More than 500,000 Medicare beneficiaries received end-of-life counseling in 2016, exceeding industry stakeholders' projections of beneficiaries who would use the service last year, according to federal data.
End-of-life discussions often center around medical directives and treatment preferences, such as hospice care, that should be carried out if patients lose the ability to make their own care decisions. Critics of the discussions have argued that federal funding should not go toward the practice, which some have likened to "death panels."
CMS in October 2015 issued a final rule that allows Medicare to reimburse providers for end-of-life discussions with patients. The rule took effect Jan. 1, 2016.
The final rule creates separate Medicare billing codes and provider reimbursement rates for end-of-life counseling. The rule allows providers to include end-of-life discussions as part of patients' annual check-ups, as well as during separate office visits and hospital stays.
Providers also can continue to be reimbursed for such discussions that occur during a patient's initial visit when he or she first enrolls in Medicare, which already was covered under the program. Medicare reimburses about $86 per session for the initial 30-minute office-based visit and about $75 per visit for additional conversations.
Patients seek end-of-life planning discussions
According to federal data, about 23,000 health care providers billed nearly $93 million for end-of-life counseling on behalf of approximately 575,000 Medicare beneficiaries in 2016. Medicare reimbursements covered more than $43 million for end-of-life counseling, while patient deductibles and coinsurance paid for about $50 million.
According to Kaiser Health News, use of end-of-life planning services in 2016 was nearly two times greater than some industry projections. For instance, the American Medical Association had projected that 300,000 Medicare beneficiaries would participate in end-of-life counseling in 2016.
According to KHN, use of the services varied widely across the United States. For example, 0.2 percent of Medicare beneficiaries in Alaska used end-of-life counseling, compared with 2.49 percent of beneficiaries in Hawaii.
Barbie Hays, a Medicare coding and compliance strategist at the American Academy of Family Physicians, said state variations in use of end-of-life planning services could stem from physicians not knowing Medicare covers such discussions.
Aging with Dignity President Paul Malley said it is "great that half a million people talked with their doctors last year" about end-of-life care. He said the data show "[p]hysician practices are learning" about the services and estimate that use of the services "will increase each year."
Michael Richards, executive director of government relations and external affairs at Gundersen Health System, said CMS could provide incentives for physicians to provide end-of-life counseling by creating a quality measure that would hold them accountable for keeping advance care plans for patients on file. "That's the next piece to ensure that these conversations providers are having are worthwhile," he said (Aleccia, Kaiser Health News, 8/14; Dickson, Modern Healthcare, 8/14).
Learn how to expand concurrent hospice care services
Research shows that hospice can increase patient and family satisfaction—and save Medicare $2,300-$10,800 per enrolled beneficiary compared to traditional care at the end of life.
Learn how your organization can develop concurrent care programs to increase access to hospice care and length of stay, while maintaining high-quality end-of-life care for patients and their families.