Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Providers
August 14, 2017 01:00 AM

Providers take advantage of new end-of-life CMS billing codes

Virgil Dickson
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Getty Images

    For years, Dr. Nathan Goldstein, chief of the palliative care division at Mount Sinai Beth Israel, would hear a common complaint from his colleagues. They saw the need to have end-of-life planning conversations with their critically ill patients, but taking a half hour or more for those talks was a tough prospect because they were not covered by Medicare.

    That changed last year when the CMS finalized the creation of the new codes in the 2016 physician fee schedule and allowed clinicians to bill Medicare for those conversations. The CMS rates range from $80 to $86 for the first 30 minutes and about $75 for each additional 30 minutes.

    "What this code does is really free up physicians to talk to patients about the things that really matter to them," Goldstein said. "It's so much easier to just order that next test as opposed to sit down and have a really complicated conversation, so this code really allows people to do that."

    The creation of this billing code has been an important catalyst for ensuring that providers, Medicare beneficiaries and their families all know the patient's desired care for his or her final days and for preventing unwanted, intensive medical interventions.

    "It's a conversation that was not occurring as often as it needed to," said Dr. Michael Wilde, vice president and chief medical officer at Sanford Health in Sioux Falls, S.D.

    Over 22,000 providers billed Medicare for end-of-life planning appointments on behalf of more than 570,000 beneficiaries in 2016, the first year these services were billable, according to the CMS. The agency has noticed that provider use of the codes is increasing, as only 220,000 people used the services in the first six months of 2016.

    Clinicians credit the jump to more doctors hearing about the codes, and the codes being added to electronic health record systems.

    Providers billing under the code received $43 million in Medicare reimbursement and another $50 million in patient deductibles and coinsurance.

    Beyond ensuring a patient is getting the care they want, a hospital can also generate significant savings by not performing unwanted care on a patient.

    "Because the patient's wishes are not known there are often maximum care decisions made," said Dr. Janis Orlowski, chief healthcare officer at the Association of American Medical Colleges. "We do everything to keep them alive, and that may not meet the actual wants or needs of the patient."

    A study in the Critical Care Medicine academic journal last year found that intensive-care unit costs could drop by as much as $1.9 billion if advance care planning and ICU-based palliative-care consultation became the standard of care for patients with chronic and serious illness.

    The need for advance care planning conversations has increased in recent years as thousands of baby boomers become eligible for Medicare each day and new medical advances are discovered that can extend the length, but not the quality, of life.

    As things are now, providers are often put in the uncomfortable situation where an ailing patient is unable to speak, and frantic family members want any and every care measure available to keep that person alive, according to Dr. Carl Olden, a family physician in Yakima, Wash., and an American Academy of Family Physicians board member.

    "We struggle not to give false hope, and it's a frustrating and challenging time for physicians," Olden said. "We spend a lot money at the end of life that doesn't provide quality or meaningful restoration of function."

    While providers and industry stakeholders are pleased with the jump in advance care conversations, more work needs to be done, according to Donald Taylor Jr., a Duke professor of public policy. The number of patients who used the codes last year account for only 1% of the Medicare population.

    He suggests more provider and beneficiary education could accelerate use.

    The CMS could offer incentives for end-of-life conversations by creating quality measures that would hold providers accountable if advance care plans on file were actually implemented, according to Michael Richards, executive director of government relations and external affairs at Gundersen Health System, an integrated healthcare organization serving counties in Wisconsin, Minnesota and Iowa.

    "That's the next piece to ensure that these conversations providers are having are worthwhile," Richards said.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    merger-arrows-money_i.png
    Option Care Health CEO stands by $3.6B Amedisys deal
    Why home is becoming the future for hospitals
    Why home is becoming the future for hospitals
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Modern Healthcare A.M. Newsletter: Sign up to receive a comprehensive weekday morning newsletter designed for busy healthcare executives who need the latest and most important healthcare news and analysis.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing