Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
J Am Geriatr Soc. 2023 Oct;71(10):3237-3243. doi: 10.1111/jgs.18476. Epub 2023 Jun 19.
The Centers for Medicare & Medicaid Services (CMS) began to reimburse clinicians for advance care planning (ACP) discussions, effective January 1, 2016. We sought to characterize the timing and setting of first-billed ACP discussions among Medicare decedents to inform future research on ACP billing codes.
Using a random 20% sample of Medicare fee-for-service beneficiaries aged 66 years and older who died in 2017-2019, we described the timing (relative to death) and setting (inpatient, nursing home, office, or outpatient with or without Medicare Annual Wellness Visit [AWV], home or community, or elsewhere) of the first-billed ACP discussion for each beneficiary.
Our study included 695,985 decedents (mean [SD] years of age, 83.2 [8.8]; 54.2% female); the proportion of decedents who had at least one billed ACP discussion increased from 9.7% in 2017 to 21.9% in 2019. We found that the proportion of first-billed ACP discussions held during the last month of life decreased from 37.0% in 2017 to 26.2% in 2019, while the proportion of first-billed ACP discussions held more than 12 months before death increased from 11.1% in 2017 to 35.2% in 2019. We also found that the proportion of first-billed ACP discussions held in the office or outpatient setting along with AWV increased over time (from 10.7% in 2017 to 14.1% in 2019), while the proportion held in the inpatient setting decreased (from 41.7% in 2017 to 38.0% in 2019).
We found that with increasing exposure to the CMS policy change, uptake of the ACP billing code has increased; first-billed ACP discussions are occurring sooner before the end-of-life stage and are more likely to occur with AWV. Future studies should evaluate changes in ACP practice patterns, rather than only an increasing uptake in ACP billing codes, following the policy implementation.
自 2016 年 1 月 1 日起，医疗保险和医疗补助服务中心（CMS）开始为临床医生提供预先护理计划（ACP）讨论报销。我们旨在描述 Medicare 死者中首次计费 ACP 讨论的时间和地点，以为未来的 ACP 计费代码研究提供信息。
使用 Medicare 按服务收费受益人中随机抽取的 20%的 66 岁及以上年龄的样本，我们描述了每位受益人的首次计费 ACP 讨论的时间（相对于死亡）和地点（住院、疗养院、办公室或门诊，是否有 Medicare 年度健康检查 [AWV]、家庭或社区或其他地方）。
我们的研究包括 695985 名死者（平均[标准差]年龄，83.2[8.8]；54.2%为女性）；至少进行一次计费 ACP 讨论的死者比例从 2017 年的 9.7%增加到 2019 年的 21.9%。我们发现，在生命的最后一个月进行的首次计费 ACP 讨论的比例从 2017 年的 37.0%下降到 2019 年的 26.2%，而在死亡前 12 个月以上进行的首次计费 ACP 讨论的比例从 2017 年的 11.1%增加到 2019 年的 35.2%。我们还发现，随着时间的推移，在办公室或门诊与 AWV 一起进行的首次计费 ACP 讨论的比例有所增加（从 2017 年的 10.7%增加到 2019 年的 14.1%），而在住院环境中进行的比例有所下降（从 2017 年的 41.7%下降到 2019 年的 38.0%）。
我们发现，随着 CMS 政策变化的不断增加，ACP 计费代码的采用率有所提高；首次计费 ACP 讨论在生命末期之前提前进行的情况越来越多，并且更有可能与 AWV 一起进行。在政策实施后，未来的研究应该评估 ACP 实践模式的变化，而不仅仅是 ACP 计费代码的采用率不断提高。
