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Reimburse Doctors for Helping Patients Plan End-of-Life Care, Experts Say

Advocates call for new billing code

Physician incentives are needed to improve end-of-life care in the U.S., health experts said March 20 at an Institute of Medicine (IOM) forum.

The forum convened at the National Academy of Sciences to discuss action on the recommendations of the IOM’s seminal fall report, Dying in America.

“Our current system is not equipped to deal with these challenges,” said IOM President Dr. Victor Dzau, citing a rising number of elderly with multiple chronic illnesses, too few palliative care services to keep pace with demand, and time pressures that keep providers from having conversations with patients about end-of-life preferences and values.

“We need to make sure that health care providers do not shy away from these discussions,” said Senate Aging Committee Chairman Susan Collins (R-Maine). “Until we solve the reimbursement issue, I don’t think we are going to make true progress.”

When people fail to plan for end-of-life care, they receive ultimately futile, invasive, and often unwanted treatments, advocates say. Surgeon and author Dr. Atul Gawande detailed the “medicalization of mortality” that has occurred during the past several decades, noting that the most likely time for Americans to undergo surgery is the last week of life.

“We fail to recognize that people have goals and priorities in their lives that we need to serve besides just living longer,” Gawande said. “The way you learn what people’s priorities are is by asking.”

Last year, the Centers for Medicare & Medicaid Services rejected a request from the American Medical Association to create a billing code for doctors to use when they spend time helping patients plan for future care. Patrick Conway, chief CMS medical officer, said the coding would be considered this year.

If physicians will be reimbursed, work remains to ensure the quality of care patients receive, according to Christine Cassel, president of the National Quality Forum. “Metrics in this area are not easy to develop, but they’re not impossible,” she said. “Payers need to know they are paying for the right kind of care.”

Source: Reuters; March 23, 2015.

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