The CMS rule, proposed last summer and finalized Friday, takes effect Jan. 1. The physician counseling is voluntary, and could be provided during seniors' annual wellness visits, or other regular office visits. “We believe patients and families deserve the opportunity to discuss these issues with their physician and care team,” said Dr. Patrick Conway, the CMS' chief medical officer.
The CMS decided not to limit how often such counseling could take place, Conway said, in part because of feedback from doctors and the public stating that people may need repeat counseling as their health needs change. “If you made a choice and you become more ill, you might want to have the discussion again,” Conway said.
U.S. Rep. Earl Blumenauer (D-Ore.), who pushed for the policy, said advance directives must be made easily accessible, and that doctors should receive training on how to have these difficult conversations. —Associated Press
The two-midnight rule calls for Medicare's payment and audit contractors to assume a hospital admission was legitimate if it spans two midnights. The agency will allow doctors to exercise judgment in admitting patients for short stays. The CMS is removing auditing oversight from its administrative contractors and instead letting quality improvement organizations (QIOs) enforce the policy. Recovery audit contractors (RACs) would be directed to focus only on hospitals with unusually high rates of denied claims.
The American Hospital Association said hospitals “look forward” to working with QIOs rather than RACs, and anticipate a fairer auditing process.
The CMS denied a request to delay enforcement, saying the Jan.1, 2016 start date was enough time for hospitals to understand the final rule. —Virgil Dickson
