Dying with a voice

I can finally die on my own terms. Someday… (and preferably much later, since I have a ton of stuff to do).

Yet I surely at least have the right to be a key decision-maker in what happens to me near the end of my life, right?

This week, the Centers for Medicare & Medicaid Services (CMS) issued proposed rule changes to its CY 2016 Physician Payment Schedule. Among dozens of topics in the 815-page document was one stellar item that has long, long been battled for: A new billing code that would allow for physician reimbursement of end-of-life services, including advanced care planning discussions.

Shouldn’t doctors be required to discuss all treatment options with dying patients, including the option of “no treatment”? Even better: Shouldn’t physicians be encouraged to discuss all options well in advance, with patients who have terminal conditions, giving those patients solid information to allow them to make educated choices about their own treatments? These healthy discussions are not going to happen for free (What physician has time for charitable, off-the-clock conversations?), so that means reimbursement.

The American Medical Association, a long-standing proponent of such options, has been fighting formally for end-of-life care Medicare reimbursement opportunities for at least five years. Long-term care groups, hospice and palliative care organizations have all joined the cause, believing it’s the best thing for person-centered care.

Formalizing reimbursement for physicians who conduct advanced care planning also takes end-of-life planning out of the "care-shadows" and legitimizes it as a valid part of the care continuum…which, of course, it is.

Finally, all those individual professional voices have trickled down to actual national rule-making. It’s only a CMS “proposed rule” for now, of course; but most groups involved in long-term care can’t wait for it to be real. And—as of today—most of them sense there will be no going back now.

Still, amid the care community applause, some really deep questions will remain for CMS:

  • What should constitute “billable counseling”?
  • What end-of-life options should be discussed?
  • How should physicians handle the “treatment refusal” option, among all the usual medical treatment options?
  • How difficult will it be for physicians/caregivers to switch to “patient-wishes-first” modes of treatment?
  • Above all: Who is going to help physicians and LTC caregivers learn how to conduct those valid and important conversations?

We all hope Long-term care leaders will decide on these things, too—but for now, I applaud CMS for acknowledging the role and importance of end-of-life care services within the primary care chain, where it has always deserved to be.

Related articles:

CMS proposes physician reimbursement for end-of-life discussions
Rethinking end-of-life care



Topics: Medicare/Medicaid