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'Substantial Increase' Found in Medicare Advance Care Planning

Analysis  |  By Melanie Blackman  
   April 05, 2021

A Health Affairs study also found prevalence of annual wellness claims to be below 7.5% for all fee-for-service Medicare patient subgroups.

There was a "substantial increase" in outpatient care planning claims between 2016 to 2019, according to a Health Affairs study released Monday afternoon.

The study found that even though there was an increase in claims of newly diagnosed conditions, the fee-for-service Medicare claims had prevalence below 7.5%.

According to the study authors, 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."

Annual wellness visits used CPT codes: G0438 and G0439, while advance care planning claims used CTP code: 99497.

The study was the first study to use national claims data to analyze demographics of outpatient beneficiaries billed for advance care planning, according to the study authors.

Other key study findings include:

  • Almost half of beneficiaries receiving advance care planning received the service during an annual wellness visit, while the remaining received the service during a different outpatient visit.
  • Fewer claims during annual wellness visits were found in Black, Hispanic, Medicaid dual-eligible patients, and patients with comorbidities, due to having fewer visits overall.

"Engaging in an advance care planning conversation in a hospital … is more difficult than following through on earlier discussions among patients, providers, and, potentially, loved ones in an outpatient setting," the study authors concluded. "Expanded use of Medicare’s advance care planning billing codes offers another tool to encourage earlier advance care planning conversations between patients and providers, and particularly when billed with annual wellness visits, may help reduce racial/ethnic disparities in these conversations."

Related: Advance Care Planning: A Quality and Patient Safety Must

Related: Physicians Collected More for Likely Surprise Bills Compared to Other Cases

Melanie Blackman is the strategy editor at HealthLeaders, an HCPro brand.


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