Promoting Advance Care Planning

AAFP, Others Urge CMS to Recognize New CPT Codes

January 07, 2015 07:27 pm News Staff

The AAFP recently joined with 10 other medical specialty organizations -- including the American College of Physicians, the American Geriatrics Society and the American College of Emergency Physicians -- in asking CMS to promote advance care planning in 2016.

[Physician holding sign that reads

Specifically, in a Dec. 30 letter(5 page PDF) to CMS Administrator Marilyn Tavenner, M.A., the groups urged CMS to recognize and make separate payment for two new CPT codes developed by the CPT Editorial Panel -- 99497 and 99498 -- that describe complex advance care planning.

Even though the codes were written and approved for calendar year (CY) 2015, CMS ruled that the codes were not valid for Medicare purposes because another code was already in use for that purpose.

"We recommend that CMS start making separate payment for these codes in CY 2016 and that the payment be based on the physician work and practice expenses inputs recommended by the AMA/Specialty Society Relative Value Update Committee (RUC)," said the letter.

Story Highlights
  • The AAFP joined 10 other medical specialty organizations in asking CMS to recognize, beginning in 2016, two new CPT codes for advance care planning.
  • In a letter to CMS Administrator Marilyn Tavenner, M.A., the groups backed their request with evidence demonstrating the value of advance care planning in patient care.
  • The organizations pointed out that use of separate codes for advance care planning is necessary to track the services, look at outcomes and utilization rates, and identify which medical specialties were providing this type of care planning for patients.

The medical organizations backed up their argument with examples of research showing the value of advance care planning in improving patient outcomes as evidenced by "fewer hospitalization, less intensive treatments, more hospice use, and the increased likelihood of a person dying in (his or her) preferred location."

The letter noted that new data suggested that advance care planning reduced the cost of end-of-life care without increasing mortality.

Furthermore, advance care planning "has become the standard of care, and consensus regarding the importance and value of these services is widespread," said the letter. It went on to specifically name both the CDC and the Institute of Medicine as government-funded organizations that have openly advocated for increased use of such planning.

Even CMS had recognized the importance of advance care planning, having included such planning as one of 19 quality measures physicians must report for the 2015 Physician Quality Reporting System, the letter noted.

The letter stated that primary care physicians and subspecialists alike acknowledge the importance of advance planning but most often cite time constraints as a barrier to providing the service to their patients with serious and complex illnesses.

"The unfortunate result is that often a patient's illness is extremely advanced by the time the patient and (his or her) family seriously consider or prepare for that possibility, and physicians with whom they have no prior relationship end up discussing end-of-life care in the emergency department or after admission to the hospital," said the letter.

The organizations pointed out that Medicare reimbursement would help to promote the use of such planning for patients. But perhaps as important, noted the letter, "Without separate codes, CMS and other stakeholders are unable to track these services to look at utilization, outcomes, and which specialties are performing ACP (advance care planning) services and where. This tracking is important for the widespread adoption of these services."

The letter closed with a reminder that CMS' recognition of the advance care planning codes was seen by physicians as an "important acknowledgement that quality-of-care can be dramatically improved when patients and their physicians work through end-of-life care issues so that patients receive their preferred care."

Notably, the AAFP brought the advance care planning codes dilemma to CMS' attention in a previous letter to Tavenner, in which AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., specifically asked CMS to explain what code is already being used to pay for these services and to clarify the issues under consideration to approve payment for the new 99497 and 99498 codes. Some private insurers may already be paying for advance care planning, that earlier letter noted.