Medicare Finalizes Payment for End-of-Life Services


On October 30, the Centers for Medicare & Medicaid Services (CMS) promulgated a final rule that would update payment policies under the 2016 Medicare Physician Fee Schedule (PFS). Among the updates is the establishment of a separate payment and payment rate for Medicare providers who provide advanced care planning services.

Eligible services would fall under two categories under this rule, which expands upon existing Medicare statute that provides for payment for advanced planning services at the initial welcome visit when a patient is first enrolled in Medicare. It also establishes separate payment codes so these services could be provided during any wellness visit. In addition, if a discussion around end-of-life care takes place during the wellness visit, the visit would be considered a preventive visit and the patient would not be subject to additional out-of-pocket expenses, such as co-insurance and deductibles.
During his 2013-2015 MAFP presidency, Dr. Fred Van Alstine (Owosso) was outspoken about the challenges Family Physicians face when it comes to end-of-life care. A solo practicing Family Physician in a rural community, Dr. Van Alstine was also the medical examiner for 20 years. In response to the new payment policy, he said, "It is tragic that far too often decisions are made at a time of crisis or by a surrogate who is unaware of their loved one's preferences. Nothing is more agonizing for a family than unguided substitutive judgement. It is my sincere hope that Family Physicians will seize the opportunity to have the 'conversation'."
The rule also finalized several other policies associated with the 2016 Medicare PFS, the first such policy updates since Congress passed the Sustainable Growth Rate (SGR) repeal legislation (a.k.a. the Medicare Access and Chip Reauthorization Act, or MACRA) in the spring. Read more.