Home Health & Hospice Week

Does no national coverage determination mean no reliable payments?

Your referring physicians may be entitled to Medicare reimbursement for patients who are on the potential path to hospice. You can encourage them to discuss hospice and other end-of-life options by letting them know about new payments for doing so.

Back in July, the Centers for Medicare & Medicaid Services released the 2016 Medicare Physician Fee Schedule proposed rule. And one of the most game-changing provisions in the proposed rule is the American Medical Association’s recommendation to make Advance Care Planning services a separately payable service under Medicare. CMS proposed two CPT® codes for the purpose, 99497 and 99498 (see Eli’s HCW, Vol. XXIV, No. 25).

“Making separate payment for ACP will help ensure that we understand our patients’ care preferences, and we are delighted that it has been included in the 2016 Physician Fee Schedule,” the American Geriatrics Society’s Steven Counsell, MD, said in a recent statement. The AGS, along with a myriad of other partner professional organizations, have been lobbying CMS to provide greater support to advance ACP.

ACP is a “comprehensive, ongoing, patientcentered approach to future health care choice communication that experts warn still is not reaching enough patients,” according to physician Wayne McCormick, a professor of medicine with the University of Washington.

Impact: “A growing body of evidence suggests that ACP can contribute to improved health outcomes (e.g., reductions in hospitalizations and intensive treatment) and also lead to deeper appreciation of patient desires, including ensuring that an individual dies in his or her preferred setting,” McCormick says. “Some studies even link ACP to increased patient satisfaction with quality of care, and with less risk for stress, anxiety, and depression among caregivers and surviving relatives.”

The National Association for Home Care & Hospice submitted comments on the rule supporting the ACP codes, the trade group says.

NAHC also advocated for a mechanism to allow payment for ACP discussions by other professionals, such as palliative care interdisciplinary team members. “As a patient’s condition changes through the course of an illness, it is not uncommon for the patient’s direct relationship with a physician to become less prominent and the patient’s direct relationship with another professional (for instance, nurse practitioner, physician’s assistant, palliative care nurse or social worker) to become more prominent,” NAHC stated in its comment letter. “There are numerous reasons for this, including the fact that the patient sometimes can no longer physically travel to see a physician so other health providers visit the patient in their home, or that some physicians and NPs have turned care over to home care providers and are not actively seeing the patient.”

Watch for CMS to issue a final rule soon. The rule will take effect Jan. 1.

Note: The proposed rule is at www.gpo.gov/fdsys/pkg/FR-2015-07-15/pdf/2015-16875.pdf.