Advance care planning in Medicare: an early look at the impact of new reimbursement on billing and clinical practice

Abstract

ObjectiveIn this study, we examined the US Medicare programme’s (government-funded social insurance for the elderly or disabled) new reimbursement for advance care planning (ACP) that began on 1 January 2016. This single-centre study addressed whether clinicians who have ACP conversations with patients will use the new reimbursement code and if the new reimbursement is successful at motivating clinicians to have more ACP conversations with patients.MethodsThis is a multimethod study. To gain a general sense of ACP practice and code visibility, we first surveyed 493 clinicians in a large academic medical centre (20% response rate). Then, for more in-depth answers and to illuminate the reasons behind survey findings, we conducted semistructured interviews with 28 physicians.ResultsWe found that while clinicians are open to using the reimbursement codes, organisational barriers such as low visibility and documentation make it difficult for clinicians to bill for ACP. Moreover, structural and professional factors have rendered Medicare’s ACP reimbursement largely ineffective at motivating healthcare providers to perform more ACP conversations during the first 3 months of this policy.ConclusionsIt does not appear that Medicare’s reimbursement of ACP has made a significant, direct impact on ACP billing or practice during the policy’s first 90 days. However, there is a symbolic role that this change can serve, and the policy could have more impact as its existence becomes more widely known. Barriers to ACP that we identify should be addressed directly to expand the use of ACP.