Health care providers increasingly want to provide end-of-life care and consultation to patients who need it. As a result, better palliative care education and guidance — and possibly added reimbursement from the Medicare program — are on the way.
Driven by increased demand from hospitals and other providers for assistance in providing end-of-life care under the tenets of the Affordable Care Act, the Center to Advance Palliative Care restructured to become a member-funded organization, no longer relying just on grants and donations.
“The demand for palliative care has grown exponentially,” says Diane Meier, director of the center. “The ACA has essentially created both the business and quality case for palliative care across the continuum — nursing homes, home care, cancer centers, dialysis units, group practices, individual physicians,” Meier says.
As a result, the number of hospitals with at least 50 beds and a palliative care team rose to 1,734 as of 2012, an increase of 10.6 percent from 2009 and 164 percent from 2000.
Since the CAPC’s founding in 1999, philanthropy was able to fund its hospital-focused services well enough that it could provide its services at no cost, for the most part, she says.
But with so many new types of providers’ seeking assistance, and the fact that the center’s leadership had decided to expand into clinical education on top of its existing operational guidance, center officials decided that the best way to keep up with demand was to start charging a membership fee.
As of late December, the NAPC had signed on more than 300 members, not counting payers. Joining were 243 hospitals, 60 hospices, eight certified home health agencies, five multispecialty group practices, five professional organizations, three large health systems and one large clinic.
The Medicare program, meanwhile, may be ready to officially reimburse physicians for providing advance care planning related to end-of-life care. The American Medical Association proposed two related codes for advance care planning in its 2015 CPT code set, one for the first 30 minutes of discussion and the other for each additional 30 minutes.
The Centers for Medicare & Medicaid Services, which has final say on the codes, decided to delay a decision about whether to provide such reimbursement — which still could be added for this year — until “after we have had the opportunity to go through notice and comment rule-making,” according to rule-making documents.
In addition to the backing by the AMA, letters of support were submitted by such groups as the Catholic Health Association, the Society of Hospital Medicine and the Pew Charitable Trusts.
“Advance care planning is such an important activity for patients and their families to undertake, always, but particularly when the patient has what is a life-limiting illness,” says Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association, which also supports the reimbursement. “That is best done with good clinical expertise and advice being provided by a trusted source, mainly the patient’s physician.”
Pew, in its letter, wrote that advance care planning conversations make it more likely that patients will have their end-of-life wishes respected, be less likely to receive unwanted interventions in the last weeks of life and be less likely to die in the hospital or ICU.
“In the absence of reimbursement, patient preferences will continue to be inadequately discussed and documented,” wrote Josh Rising, M.D., director of health care programs at Pew.