End-of-Life Care Funding Prioritized by CMS

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The final Measure Development Plan, authorized by the Medicare Access and CHIP Reauthorization Act of 2015, acknowledges the need for more and better measures to define quality in end-of-life and palliative care.

On May 2, the Centers for Medicare & Medicaid Services (CMS) released a final plan that outlines how the agency intends to use $75 million for the development of measures to assess the quality of clinical care provided by physicians under Medicare. Earlier this year, The Pew Charitable Trusts submitted comments urging the agency to prioritize the development of metrics that could assess the quality of care given to individuals facing chronic, life-limiting illness and those who are near the end of their lives. While 80 percent of individuals who die every year in the U.S. are on Medicare, there are relatively few measures that assess the care provided near the end of life. The need for new measures will only increase as the number of older adults in the U.S. continues to rise.

The final Measure Development Plan, authorized by the Medicare Access and CHIP Reauthorization Act of 2015, acknowledges the need for more and better measures to define quality in end-of-life and palliative care. Palliative care refers to comprehensive management of the physical, psychological, emotional, and spiritual needs of patients with chronic, debilitating, or life-threatening illness, and also supports their families. The plan specifically identifies shared decision-making and personal preferences as key topics for the development of metrics. CMS intends to work with a broad range of specialty societies representing palliative and end-of-life professionals to develop the measures laid out in the plan.

In addition to specialty-specific measures, CMS will explore amending the current patient experience survey. This survey—and others like it administered across different settings of care, including hospitals and nursing homes—reflects an individual’s interaction with his or her physicians and experience with clinical setting. The survey contains questions such as whether he or she was treated with respect. The CMS plan proposes incorporating additional questions, such as whether the provider acted in accordance with the patient’s preferences, or whether family members participated in care discussions. For individuals near the end of their lives, these topics are extremely important because many individuals are often unable to communicate their needs during treatment discussions, and family members must often take on the critical role of advocate. CMS intends to “partner with patients/caregivers throughout the measure development process to focus on what is best for patients, and to integrate personal goals and preferences into appropriate measures.” This effort to include and elevate the experience of patients and their families is a welcome shift in quality measure development that has, up until now, been dominated by clinical experts. 

Pew commends the work of CMS in developing a more person- and family-centered health care system and will continue to work with the agency to identify meaningful metrics for people facing the end of their lives.

Lee Goldberg directs The Pew Charitable Trusts’ improving end-of-life care project.