Utilization of ACP CPT codes among high-need Medicare beneficiaries in 2017: A brief report.

Autor: Reich AJ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America., Jin G; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America., Gupta A; 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., Kim D; Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America., Lipstiz S; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America., Prigerson HG; Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, United States of America., Tjia J; Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America., Ladin K; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America.; Research on Ethics, Aging, and Community Health (REACH), Tufts University, Boston, MA, United States of America., Halpern SD; Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, United States of America.; The Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America., Cooper Z; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America., Weissman JS; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Feb 05; Vol. 15 (2), pp. e0228553. Date of Electronic Publication: 2020 Feb 05 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0228553
Abstrakt: Importance: 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.
Objective: To compare rates of billed ACP discussions among a cohort of high-need Medicare beneficiaries with the non-high-needs Medicare population.
Design: 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.
Setting: Nationally representative FFS Medicare 20% sample.
Participants: 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.
Exposure: Receipt of a billed ACP discussion, CPT codes 99497 or 99498.
Main Outcome and Measure: 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.
Results: 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).
Conclusions and Relevance: 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.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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