Reimbursement for Advance Care Planning Dropped… Again

In an unfortunate reversal at the start of this year, the Obama administration decided to drop reimbursement for physicians for advance care planning as part of the annual wellness visit for Medicare recipients. This comes as a disappointment to many hospice workers and palliative care providers who incorporate end-of-life discussions into their practice. While patients and providers can still have these conversations, the CMS Medicare regulation will not provide reimbursement for this service. The likely decision behind this move is a strategy by the Obama administration to prevent the newly elected Republican majority in the House from overturning the health care reform bill.

Thomas Quinn of Pallimed posted dispirited comments on this ruling last week:

“The rather lame excuse given is that a procedural lapse caused the new rule to be omitted in an earlier, proposed, set of rules, so this part of the rule did not have adequate time for public comment. The result, of course, is confusion at all levels and very mixed messages coming from the administration.

… Advance care planning and end-of-life care have been largely missing from thoughtful conversation about health reform in Congress.  I suppose this might be a trigger to try to jump-start that conversation again, but… it is disheartening.”

According to a January 4 article in the New York Times, officials from the Department of Health and Human Services also expressed disdain with the decision, saying the administration should promote advance care planning discussions to help ensure that patients get the care they want.

The provision for advance care planning reimbursement had previously been dropped from the rule due to political opposition from prominent Republicans and inaccurate statements that it would create a government panel to make end-of-life decisions for Medicare patients. Despite the media uproar caused by 2008 Republican vice-presidential hopeful Sara Palin’s references to “Obama’s death panel,” it seemed in November 2010 that reimbursement for advance care planning would be included in the final regulation published in the Federal Register. (See our November 9, 2010, post to this effect.) As Pallimed pointed out, the administration is claiming the omission of the new rule in the earlier version left no time for public comment and therefore could not be included in the final regulation.

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