The deadline for comments on a key method for facilitating early death is Tuesday just after Labor Day weekend. Buried in 250 pages of changes to the CPT procedural codes required to claim Medicare payment are two new ones, 99497 and 99498. These pay for end-of-life discussions with physicians or other “qualified professionals.”
Such discussions often culminate in POLST—Physician Orders for Life-Sustaining Treatment. They are supposed to reflect the patient’s “choices” for what is to be done, or not done, in the event of an illness or accident.
The “qualified professional” in Advance Care Planning may be a “facilitator” whose training was funded by the Affordable Care Act, using a curriculum such as Respecting Choices®.
The creation of these special codes was promoted by the National POLST Paradigm Task Force. The electronic medical record will help identify who has or has not completed a standardized form.
Patients need to understand that “life-sustaining treatment” includes food and water. “Artificially administered nutrition and hydration” may be by intravenous or feeding tube, which may be given (or withheld) even though the patient is potentially able to eat or drink but is temporarily unable to do so—perhaps because of heavy sedation.
Physicians may be pressured to meet a quota for POLST forms and to conform to government-prescribed standards for an “acceptable” conversation. The existence of a form may make it impossible for physicians or family members to override the pre-written orders agreed to in a scripted session with a facilitator, even if the attending physician believes there is a prospect of recovery, AAPS warns.
Ensuring an early demise is an effective way to achieve the stated goal of reducing healthcare costs. And the well-funded, expansive “palliative care” movement has been working for decades to promote euthanasia by another name, observes AAPS.
Elizabeth Wickham of LifeTree.org points out that the Obama Administration withdrew earlier, similar regulations in 2011 after a New York Times article called attention to it.
“The ‘death panels’ have come back from the dead with news that the Centers for Medicare and Medicaid Services (CMS) is going to pay for ‘end of life counseling’ for Medicare beneficiaries as a separate service. What this really means is they are pushing these conversations by adding a financial carrot,” states AAPS president Richard Amerling, M.D.
Comments may be submitted until 5 p.m. Eastern time, Sept 8.
AAPS Comments to CMS can be read here: http://www.aapsonline.org/index.php/site/article/aaps_comments_opposing_cpt_codes_for_end-of-life_discussions/
Sample Comments from a physician:
I am a psychiatrist who practices in Wisconsin, and I object to the proposed CPT codes 99497 and 99498.
The Medicare program should not be creating incentives for patients to decline medical care. CPT codes 99497 and 99498 would apparently compensate a practitioner for obtaining consent by patients to the denial of care. This is objectionable to me as a physician and as a patient.
Particularly in the field of psychiatry, it is essential that patients can fully trust their physicians. It is unethical and detrimental for Medicare to create financial incentives for physicians to try to persuade their own patients to forgo medical care. Our government should not be trying to reward physicians and others for talking patients out of receiving medical care.
The proposed CPT codes 99497 and 99498 would be harmful to the medical profession and to patients. Please withdraw them.