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New data from the Centers for Medicare and Medicaid Services (CMS) showed that more than 570,000 beneficiaries, roughly 1% of the Medicare population, made use of advance care planning appointments in 2016, the first year such services were billable. This exceeded the American Medical Association’s projections by almost 100%.
We are encouraged by these numbers. Earlier this year, the CMS released data showing that 220,000 people had participated in advance care planning counseling with nearly 14,000 providers in the first six-months of 2016. The rate of claims accelerated in the second half of the year, likely due to providers learning more about the new billing procedures. Findings from an April 2016 National Survey of physicians indicated that most had not yet billed Medicare for such services due to the lack of formal systems for assessing patient wishes and electronic health records (EHRs) to document them.
While the number of beneficiaries more than doubled, the provider base grew more modestly, from 14,000 to 22,000, suggesting that there is an expanding core group of early adopters offering these services to an increasingly interested population of patients. These conversations are billed in 30 minute increments, with the duration of claimed services averaging 30.8 minutes throughout the year, suggesting that that fears of the code’s potential for abuse were overstated. A total of $93 million in charges were billed to Medicare, though the CMS notes that more than half of that was covered by patient deductibles and coinsurance. Addressing this potential barrier is one reason the recently introduced Patient Choice and Quality Care Act (PCQCA) of 2017 (S. 1334) would remove any patient copays for this important activity.
Advance care planning conversations themselves are not new. However, according to a recently released review by the Perelman School of Medicine at the University of Pennsylvania, only a third of Americans have completed some form of advance directive and this number has not increased over the past times. But patient interest in having these conversations has historically been high; a 2014 report by the Institute of Medicine found that 89% of those surveyed believed providers should discuss these issues with patients (though only 17% had had discussions themselves).
C-TAC continues to support the use and expansion of these codes through ongoing provider education and policy advocacy efforts, such as the Patient Choice and Quality Care Act (PCQCA) of 2017 (S. 1334), which also allows social workers to bill Medicare for advance care planning services and the Medicare Choices Empowerment and Protection Act of 2017 H.R. 3181, which offers a one-time $75 payment to beneficiaries who participate in advance care planning. Furthermore, C-TAC supports the expansion of structural supports for the use of these codes, including formalized patient assessment procedures and adequate EHRs for their documentation.