The CMS is moving forward with plans to create distinct Medicare billing codes and rates for end-of-life care planning, a policy that physicians greeted enthusiastically when it was proposed in July.
The Obama administration included the policy in the final version of the 2016 physician payment rule, which is the first update to Medicare's physician payment policies since Congress scrapped the sustainable growth-rate (SGR) formula this year.
Although discussions about paying for end-of-life treatment planning touched off the “death panels” controversy during the drafting of the Affordable Care Act, physicians have long argued for Medicare to support such conversations.
Under current policy, Medicare provides coverage for advance care planning only during an initial visit when patients first enroll in the program.
The new rule separates advance care planning as a separate billing code, allowing physicians and patients more flexibility, including the opportunity to have the conversations included as part of yearly check-ups.
"As a physician and a son, I personally know how important these discussions are for patients and families," Dr. Patrick Conway, the CMS' chief medical officer, said in an interview with the Associated Press. "We believe patients and families deserve the opportunity to discuss these issues with their physician and care team."
In comment letters responding to the draft rule, many industry and advocacy groups said the CMS should issue a national coverage determination to ensure that payment contractors apply the policy consistently across the country. However, the agency will observe how the rule is implemented before deciding whether that is necessary.
The rule also finalizes the addition of several new features on Medicare's Physician Compare website. But the site will not, as the CMS had proposed, include a green check mark next to the names of providers who received payment bonuses for performing well on cost and quality measures.
Physician groups expressed concern in comment letters that the value-based payment modifier used to make those adjustments is likely to be misinterpreted by the public.
Many who commented also said they're not content with the methodology behind the payment modifier and pointed out that it will be phased out in 2018 as Medicare moves to the new Merit-based Incentive Payment System called for in the legislation replacing the SGR.
The CMS will apply the value-based payment modifier to physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists in 2018, both in groups and solo practices. As is the policy for physicians, the modifier will be waived for those participating in value-based demonstration programs administered by the CMS Innovation Center, such as the Pioneer accountable care organization model.
The final rule also allows hospitals, federally qualified health centers and rural health clinics to pay physicians for the purpose of compensating nonphysician practitioners who provide primary care or mental-health services to their patients. It also allows timeshare arrangements for overhead costs and the use of office space. To expand access to care in rural or underserved areas, the policy carves out an exception to Stark law restrictions on physician referrals.