Early Utilization Patterns of the New Medicare Procedure Codes for Advance Care Planning

Assessment of First-Year Use of Medicare's Advance Care Planning Billing CodesAdvance care planning (ACP) conversations occur infrequently among patients and their health care professionals, and when they do occur, the context is often a stressful clinical situation.1,2 Advance care planning conversations that occur too late (or not at all) can result in care that is invasive, expensive, and not aligned with patients' wishes.To encourage health care professionals to initiate ACP discussions, Medicare began reimbursing for ACP services on January 1, 2016, under a separate billing code.Our study aims to characterize the first year of ACP code use and to describe beneficiary characteristics associated with receipt of ACP services.Methods | For this retrospective observational analysis, we used Medicare fee-for-service Parts A and B claims, the Medicare coverage and denominator files, and US Census Bureau data.All beneficiaries in New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) continuously enrolled in Parts A and B in 2016 were included in this sample.Beneficiaries who died during the study year were included until their death.The authors have access to Medicare claims data under an agreement between Healthcentric Advisors and the Centers for Medicare & Medicaid Services for use of these data to evaluate improvement in care quality.Institutional review board review is not required in these circumstances, per organizational policy.Our primary outcome was the number of Medicare feefor-service beneficiaries with an ACP claim in 2016.Secondary outcomes included beneficiary-level estimates of having a claim and the number of beneficiaries whose ACP service occurred during their annual wellness visit.We used χ 2 tests to compare beneficiary characteristics by ACP claim status.Using multivariable logistic regression, we identified variables associated with a beneficiary having any ACP claim, adjusting for age, sex, race/ethnicity, state of residence, dual-eligibility status (for Medicare and Medicaid), median income of resi-dence, and the presence of certain chronic conditions.Findings were considered significant at P < .05(2-sided).