Medicare won’t pay physicians for counseling their patients on advance care directives in 2015, but they are open to doing it sometime in the future.
In the 2015 Medicare Physician Fee Schedule, federal officials said they “will consider” whether to pay for codes related to advance care planning services after they have had the opportunity to go through notice and comment rulemaking.
The final physician payment rule , which was released on Oct. 31, highlights two codes recently created by the American Medical Association’s Relative Value Update Committee. The CPT code 99497 covers the first 30 minutes of a face-to-face discussion with the patient, family member, or surrogate about advance directives, as well as the completion of forms. The add-on CPT code 99498 covers each additional 30 minutes.
Physicians can use the new codes, but Medicare will not pay for them in 2015, according to the rule.
Dr. Diane E. Meier, director of the Center to Advance Palliative Care , said the agency’s decision not to move forward immediately with payment is not a surprise. “I think it’s promising,” she said. “I think it’s not surprising that they are being extremely cautious and hesitant given the political firestorm that an effort to do this created in 2009.”
Public opinion on end-of-life care is beginning to shift, Dr. Meier said, which could bode well for future Medicare payment. But payment is only one barrier to making counseling available to all patients. Training physicians and other health care providers in how to have conversations about the end of life is a far bigger hurdle, she said.
“If the clinician is afraid, uncomfortable, doesn’t even know how to begin, it doesn’t matter if there’s a payment,” she said. “They’re not going to do it.”
There has been some momentum building for Medicare payment for end-of-life counseling, including pressure from Congress. In September, 34 members of the U.S. House of Representatives wrote to CMS urging them to begin paying for the newly created codes 99497 and 99498.
The Institute of Medicine in its September report, Dying in America , also recommended that physicians be compensated for counseling patients on end-of-life planning.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
