The 2010 Patient Protection and Affordable Care Act (Obamacare) encourages a “medical home” model of care, which aims to improve patient access and quality of care through increased communication between physicians and patients and increased care coordination, while simultaneously reducing costs. In an effort to jump start this model, starting in 2016, Medicare will pay physicians to provide patients with advance care planning (“ACP”) services, including a face to-face meeting to explain, discuss and complete advance directives such as a health care proxy. The meeting could be with a patient or his or her authorized family member, health care agent or other surrogate.
The 2010 Patient Protection and Affordable Care Act (Obamacare) encourages a “medical home” model of care, which aims to improve patient access and quality of care through increased communication between physicians and patients and increased care coordination, while simultaneously reducing costs. In an effort to jump start this model, starting in 2016, Medicare will pay physicians to provide patients with advance care planning (“ACP”) services, including a face to-face meeting to explain, discuss and complete advance directives such as a health care proxy. The meeting could be with a patient or his or her authorized family member, health care agent or other surrogate.
To qualify for payment, the service must be reasonable and necessary for the diagnosis and treatment of the patient’s illness or injury. For example, Medicare would pay in the following case: A 68 year old male has heart failure and diabetes on multiple medications. He is seen by his physician for the evaluation and management (“E/M”) of these diseases. In addition to discussing short term treatment options, the patient wants to discuss long-term treatment options and planning, such as if he needs a heart transplant if his congestive heart failure worsens and advance care planning including his wishes regarding care and treatment if he suffers a health event that adversely affects his decision-making capacity.
In the example above, the physician would bill under one CPT code for the E/M service and another for the ACP service. Billing for ACP services would be in increments of 30 minutes. An ACP service does not have to occur on the same day as another E/M services and can be provided in a hospital, physician office or other setting. Patients can also elect to receive ACP services as part of an Annual Wellness Visit, in which case, the patient would not have to pay a deductible or coinsurance.
“Incident to” billing rules apply if an ACP service is furnished incident to the services of the billing physician, but only if the billing physician provides a minimum of direct supervision and also manages, participates and meaningfully contributes to the provision of the services.
This regulation, by promoting meaningful communication between physicians and patients about end of life issues, may reduce situations where, due to lack of advance planning, patients receive end of life care that is unwanted and unnecessary, and imposes an extraordinary burden in light of the patient’s medical condition and prognosis.
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