New report urges sweeping change to end-of-life care system in U.S.

All-encompassing change to the U.S.’s end-of-life care system is urgently needed, according to a new report, “Dying in America,” from the Institute of Medicine (IOM).

“Many people nearing the end of life may not be physically or mentally capable of making their own care decisions. In addition, family members and clinicians may not be able to accurately guess what a person’s care preferences may be. Therefore, advance care planning is critically important to ensure that patients’ goals and needs are met,” the report says.

The IOM issued five recommendations for improving end-of-life care:

Focused patient-centered, family-oriented care delivery;

Improved physician-patient communication and advanced-care planning;

Increased palliative care training and professional development;

Reformed payment systems to encourage planning conversations; and

Increased public education and patient engagement.

The recommendations to have the Centers for Medicare and Medicaid Services (CMS) reimburse for end-of-life discussions is already moving forward after years of getting bogged down in politics.

The American Medical Association recently submitted reimbursement codes to CMS for the discussions. If approved by CMS in November, they will be included in the 2015 physician fee schedule.

The latest effort grew out of standard operating procedure as opposed to the ill-fated attempt in 2009 to provide for reimbursement under the Affordable Care Act (ACA), according to the AMA.

READ: Prognosis on End-of-Life Care

Three bills have also been introduced in the last two years that would change the end-of-life care process.

The Care Planning Act (S. 1439) was introduced in August 2013 by by Sen. Mark R. Warner (D-Va.) and Sen. Johnny Isakson (R-Ga.). It is “designed to give people with serious illness the freedom to make more informed choices about their care, and the power to have those choices honored … It offers a patient centered approach to preplanning for care,” according to Warner’s office.

H.R. 1173 introduced in March 2013 by Rep. Earl Blumenauer (D-Ore.) would provide Medicare and Medicaid coverage for voluntary consultations between patients and their doctors about advance care planning, as well as ensure that an individual’s electronic health record is able to display any current advance directive.

In April, Senators Tom Coburn (R-OK) and Chris Coons (D-DE) introduced S. 2240, the Medicare Choices Empowerment and Protection Act, a bill to encourage Medicare beneficiaries to create advance directives.