning as one of the key areas of focus and recommendations. The IOM report recommends that standards for clinician-patient communication and advance care planning be developed that are measurable, actionable, and evidence-based. The report states that "payers and health care delivery organizations should adopt these standard and their supporting processes, and integrate them into assessments, care plans and the reporting of health care quality"
  • There is an evidence base for communication and advance care planning 
    • The journal JAMA Internal Medicine recently published an excellent article from the American College of Physicians High Value Care Task Force, Communication about Serious Illness Care Goals: A Review and Synthesis of Best Practices. Drs. Bernacki and Block report that communication about serious illness care preferences improved clinical outcomes without increasing anxiety, depression, or loss of hope, but did reduce surrogate distress. The practical guidance for clinicians section is a MUST READ.
  • There are resources for patients and families 
  • There are resoucrces Health Care providers can use to learn to do this well 
    • VitalTalk is a great place where clinicians can develop the skills of challenging conversations. Check out the VitalTalk clinicians section where you can view quick guides on key skills and then try the Watch, Read, Reflect sub-section to improve your skills.

Advance care planning should be considered the standard of care for excellent communication and delivering patient-centered care.

So, on behalf of GeriPal, and geriatricians and palliative care providers everywhere, let me just say a GIANT THANK YOU to CMS for taking this important step towards recognizing the value of physicians communicating with patients and learning patient preferences. Thank you!

Why don't you take a minute to let CMS know how important this is and how useful the new codes are in practice. The agency will be accepting comments over the next 60 days. (Comments can be submitted online at regulations.gov. Check the proposed rule webpage after July 15 for a direct link.)

by: Paul Tatum

Note: For more info, see the post on Pallimed by Phil Rodgers on this same subject, with a different focus. Comments can be submitted online at regulations.gov

Comments

Popular posts from this blog

Practical Advice for the End of Life: A Podcast with BJ Miller

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End."

As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care.  His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times.  As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement.

The book he and Berger wrote is filled to the brim with practical advice.  I mean, nuts and bolts practical advice.  Things like:
How to clean out not only your emotional house but your physical house (turns out there are services for that!)Posting about your illness on social media (should you post to Facebook)What is the difference between a funeral home and mortuaryCan I afford to die?  …

Improving Advance Care Planning for Latinos with Cancer: A Podcast with Fischer and Fink

In this week's GeriPal podcast we talk with Stacy Fischer, MD and Regina Fink, RN, PhD, both from the University of Colorado, about a lay health navigator intervention to improve advance care planning with Latinos with advanced cancer.  The issue of lay health navigators raises several issues that we discuss, including:
What is a lay health navigator?What do they do?  How are they trained?What do lay health navigators offer that specialized palliative care doesn't?  Are they replacing us?What makes the health navigator intervention particularly appropriate for Latinos and rural individuals?  For advance care planning? Eric and I had fun singing in French (yes French, not Spanish, listen to the podcast to learn why).
Enjoy! -@AlexSmithMD




You can also find us onYoutube!



Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher

Transcript

Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, I'm really excited about toda…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …