Makayla K. Palmer (
Mireille Jacobson is an associate professor at the Leonard Davis School of Gerontology and codirector of the Aging and Cognition Program at the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, in Los Angeles, California.
Health Aff (Millwood). 2021 Apr;40(4):613-621. doi: 10.1377/hlthaff.2020.01895.
In 2016 fee-for-service Medicare began reimbursing physicians for advance care planning conversations with enrollees during outpatient visits and waived the copayment for advance care planning when it was part of the Medicare annual wellness visit. Advance care planning is intended to help providers treat patients in ways consistent with their wishes and may also reduce unnecessary health care use and spending. Examining fee-for-service Medicare claims, we found a substantial increase in outpatient advance care planning claims between 2016 and 2019, although prevalence remained below 7.5 percent for all patient subgroups analyzed. Roughly half of beneficiaries with advance care planning claims received the service at an annual wellness visit; the remainder received it at a different outpatient visit. Among those with claims, Black, Hispanic, and Medicaid dual-eligible patients and patients with comorbidities were less likely to have a claim at an annual wellness visit, largely because they have fewer such visits overall. Medicare's annual wellness visits offer the potential to expand enrollees' access to advance care planning at no expense to them, in advance of serious illness, and to populations less likely to undertake advance care planning generally.
2016 年，按服务收费的医疗保险开始向医生报销门诊就诊时与参保人进行的预先护理计划谈话的费用，并免除预先护理计划的共付额，只要它是医疗保险年度健康检查的一部分。预先护理计划旨在帮助提供者以符合患者意愿的方式治疗患者，也可能减少不必要的医疗保健使用和支出。通过审查按服务收费的医疗保险索赔，我们发现 2016 年至 2019 年门诊预先护理计划索赔大幅增加，尽管所有分析的患者亚组的流行率仍低于 7.5%。大约一半有预先护理计划索赔的受益人在年度健康检查中获得了这项服务；其余的则在不同的门诊就诊中获得。在有索赔的人当中，黑人和西班牙裔、同时参加医疗补助和医疗保险的双重保险人和患有合并症的人在年度健康检查中获得索赔的可能性较小，主要是因为他们总体上进行此类检查的次数较少。医疗保险的年度健康检查为参保人提供了在没有费用的情况下提前获得预先护理计划的机会，在患病之前，并为一般不太可能进行预先护理计划的人群提供机会。
