Five years after his legislative provision to authorize Medicare and Medicaid payment for end-of-life counseling was stripped from the then-pending Obamacare legislation, Rep. Earl Blumenauer (D-Ore.) got what he wanted last week in the new physician payment rules.
The next challenge to improving care for the aging and the dying is to ballyhoo the new payment mechanisms and encourage physicians to actually provide the end-of-life counseling.
In addition, to achieve their full potential, end-of-life directives must be created in an electronic form either on or compatible with physicians' electronic health-record systems.
Their format also should be interoperable so that the directives can be found, transferred and incorporated into another physician's EHR and workflow when and where they are needed.
“I'm not planning on taking a victory lap,” Blumenauer said during a telephone interview. “We're pleased that it (payment) is there, but we're going to roll up our sleeves and get on with it.”
Starting next year, Medicare will pay for the counseling sessions, thanks to inclusion of the provision in the 2016 physician fee schedule released Friday by the CMS.
To get to this point, the former Portland city councilman, county commissioner and state legislator ploddingly overcame a vociferous cadre of radical Obamacare opponents who alleged the payment plan was part of a “death panel” scheme to prematurely end the lives of senior citizens to save the government money.
“We were able to keep it in the House version of the Affordable Care Act, and we've been building on it (that support) ever since,” Blumenauer said. “By being right and by being persistent, we've basically beaten down the objection and built basic support.”
Payments, which will start next year, vary based on where in the country care is provided, but, with rounding, are $86 for 30 minutes in a doctor's office, $80 for 30 minutes in a hospital, and $75 for 30 additional minutes in either a doctor's office or a hospital, according to the congressman's office.
Blumenauer said the payment amounts are “enough to get the conversation started” and make it “worth the physician's while” to consult with patients on end-of-life issues, including helping draft a directive.
Several health information technology vendors have versions of support software available to assist physicians, patients or both in drafting directives, but a lack of interoperability between these systems is a barrier to their widespread adoption and use.
“It removed the financial disincentive” to have the conversation, Blumenauer said. “But most important is the signal; that the federal government places a value on this conversation. More physicians will take it seriously.”
Blumenauer said a lot of work remains in publicizing the new payment mechanism and promoting its use, but, “In the last 120 hours, we've probably had more publicity and interest than we've had in the last year.”
Congress is being encouraged by the American Medical Association and more than 100 state physicians' societies and medical special physician groups to intervene in Stage 3 of the federal EHR incentive payment program.
One way to jump-start the promotion of end-of-life counseling and the creation of interoperable electronic directives is to bake them into any revised set of Stage 3 meaningful-use requirements and vendor testing and certification criteria.
But Blumenauer wasn't specific about what those next steps might be, other than publicizing the recently won payments.
“I'm planning on reassembling the interest groups and get a laundry list” of what else needs to be done, Blumenauer said. Then, they'll prioritize the list and work toward getting them done, too, he said.
