Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America.
Department of Health Policy, College of Global Public Health, New York University, New York, NY, United States of America.
PLoS One. 2020 Feb 5;15(2):e0228553. doi: 10.1371/journal.pone.0228553. eCollection 2020.
Medicare beneficiaries with high medical needs can benefit from Advance Care Planning (ACP). Medicare reimburses clinical providers for ACP discussions, but it is unknown whether high-need beneficiaries are receiving this service.
To compare rates of billed ACP discussions among a cohort of high-need Medicare beneficiaries with the non-high-needs Medicare population.
Retrospective analysis of Medicare Fee-for-Service (FFS) claims in 2017 comparing high-need beneficiaries (seriously ill, frail, ESRD, and disabled) with non-high need beneficiaries.
Nationally representative FFS Medicare 20% sample.
Medicare beneficiaries were assigned to one of the following classifications: seriously ill (65+), frail (65+), seriously ill & frail (65+); non-high need (65+); end stage renal disease (ESRD) or disabled (<65). All participants had data available for years 2016-2017.
Receipt of a billed ACP discussion, CPT codes 99497 or 99498.
Rates of billed ACP visits were compared between high-need patients and non-high-need patients. Rates were adjusted for the 65+ population for sex, age, race/ethnicity, Charlson comorbidity index, Medicare/Medicaid dual eligibility status, and Hospital Referral Region.
Among the 65+ groups, those most likely to have a billed ACP discussion included seriously ill & frail (5.2%), seriously ill (4.2%), and frail (3.3%). Rates remained consistent after adjusting (4.5%, 4.0%, 3.1%, respectively). Each subgroup differed significantly (p < .05) from non-high need beneficiaries (2.3%) in both unadjusted and adjusted analyses. Among the <65 high need groups, the rates were 2.7% for ESRD and 1.3% for the disabled (the latter p < .05 compared with non-high needs).
While rates of billed ACP discussions varied among patient groups with high medical needs, overall they were relatively low, even among a cohort of patients for whom ACP may be especially relevant.
有高医疗需求的 Medicare 受保人可以从预先医疗指示（ACP）中受益。Medicare 为 ACP 讨论向临床医生提供报销，但尚不清楚高需求受保人是否获得了这项服务。
比较一组高需求 Medicare 受保人与非高需求 Medicare 人群中计费 ACP 讨论的比率。
对 2017 年 Medicare 按服务收费（FFS）索赔进行回顾性分析，比较高需求受保人（重病、体弱、终末期肾病和残疾）与非高需求受保人。
全国代表性的 FFS Medicare 20%样本。
将 Medicare 受保人分为以下类别之一：重病（65+）、体弱（65+）、重病和体弱（65+）；非高需求（65+）；终末期肾病（ESRD）或残疾（<65）。所有参与者在 2016-2017 年均有数据可用。
计费的 ACP 讨论，CPT 代码 99497 或 99498。
比较高需求患者和非高需求患者之间计费 ACP 访问的比率。根据性别、年龄、种族/民族、Charlson 合并症指数、Medicare/Medicaid 双重资格状况和医院转诊区域，对 65+人群进行了调整。
在 65+组中，最有可能进行计费 ACP 讨论的是重病和体弱（5.2%）、重病（4.2%）和体弱（3.3%）。调整后结果保持一致（分别为 4.5%、4.0%和 3.1%）。在未经调整和调整分析中，每个亚组与非高需求受保人（2.3%）均有显著差异（p<0.05）。在<65 岁的高需求组中，ESRD 的比率为 2.7%，残疾的比率为 1.3%（后者与非高需求相比差异有统计学意义 p<0.05）。
尽管高医疗需求患者群体的计费 ACP 讨论率存在差异，但总体而言，即使在 ACP 可能特别相关的患者队列中，这些比率也相对较低。
