Study finds low prevalence of advance care planning among Medicare beneficiaries

A male primary care doctor and his patient sit across from each other talking. Both are wearing masks
A new study found the prevalence of advance care planning Medicare claims is low among beneficiaries, with a low reimbursement rate a potential reason. (Getty/Geber86)

A new study found a low prevalence of physicians having advance care planning talks with their patients despite a steady growth in Medicare claims.

The study, published Monday in the journal Health Affairs, found a lack of training has been a barrier for doctors to engage in such care planning conversations, which aim to give patients medical care consistent with their wishes and values as well as discuss end-of-life care issues.

“Increasing rates of advance care planning are widely recognized as an important focus of health system reform,” the study said.

Medicare started to reimburse providers for advance care planning starting in 2016 as part of a beneficiary’s annual wellness visit, and, predictably, the number of claims has grown steadily each year since. While there were 17,000 beneficiaries with advance care claims in 2017, the number ballooned to just under 120,000 per month in 2019.

However, the prevalence of advance care planning remains low.

“Fewer than 7.5% of beneficiaries who experienced recent onset of any of the conditions studied here or who died within the year had an advance care planning claim,” the study said.

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There are several reasons for this figure, chief among them that physicians' offices have “not been a common venue for discussions of end-of-life care, a key focus of advance care planning conversations,” researchers added.

While 60% of Medicare beneficiaries who were 65 years or older reported having an end-of-life conversation, only 27% of those did it in a physician's office.

“Because end-of-life conversations have primarily occurred in conjunction with estate planning, sruveys have found socioeconomic disparities in end-of-life planning,” the study said. “This is concerning, as patients likely have questions about end-of-life care that physicians are better equipped to answer than lawyers.”

The study outlines several barriers to expansion of advance care planning prevalence. Part of the issue is physicians may not know about the billing code.

Another major problem is that the current Medicare rate of $80 to $86 for the first 30 minutes of an advance care planning talk is considered too low “to adopt widespread adoption,” the study added.

“One survey of physicians in early 2016 found that 75% felt the new advance care planning benefit made them more likely to talk about the subject, but another early survey found that just 16% of primary care physicians and 4.4% of specialists said reimbursement was enough to incentivize advance care planning,” Health Affairs said.

The study suggested that Medicare consider a higher reimbursement rate for specialists and potentially increase it among primary care physicians to spur more adoption.

Physicians also don’t have much training in end-of-life conversations, with researchers pointing to a 2016 survey that found 68% of them had no training in such conversations.