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New Data on ACP Billing Codes Use Shows Significant Increases

C-TAC has obtained CMS data for the full calendar year 2017 for the Advance Care Planning (ACP) billing codes. This is the second full year of data for these codes and they show significant increases vs 2016.

Calendar 2017 vs 2016 ACP Claims

*Calculated using 2016 calendar year data for total Medicare beneficiaries as 2017 enrollment not yet available

Financial Data on CY 2017 vs 2016 ACP Billing

For calendar year 2017 period, bills were submitted for a total of 974,168 different Medicare beneficiaries. This represents just less than 2% of all Medicare beneficiaries and is up 70% from the year before. The total value of ACP billing in 2017 was $176.8 million, up almost 70% vs 2016. Further findings:

  1. Almost 50% more providers billed for these services in 2017 and had them with more beneficiaries. The 33,869 providers filing claims in 2017 is 48% higher than the 22,864 in 2016. The number of beneficiaries per provider also rose from 25.1 to 28.8.
  2. The amount of time for these services is holding steady at around 31 minutes. The latest data showed an average of 31.i minutes vs. 30.8 minutes for the previous year, a tiny increase.
  3. The rate of Medicare reimbursement dropped. Only 40.9% of the claims filed in 2017 were reimbursed vs. 47% for the previous year. This difference represents growing patient co-pays and deductibles for these services.

Indicated Actions

  1. The codes are still relatively new and It likely takes time for new codes and their procedures to become part of regular clinical practice. However, given that less than 2% of beneficiaries received such billable services, it’s also possible that some providers are still unware of them or unable to use them in practice. Providers continue to express concern that it is difficult to work these into packed clinical schedules, even when all involved agree that they are needed. Therefore, the advanced illness field should be actively encouraging ACP conversations and billing for them since this is an important activity and usage of the codes confirms that to the Administration.
  2. Providers continue to need help learning how to best have ACP conversations. Respecting Choices is one of the proven vehicles for such training and has materials to support learning to have conversations across the continuum of an illness.

The gap between the amount billed and paid out highlights that future policy should address and, ideally reduce, copays and deductibles for these services. ACP can be challenging for both clinicians and patients and any barriers to it should be removed. Examples of legislative efforts to do so include the Patient Quality and Care Act, which removes such copays, and the Medicare Choices Act, which would actually provide a one-time payment of $75 to Medicare beneficiaries to participate in this process.

 

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1 Comment

  1. Deborah Love on November 15, 2018 at 6:27 pm

    Your assessment that providers have a difficult time fitting these conversations into a busy patient load is accurate – especially given the CMS reimbursement. (They can bill for three patient visits during this 30 min. time).
    Rather than paying patients to engage in the conversation, a better strategy would be expanding who can bill for these conversations. There is a growing body of work demonstrating that nurses and social workers are equally if not more effective in conducting these conversations, with notable outcomes. I hope C-TAC will include this expansion in their advocacy agenda.

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