Comments on Payment for Advance Care Planning


CMS gently proposes [2015] paying for advance care planning discussions between patients and physicians under Medicare. While this is certainly a good beginning, CMS coverage should encourage comprehensive care planning, not just “brink-of-death” care and not just for eventual incompetence but also for persons now incompetent and those who retain competence to the end of life but need a coherent plan of services. CMS might also be encouraged to set a national payment rate. This notice would actually allow different parts of the country to provide no payment or an unusually high payment. The link to a PDF file of our draft comments, written by Holly Stanley, MD, and Joanne Lynn, MD, can be found here: CECAI Medicare Physician Fee Schedule Comment Letter

3 comments on “Comments on Payment for Advance Care Planning”

  1. Hello Dr. Stanley, some thoughts re: Advanced Planning. It makes monumental good sense to put in place at the very least some ‘order’ what to do as someone is facing the specter their life either ending because of a no longer treatable disease or facing the knowledge of having a non treatable disease that in the future will end life. Today we as practitioners don’t like the thought of even broaching such an event and yet there it is. Be prepared to hear from those such as MS S. Palen remember the ‘Death Panels’ and the ‘Big Government’ interfering in decision making in this area. Pre planning is a sensible and reasonable approach. The stress of trying to make decisions during such a difficult time is not the time to make these kind of decisions. Your thoughts? Thanks Dave Colarusso ADRN BSED BSNH MA GER RN-C


  2. Agreed, esp regarding the incredibly asinine – yet unquestioningly accepted – “death panel” rhetoric. You are doing a great service to society, the cost of which is negligible, particularly as compared to the obscene sums wasted on what is disingenuously disguised as “defense” but which are the REAL death panels – wars waged worldwide for the mere purpose of enriching a few greedy individuals. Odd, isn’t it, when one considers that those very same groups fund the relentless and frequently deadly effort to prevent a woman from making a very personal medical decision with her doctor on the pretext of the “sacredness of life” of an unborn fetus – some states even extending legal “personhood” status to a zygote only a few moments after the possible fertilization of an egg – while from the very nanosecond of birth and throughout it’s entire lifetime there is no further concern for that “person’s” physical or mental health, happiness, well-being, or anything else. Funding for prenatal care, neonatal care, childhood nutrition – 1 in 4 American children don’t have enough to eat, a national disgrace in such a wealthy nation – childcare, preschool, public schools and colleges has been and continues to be ruthlessly slashed; Medicaid is a perennial target for cuts and hate rhetoric (the “lazy,” the poor, the “illegals” are wasting the tax dollars of the (self) righteous and hard-working); Medicare has barely survived the chopping block our new Speaker of the House Paul Ryan has repeatedly placed it on for almost a decade several times, but that’s unlikely to happen again given the complexion of the current Congress, the increasingly hostile political climate, and the moneyed elite and corporations behind the upcoming elections. Already Speaker Ryan is resurrecting his odious plan to eliminate Medicare and replace it with block grants to states that would distribute less than a couple hundred dollars to current Medicare recipients which would purportedly “allow” them to purchase health insurance on the “open market” – with the ACA’s repeal it’s extremely unlikely the disabled/elderly could ever hope to afford even the worst health insurance, especially on a fixed income without any COLA and the runaway inflation of health care costs once there are no longer any controls in place. Meanwhile, the disabled barely regained the 20% of their (already meager) EARNED SSDI income which had been arbitrarily cut by Congress as its first official act upon taking office this past January after gaining control of both Houses with today’s vote on the budget extension. Unfortunately, the Older Americans Act was allowed to expire without a vote to extend it, leaving millions of elderly and infirm citizens without adequate food or the assistance they had enjoyed for many years thanks to the Act. Sadly however, funding for this Act, like virtually every other program intended to benefit any vulnerable population in this country, had been regularly cut, over and over, resulting in a lengthy wait list for the vital services it provided, which is certain to become even longer now. Keep in mind that so far I’ve been discussing programs benefitting the LIVING. If this is all that’s being done – and grudgingly, at best – for people during their lifetimes, is it any wonder that no one is willing to look at how we approach them in their later years and as they prepare for their last days on this Earth? If this country spent just half, or even one fourth, of the money it devotes to waging war and dealing death on caring for PEOPLE – living, breathing, human beings – we would be living in a vastly different world. I’m guessing that most of the strife, negativity, divisiveness, intolerance, and hate we’re experiencing now would be greatly reduced, not only by the mere fact that people would be healthier and happier, and therefore less angry and hostile, but by virtue of the resulting focus of society on quality of life for ALL as the main purpose of society as a whole to begin with! Awareness then, is but the first step, but it’s a very important start and quite likely the only way to get anyone to care enough to speak out. Unfortunately though, it won’t be enough until and unless we can take back control of our government from the profit-driven warmongers and multinationals who value shareholder profits over human life. Then we can direct our efforts and easily fund programs that will serve and BENEFIT the living in every stage of life right up to the moment of death, and insure that every one of us can live out our lIves with dignity.


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