The Washington Examiner had a nice little article on a small bipartisan bill for a Medicare payment tweak. The Center for Medicare and Medicaid Services would be authorized to pay a one time incentive of $75 for an advanced care directive or a living will to be filed by a Medicare member.
A bipartisan bill set to be introduced on Tuesday would pay seniors $75 to put together a living will that lays out a patient’s wishes on medical treatment to doctors and family members should they become incapacitated.
The bill, provided exclusively to the Washington Examiner, is aimed at getting seniors to talk with family members about how to deal with end-of-life issues, according to a Senate aide familiar with the bill. The problem today is that many family members don’t talk about these issues until it’s too late….
…The program would be completely voluntary….
a 2015 study by the healthcare consulting firm Avalere found that a one-time incentive could have reduced federal spending by $13.8 billion from 2015 to 2024. While the incentive could cost $7.2 billion, it would be offset by an estimated $21 billion in savings from reduced end-of-life Medicare spending.
It has bipartisan support in both chambers and most of the major interest groups that could grind this to a halt are on board with it.
We know that end of life is often chaotic. We know that end of life pits multiple interests against each other. We know that the person who is dying may not be able to fully inform everyone of their wishes. We know this.
CMS, in 2016, authorized physicians to be paid for end of life and advanced care counseling sessions. There is a now dedicated procedure code for that. The early evidence (some of it by my boss and colleague Don Taylor**) is that there are significant barriers to providers actually billing for these sessions but the incentives are lining up to actually allow for more patient autonomy and voice at the end of life.
I don’t know how much a $75 incentive payment will prompt an incremental increase in advanced care directives being filed and then more importantly, being followed but this is a worthwhile experiment. This bill is a little nibble at the edge of the US healthcare system but it is an attempt to encourage more talking which will lead to a little less doing.
** Tsai, Gawin, and Donald H. Taylor. “Advance care planning in Medicare: an early look at the impact of new reimbursement on billing and clinical practice.” BMJ Supportive & Palliative Care (2017): bmjspcare-2016.