Payers starting to provide incentive for end-of-life discussion

Friday, May 20, 2016 10:52 AM

Medicare and some commercial payers will pay physicians to have end-of-life discussions with their patients, demonstrating the growing recognition of the importance of having these conversations before the timing and circumstances become difficult.

Medicare began paying for voluntary advanced care planning in 2016 as an optional element of the annual wellness visit through CPT codes 99497 and 99498. Voluntary ACP means the face-to-face service between a physician (or other qualified health care professional) and the patient discussing advance directives, with or without completing relevant legal forms. An advance directive is a legal document that spells out what medical treatment a person would allow or refuse in the event that he or she is unable to communicate with doctors.

Anthem Blue Cross and Blue Shield includes advance care planning in their per-member-per-month payment for their Enhanced Personal Health Care (EPHC) or patient-centered medical home (PCMH) program. And Aetna has their Compassionate Care Program through which Aetna case manager nurses are available to counsel patients and their families by phone on arranging for care, managing benefits and planning for advanced care.

Other payers either pay for these services or likely will in the future as they tend to follow Medicare’s lead, particularly as all trend toward a holistic and more cost-effective approach to patient care.