CMS has gone through an expedited rule making process to remove the voluntary end-of-life care provision from annual wellness visits (AWV).
Part B News subscribers can read
our full coverage of this story, but here is CMS's full explanation for why it is scrubbing
end-of-life care from the services.
"... we published the proposed rule entitled 'Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011,'" CMS says in a rule posted on the Federal Register. "In response to this publication, we received comments from health care providers, and others urging us to add voluntary advance care planning as a specified element of the definitions of both the 'first annual wellness visit' and the 'subsequent annual wellness visit.' The commenters stated that their recommendations were based upon a number of recent research studies, and the inclusion by the Medicare initial preventive physical examination (IPPE) provisions of a similar element in the existing IPPE benefit.
"CMS agreed with the commenters that voluntary advance care planning should be added as a specified element in the definitions of both the 'first annual wellness visit' and the 'subsequent annual wellness visit' based on the evidence provided and the inclusion of a similar element in the IPPE benefit (also referred to as the Welcome to Medicare exam) since January 1, 2009, and incorporated it into the final rule," the agency states.
End-of-life care planning advocates included the National Business Group on Health, the Alzheimer's Association and the American College of Physicians.
"Knowledge of the patient’s wishes about treatment and the patient’s designation of a health care proxy can prevent confusion and distress for the family and all involved health care providers at the end of the patient’s life," the Alzheimer's Association wrote in comments on the proposed 2011 Medicare Physician Fee Schedule in August. "Indeed, it would be appropriate for CMS to encourage primary care practitioners to use this opportunity to promote advance care planning as is currently included in the 'Welcome to Medicare' examination."
"It is appropriate for physicians to engage competent adult patients in a discussion of their values and preferences and to establish and maintain advance care plans," the American College of Physicians wrote in its comments on the fee schedule. "Studies show that patients who engage a physician in advance care planning experience less anxiety and are more likely to continue the dialogue with family and other caregivers. Congress has recognized the appropriateness and value of these discussions by adding end-of-life care planning as a required component of the IPPE benefit through the Medicare Improvements for Patients and Providers Act of 2008."
However, CMS says the subject needs further discussion. CMS writes: "It has since become apparent that we did not have an opportunity to consider prior to the issuance of the final rule the wide range of views on this subject held by a broad range of stakeholders (including members of Congress and those who were involved with this provision during the debate on the Affordable Care Act). Therefore, we are rescinding the provision of the final rule that includes voluntary advance care planning as a specified element of the annual wellness visits providing personalized prevention plan services, and returning to the policy that was proposed, which was limited to the elements specified in the Act. We are revising our regulation at §410.15(a) to remove voluntary advance care planning as a specified element from the definitions of 'first annual wellness visit providing personalized prevention plan services' and 'subsequent annual wellness visit providing personalized prevention plan services' and to remove the definition of 'voluntary advance care planning.'"