Two Five-Digit Codes That Mean Big Progress for Long-Term Care Providers
They may each be only five digits long, but two new Advance Care Planning (ACP) codes included in the recently released Medicare Physician Fee Schedule proposed rule for 2016 reflect big progress for the provision of person-centered care for older adults, including those residing in long-term care (LTC) settings. After years of advocacy led by the American Geriatrics Society (AGS) and a diverse cadre of other health experts, recognition of ACP by the Centers of Medicare and Medicaid Services (CMS) could give LTC professionals, and the older adults they care for, a new platform for improving health and wellbeing by embedding conversation and informed decision-making in the care continuum.
ACP is a comprehensive, ongoing, person-centered approach to communication about future healthcare choices. Through brief, voluntary conversations with health professionals and caregivers, older adults are given the opportunity to make personal wishes and expectations known, particularly when it comes to LTC and end-of-life planning. ACP helps situate the person at the center of his or her care, and can serve as an invaluable connector between medical expertise and respectful, responsive attention to a person as more than just the sum of his or her chronic medical conditions.
As AGS President Steven R. Counsell, MD, AGSF, observes, the proposal to include ACP in the roster of recognized services for Medicare beneficiaries holds promise for helping “patients and their families, who often look to geriatrics experts and LTC professionals for assistance with planning for their future care.”
In part, that is because an increasing body of literature is showing that talking about LTC expectations can improve care outcomes and advance our health system’s sensitivity to quality rather than quantity of care. Beyond increasing the likelihood that people’s wishes are clearly understood and respected, ACP leads to fewer hospitalizations, less intensive treatments, and an increased likelihood that people will spend their finals days in a setting they choose rather than in an environment they would ultimately prefer to avoid.1–3 In a study of more than 1,500 older adults, those with documented end-of-life care preferences were the most likely to die at home with hospice or in a nursing facility.2 They were also less likely to have a feeding tube or a respirator in their final days, speaking to the value of making wishes known before reaching decisional incapacity.2
ACP also helps surviving caregivers and relatives better understand and cope with the LTC continuum. One study involving family members of people with documented end-of-life care wishes found that these family members reported fewer concerns with understanding professional communication and less anxiety over what to expect from the end-of-life process.2
Earlier this year, the AGS and 65 other organizations representing patients, health professionals, caregivers, faith-based healthcare systems, and many others joined together to urge CMS to make separate payment for voluntary ACP services under Medicare. With the successful addition of these codes to the 2016 Medicare Physician Fee Schedule, the CMS and LTC providers across the country will be able not only to offer these important services to beneficiaries but also to compile rich data on how they are being furnished and the impact they have on care quality and effectiveness. Such data will help inform the future of ACP services as the LTC community seeks to make actionable the health and care preferences of older adults.
The 2016 Medicare Physician Fee Schedule proposed rule will remain open for public comment through September 8th at FederalRegister.gov. Geriatrics healthcare professionals and all health advocates are strongly encouraged to share their support, feedback, and recommendations, which have been essential to the adoption of similar services in the past.
References
1. Detering KM, Hancock AD, Reade MC, Silvester W.The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010;340;C1345.
2. Teno JM, Gruneir A, Schwartz Z, Nanda A, Wetle T. Association between advance directives and quality of end-of-life care: A national study. Journal of the American Geriatrics Society. 2007;55(2):189-194.
3. Molloy DW, Guyatt GH, Russo R, et al. Systemtic implementation of an advance directive program in nursing homes: A randomized controlled trial. JAMA. 2000;283(11):1437-1444.
