Reimbursement for Advanced Care Planning Discussions will Improve Quality of Life

How do we ensure that patients have a say in the kind of care they receive at the end of life?  That question was put to a test in 2015 when the Center for Medicare and Medicaid services proposed a rule reimbursing physicians for advanced care planning discussions with patients.

A study published in BMJ Supportive and Palliative Care by Don Taylor, Nrupen Bhavsar, Sara Constand and Matthew Harker, all of Duke University, examined public comments on the proposed rule to provide a baseline assessment of public perception of advanced care planning.

Of 2225 public comments, about one-third were relevant to the discussion of advanced care planning.  Of those comments relevant to the issue, 81 percent were positive, welcoming the proposed change.  Nineteen percent were negative and one percent were neutral.

Positive commenters often recounted their personal experiences caring for a loved one and noted that they would have welcomed a discussion with their loved one’s physician. Negative commenters were primarily advocacy organizations focused on their professional understanding of what it means to protect human life or care for critically ill patients.

Overall, the research team concluded that discussions of end of life issues are becoming more politically acceptable and focused on making care decisions more ‘patient centered’. This may be the first study to document a perceived change in willingness to pay for advanced care planning discussions. Because Medicare is the insurer for 8 of 10 individuals who die in the United States annually, paying for these discussions between physicians, patients, and their families regarding care preference has the potential to have a large impact on the quality of life of people who are very near death, an important public health issue.