Financial Compensation for Advance Care Planning? Concept may not be Dead on Arrival

The idea of using financial incentives to encourage advance care planning has resurfaced in Washington.  After the “death panel” accusations against this provision in the Affordable Care Act (ACA) forced its early removal from the bill, any discussion reimbursement for advance care planning became political poison.

But the tide may be turning.  Three initiatives in the works are giving the subject new life.

The first is a recommendation from the American Medical Association (AMA), calling for Medicare to enable doctors who take the time to discuss advance care planning with their patients to bill Medicare for this service.  Physicians explain that right now they have to shoehorn these conversations into office visits that have another purpose — and don’t allow for the lengthy, complex discussions that are required to meet their patients’ needs. If Medicare adopts the AMA’s proposal, it would be a regulatory approach to instituting this practice.

The second is a bipartisan bill, the Personalize Your Care Act, introduced by Rep. Earl Blumenauer (D-OR) to provide physician reimbursement under Medicare for advance care planning. At a recent presentation on Capitol Hill that I attended, Rep. Blumenauer explained that he is personally trying to visit all 435 Members of Congress to discuss this legislation.  His goal is to clarify that the purpose of the bill is to help patients articulate and document whatever type and level of care they want as they near the end of their lives or face a life-threatening condition.  The goal, he said, is to “give people the care they want – no more, and no less.”  Rep. Blumenauer’s cosponsors include Republicans who oppose the ACA.

Third is a novel approach that would provide a financial incentive directly to the Medicare beneficiary.  The Medicare Choices Empowerment and Protection Act, offered by a bipartisan group of senators a few months ago, would pay $75 to any Medicare beneficiary who completes an advance directive through an online vendor, or $50 to those who complete a hardcopy directive. The bill’s sponsors are Senators Tom Coburn, MD (R-OK), Christopher Coons (D-DE) and Richard Blumenthal (D-CT).  It includes provisions for an accreditation system for businesses and organizations that provide and store advance directives, and for the federal government to keep track of these accredited vendors. In anticipation of concerns about the government having access to individuals’ health care directives, a summary of the bill from Senator Coburn’s website emphasizes that, “CMS (Centers for Medicare & Medicaid Services) would not hold a database of these documents, but rather would only keep track of the organization that maintains an advance directive record for a beneficiary.” mbnopqrst
A few states also have these policies in place or underway.  If new proposals are introduced your state, please let me know.

Stay tuned for more developments on this front – I hope.

Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directives registry in the U.S., which ensures that the emergency information and healthcare directives of its 200,000+ enrollees are immediately available 24/7/365. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A member of the Center for Advocacy for the Rights and Interests of the Elderly, the International Society of Advance Care Planning, and the Coalition to Transform Advanced Care, she is active in health education and public engagement related to advance care planning and advance directives and serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative. Randi is an ongoing contributor to the Academy blog.

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