CMS Proposes New Medicare Physician Payments for Advance Care Planning Counseling

CMS has proposed a new Medicare reimbursement policy that includes separate payments to physicians for counseling patients on advance care planning.  "For Medicare beneficiaries who choose to pursue it, advance care planning is a service that includes early conversations between patients and their practitioners, both before an illness progresses and during the course of treatment, to decide on the type of care that is right for them,” according to CMS.  Under the proposal, beginning in January 2016, the Medicare physician fee schedule would include two new Current Procedural Terminology (CPT) codes for advance care planning – one would cover the first 30 minutes; the other, any subsequent 30-minute blocks of time. 

The advance care planning proposal is just one aspect of the first payment update to the physician payment schedule since the repeal of the sustainable growth rate earlier this year through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).   The update includes several proposals aimed at promoting high-quality, value-based care, including:

• updates to the Physician Quality Reporting System, which provide information on the quality of care delivered by physicians participating in Medicare;
• updates to the Physician Value-Based Payment Modifier, which links a portion of physician payments to the quality and cost of care they deliver, including application of the Modifier to non-physician professionals, such as physician assistants and nurse practitioners, beginning in 2018;
• a change in the Medicare EHR Incentive Program in relation to the definition of certified EHR technology for purposes of electronic submission of Clinical Quality Measures
• an amendment to the definition of primary care services under the Medicare Shared Savings Program (the accountable care organization program) to exclude claims submitted by skilled nursing facilities.  This would exclude primary care services billed by skilled nursing facilities from consideration in assigning residents to an accountable care organization.

CMS is seeking comments on the proposed rule by 5:00 pm on September 8, 2015.  Comments may be submitted electronically here, by following the instructions for “submitting a comment.”

Contact:  Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.