More Seniors Will Spend Their Final Days at Home

Medical Society Advocates for Care Planning

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THE CHICAGO Medical Society was instrumental in the creation of advanced care planning codes. Several CMS members served on a team of physicians with expertise in this area in order to help the Illinois State Medical Society prepare a formal application and present a case to the CPT Editorial Panel.

Now that the codes have been added and assigned fees associated with providing services, CMS is encouraging study into the use of Current Procedural Terminology (CPT) codes 9949 and 99498. The goal is to understand the barriers to physicians and patients having discussions about advanced care planning, CMS wrote in its resolution to the American Medical Association (AMA).

Often advanced care planning includes an introduction to concepts and a discussion with patients face-to-face, and it might also include family members or surrogates. However, the complexity of advanced care planning and completion of an advanced directive may require multiple providers over multiple visits (physician,nurse-practitioner or physician’s assistant, social worker or case manager).

CMS is requesting the AMA to assess the use of advanced care planning codes 99497 and 99498. Additionally, CMS is urging AMA to enable use of these codes when sufficient time and effort is spent in face-to-face contact with patients and families and when spread out over multiple clinical visits to satisfy the time requirements. These discussions are complex and need to take place over extended periods.

Healthcare providers are planning to focus near-term investment in home healthcare and models that support it
By Chad Beste and Jim Watson

SENIORS—the fastest-growing U.S. age demographic—are poised to make up more than 20% of the population by 2029. And they’re moving to the driver’s seat of care. Now, they’re demanding elder care more rooted in empathy and designed on their own terms—and in their own homes.

Historically, healthcare providers have fallen into a trap of medicalizing old age so much that they recommend continued treatments even if the ultimate outcome remains the same. Physicians have been hesitant to have difficult conversations with their patients about realistic end-of-life care options. Important questions— like what metrics patients use to measure quality of life—have gone unasked.

Now, the winds are changing direction. Providers are getting more comfortable with having productive, uncomfortable conversations with their patients about their realistic end-of-life care goals. They’re talking with patients to determine whether additional care makes sense, or whether the focus should be on simply maximizing the comfort in their final days. Simultaneously, seniors’ expectations about their own care is changing. They want to remain in their homes and avoid unpleasant, and often traumatic, medical procedures—even if they may prolong their lives.

Providers’ near-term investment plans are mirroring this trend.

In BDO’s Candid Conversations on Elder Care, we worked with NEJM Catalyst to survey healthcare executives, clinical leaders and clinicians at nearly 500 organizations about the outlook for elder care investment and innovation as they work to meet the changing needs of the fastest-growing U.S. age demographic.

As our study shows, we’ll see greater investment in home health, palliative care and geriatrics, along with a move away from facilityfocused models. Part of that includes improved training for physicians to have these important conversations about end-of life care. Another piece of that means hiring or training more onstaff geriatric caretakers to identify health risk factors for seniors before they evolve into greater health problems.

And there’s yet another, blurrier piece of the puzzle that must be considered.

With the continued convergence of the healthcare supply chain, new types of entities—for which we don’t yet have names—will form, and providers will need to create and fill new types of roles. The healthcare organization of the future will rely more on technologies like robotics, virtual reality, telemedicine and wearables. Healthcare’s workforce will need to evolve to meet the new risks associated with such technologies and to fully capitalize on them in a way that maximizes high-quality, safe innovation around patient care.

Chad Beste and Jim Watson are healthcare advisory partners in the Rosemont office of BDO USA, LLP, an international accounting, tax, audit and consulting company.