In collaboration with a number of other advocacy organizations, this week the Center for Medicare Advocacy submitted comments to CMS about two sets of proposed rules:
The Center’s comments primarily focus on expressing strong support for the proposal to add new codes recognizing separate payment for Advance Care Planning (ACP), including medical treatment near the end of life. Unfortunately, most people have no documentation of their preferences for care at the end-of-life or during incapacitation. Advance care planning allows patients and families to learn about the types of decisions that they might need to make near the end of life, and to consider those decisions ahead of time. Importantly, advance care planning also allows patients to alert others, including providers and family members, about their preferences and to legally document those preferences in case the patient later becomes unable to communicate his or her preferences. The Center also offered suggestions for implementing effective ACP, including: precluding cost-sharing for beneficiaries; expanding the scope of services payable under the advance care planning benefit to include the services of non-health professionals; and engaging in significant beneficiary and provider education about the ACP benefit.
In this proposed rule, CMS outlines a mandatory, retrospective bundled payment model in which acute care hospitals, as the holder of the payment “bundle,” would be financially accountable for both hospital care associated with lower extremity joint replacements as well as all related post-acute care (PAC) for 90 days following discharge from the hospital. Before adopting this rule and other PAC-related proposals, the Center urges CMS to take sufficient time to collect and analyze data as required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Pub.L. 113-185). Without adequate consumer protections, bundled payment proposals such as these can compel beneficiary care in the least intensive setting, regardless of an individual’s needs, and could otherwise inappropriately limit access to Medicare coverage for medically necessary medical care and rehabilitation.