Pew Urges CMS to Consider Physician-Focused Payment Models
“Unfortunately, our health system does not currently have an effective and consistent strategy."
By - Lack of financial reimbursement may be preventing physicians from initiating imperative end-of-life discussions about a patient’s definitive health desires and wishes.
The Pew Charitable Trusts (Pew) is concerned with the lack of attention end-of-life conversations hold currently in the healthcare space. The organization is speaking out on recent proposed statements from the Centers for Medicare & Medicaid Services (CMS).
CMS is planning a series of amendments to the physician payment system under MACRA about how financial hardship decreases dignity and respect among patients, their families, and physicians.
Pew says there are many challenges requiring addressing with CMS's October announcement about reimbursing physicians at the start of next year for advance planning discussions.
Lee Goldberg, Director of the Improving End-of-Life Care Project at The Pew Charitable Trusts, urges CMS in a November letter to address various snags associated with helping patients acquire both palliative and end-of-life care under the MIPS program.
Pew urges CMS to confirm MIPS bolsters the transmission of advance care plans, an imperative aspect of the overall shared-decision making process, across care settings.
“The need for palliative care — the comprehensive care and management of the physical, psychological, emotional, and spiritual needs of patients with chronic, debilitating, or life-threatening illness and their families — is growing rapidly,” states Goldberg.
The reported 25 percent of adults with multiple chronic conditions would benefit from palliative care, says Goldberg.
Chronic illness makes up 93 percent of Medicare spending. In 2010, among the 14 percent of Medicare beneficiaries with at least 6 chronic conditions, over 60 percent were hospitalized. These beneficiaries had hospital readmission rates that were 30 percent higher than the national average.
“Unfortunately, our health system does not currently have an effective and consistent strategy to provide supportive care to this population. Access to palliative care can increase patient satisfaction, improve clinical outcomes, and reduce costs of care for patients enrolled in palliative care services,” Goldberg asserts.
“Advance care planning can also significantly improve outcomes of care, including increased compliance with patient preferences, fewer hospitalizations, and less intensive treatments.”
Goldberg says CMS can address various challenges – improved quality of services assessment, advanced access to care regardless of diagnosis, geography, or care setting, and guaranteeing patients’ desires are communicated across various care settings within the MIPS program.
“Medicare payment rules make it difficult for people who are ineligible for hospice to access community-based palliative care,” says Goldberg in reference to a report that one in three hospitals lack a palliative care program.
“Since Medicare regulations only allow prescribing providers to bill for services in an outpatient setting, it is therefore difficult for community-based organizations and small practices to provide the full interdisciplinary team that is a key component of palliative care.”
“CMS needs to develop models of care that can broaden access to high-quality palliative care,” Goldberg maintains.
“Additionally, CMS needs to develop models that expand payment to include the full interdisciplinary care team. As CMS is considering models of care that would be appropriate for physician-focused payment models, we encourage the agency to include models that offer a robust palliative care component.”
