The branding of end-of-life counseling as "death panels" derailed language supporting end-of-life counseling in the Affordable Care Act, but support from the American Medical Association may rekindle the concept -- at least for Medicare patients.
Source: Aetna
The AMA, which puts together a list of medical reimbursement codes that is typically adopted by Medicare, included end-of-life counseling when it submitted proposed codes for this year. That move should give physicians more flexibility in providing counseling to the sickest of patients because it clears the way for doctors to get paid for providing such counseling. If end-of-life counseling does become reimbursable for Medicare patients, it may clear the way for more insurers, like UnitedHealth Group (UNH 0.84%) and Aetna (NYSE: AET), to reimburse it, too.
A divisive topic
The fear of sick and frail patients being steered away from curative care prompted a backlash against end-of-life counseling when it was considered for inclusion in the Affordable Care Act.
Objections stem from concerns that doctors could be subtly pressured by healthcare payers, such as insurers, to advocate against high cost healthcare for patients suffering from terminal illness.
The labeling of such counseling as a "death panel" caused the provision to be dumped from the Act, but many doctors remain in favor of providing such services.
According to the American Medical Association, providing end-of-life counseling is important to making sure patients (and their family) understand the consequences, both positive and negative, of end-of-life decisions.
A study of seniors conducted in part by UnitedHealth Group revealed that more than a quarter of seniors cited not being able to care for oneself and being a burden to others as their biggest fears as they age. That suggests there may be significant demand for counseling that helps seniors better understand their healthcare options.
Source: Vital Decisions
Solutions are already here
Make no mistake; these conversations are already happening already between doctors and patients. It's just that those conversations are currently being shoehorned into doctor visits for other healthcare needs or could be occurring and being billed by doctors under other medical billing codes.
Although Medicare doesn't offer specific end-of-life billing codes to doctors, some private healthcare insurers are already providing these services to their members either directly or through privately owned third-party companies like Vital Decisions, which staffs a call center of social workers trained to help patients navigate end-of-life care decisions.
One of the early leaders in providing end-of-life counseling has been Aetna, which launched a pilot program to discuss palliative and curative healthcare options with patients in 2005. Aetna's compassionate care program offers patient access to case managers that discuss disease progression, care preferences, and advance directives, legal documents that outline patient's decisions. The pilot program was so successful that the company has since rolled it out nationally.
But its not just private insurers that are opening the door for such discussions with patients. State Medicaid programs are also experimenting with advance care reimbursement. For example, in Colorado doctors receive up to $80 for a 30-minute advance care planning conversation.
Fool-worthy final thoughts
UnitedHealth's study showed that 64% of seniors age 75 years and older have discussed end-of-life matters with loved ones and over 50% have created advance directives such as a living will. That suggests that many seniors may benefit from open and honest conversations with experienced counselors such as primary care physicians.
The Centers for Medicare and Medicaid Services will decide this fall whether to include the new billing code suggested by the AMA. If they adopt it, the decision could prompt more insurers to adopt reimbursement for such counseling because Medicare is the country's largest insurer of seniors and it often sets the standard for the insurance industry; particularly at private insurers like UnitedHealth and Aetna, which offer Medicare Advantage plans that typically offer additional services in their plans than original Medicare.
