Diverse Cadre of Medical Specialties Urge CMS Support for Advance Care Planning Codes

Led by the American Geriatrics Society (AGS), nearly a dozen professional societies across an array of medical specialties are urging the Centers for Medicare and Medicaid Services (CMS) to support advance care planning (ACP)—a comprehensive, ongoing, patient-centered approach to communication about future healthcare choices—for payment beginning in 2016. In a letter recently submitted to CMS Administrator Marilyn Tavenner, groups of clinicians, researchers, and advocates urged the nation’s largest health insurer to recognize two new Current Procedural Terminology (CPT) codes for discussing ACP directives with patients and their families. While not yet valid for Medicare purposes, these codes could play a vital role in tracking utilization and outcomes for ACP services, a recognized standard of high quality care that still is not reaching enough patients, according to industry experts.

“These complex, vitally important conversations add a key layer of support for serious, long-term health planning and care,” explains Jennie Chin Hansen, CEO of the AGS. “Through this patient-centered approach to care, health professionals’ efforts to enhance quality of life are aligned with the needs and wishes of patients and their families. It’s just as much about care as it is about conversation, which makes advance care planning an invaluable connector between patients and their long-term health expectations.”

Indeed, research suggests ACP conversations significantly improve health outcomes, increasing the likelihood of understanding and adhering to patient wishes and reducing hospitalizations, intensive treatment, and the likelihood of a person dying outside their preferred setting. ACP contributes to higher patient satisfaction with quality of care, as well as less risk of stress, anxiety, and depression in surrogates and surviving relatives. As such, leading healthcare organizations, from the Centers for Disease Control and Prevention to the Institute of Medicine, have advocated for increased use of ACP. CMS has noted that care plan development is applicable to most older patients and has identified ACP as one of several “broadly applicable” quality measures that eligible professionals will need to report for the Physician Quality Reporting System.

And while emerging data show ACP can reduce end-of-life costs without increasing mortality, such insights have yet to increase the number of patients receiving these vital services. Guidelines, for example, recommend that initial discussions of care goals and end-of-life planning occur when a patient is relatively stable, yet data from a study of cancer patients suggest more than half of ACP conversations occur in an inpatient setting.

“Although these services support patient choices and enhance quality of life throughout an illness, many health professionals also struggle with when and how to offer them,” notes AGS President Wayne C. McCormick, MD, MPH, AGSF. The unfortunate result, as Dr. McCormick explains, is that illness can be far advanced by the time patients and their families can consider and prepare for difficult decisions. “Medicare reimbursement, supported by the adoption of these new CPT codes, would go a long way toward ensuring these services are provided accurately, appropriately, and with dignity. That’s why our members and many others view CMS recognition as an important acknowledgment that quality of care can dramatically improve through advanced care planning.”

AGS was joined by cosigners from 10 partner societies, including AMDA–the Society for Post-Acute Long-Term Care Medicine, the American Academy of Family Physicians, the American Academy of Home Care Medicine, the American Academy of Hospice and Palliative Medicine, the American Academy of Neurology, the American College of Emergency Physicians, the American College of Physicians, the American Osteopathic Association, the American Society for Blood and Marrow Transplantation, and the American Thoracic Society.