By Jill Drachenberg, Editor, AHC Media
Advance care planning discussions with primary care physicians are on the rise, spurred by billing codes from the Centers for Medicare & Medicaid Services (CMS), according to new data from the agency.
The CMS billing codes went into effect in January 2016. Between January and June, 14,000 providers billed for advance care planning discussions with 223,000 patients — a billing total of $35 million. Full-year data on the discussions will be released this summer.
Physicians use advance care planning discussions to inform Medicare patients of their options for end-of-life care and determine what plans of care best suit their wishes if patients are unable to speak for themselves. Detractors of the CMS rule fear that such discussions could lead to “death panels” and life-ending, rather than life-sustaining, treatments.
There is evidence that advance care planning can lower skilled nursing facility (SNF) readmission rates and reduce healthcare costs. Frederick Regional Health System in Frederick, MD, implemented an advance care planning pilot study with patients discharged to SNFs in 2015. Hospital readmission rates for patients discharged without advance directive education was 21%, and 12.5% for patients with advance directives. Patients with advance directives also saw 66% reduction in healthcare costs, and fewer healthcare encounters.
“We also saw an increase to 43 days for patients’ days in hospice among the advance directives group,” Jackie Dinterman, MA, LBSW, ACM, manager of care management for Frederick Regional Health System, told Case Management Advisor. “For those without an advance directive, the average days in hospice care was 14 days — so they didn’t receive a lot of benefits that you can get from the hospice program.”
For more information on the advance directive pilot study and education efforts, see the March issue of Case Management Advisor. Medical Ethics Advisor also provides extensive coverage of advance care planning methods.