The U.S. Centers for Medicare & Medicaid Services (CMS) has proposed new pathways to support family caregivers for patients with serious illnesses.
The agency’s 2024 physician fee schedule proposed rule contains a number of provisions related to caregiver assistance, health equity, interdisciplinary care and social determinants of health.
“CMS is proposing coding and payment for several new services to help underserved populations, including addressing unmet health-related social needs that can potentially interfere with the diagnosis and treatment of medical problems,” the agency indicated in a fact sheet. “First, CMS is proposing to pay for certain caregiver training services in specified circumstances, so that practitioners are appropriately paid for engaging with caregivers to support people with Medicare in carrying out their treatment plans.”
Annually, nearly 53 million people assist family members or other loved ones in maintaining health, quality of life, and independence due to aging, disability, or a chronic health condition, according to the Administration for Community Living (ACL).
For 2024, CMS is proposing payment to practitioners who train and involve caregivers in supporting patients with certain diseases or illnesses. These payments would cover services by a physician, non-physician practitioner or therapist under an individualized treatment plan.
Through its annual physician fee schedule rule, Medicare establishes payment for the services of physicians and other professionals — including palliative care — provided in physician offices, hospitals, ambulatory surgical centers, clinical laboratories, skilled nursing facilities, hospices, outpatient dialysis facilities, patient homes and other post-acute care settings.
The 2024 proposal also contained components designed to expand community health integration services, including separate coding and payment systems. It also included proposed improvements to patient navigation services, as well as coding and payment for social determinants of health risk assessments.
The stress and financial burden of caregiving can be a barrier to hospice utilization. Many hospice patients would not be able to receive care in their homes unless their family and loved ones are able to care for them.
Terminally ill patients who lack care from family or friends are often less likely to choose hospice, a 2020 study found.
Even when a caregiver is present, that person may be elderly or ill themselves, or unable to be in the home around the clock due to work or other obligations. Nearly 20% of unpaid caregivers are elderly, frail, or chronically ill themselves, according to the U.S. Centers for Disease Control & Prevention (CDC).
Moreover, roughly three-quarters of family caregivers spend upwards of $7,200 annually for costs related to caring for loved ones, AARP reported. For many caregivers, this amounts to 26% of their income, according to AARP.
Replacing the work of family caregivers with paid services would cost an estimated $470 billion each year, ACL indicated.
CMS’ proposed caregiver support follows an executive order issued in April by President Joe Biden that contained a number of actions related to health and education.
“Without adequate resources, family caregiving can affect caregivers’ own physical and emotional health and well-being and contribute to financial strain,” the order indicated. “These negative consequences are felt most acutely by women, who make up nearly two-thirds of family caregivers and drop out of the workforce at a rate three times higher than men.”