Advance Care Planning Coverage

Angie SzumlinskiCompliance, Training

In 2016 Medicare launched a much-anticipated advance care planning (ACP) benefit that pays physicians to counsel patients about living wills, advance directives, and end-of-life care options. During the ACP process clinicians can help patients determine the type of care they would want in a medical crisis or at the end of life and reassure them that their preferences will be observed. However, the benefit isn’t being widely used.

Medicare pays $86 for 16 to 30 minutes of ACP as a stand-alone service at any outpatient visit, subject to a 20% co-payment, with an additional $75 for up to a half-hour of additional counseling. To encourage ACP prior to a serious illness, the co-payment is waived if the service occurs during an annual wellness visit. Physicians, nurse practitioners, and physician assistants of any specialty may bill for the service, and they should offer a patient or surrogate an opportunity to decline the discussion. Medicare does not require that counseling lead to the completion of an advance directive, a legal document often called a “living will”.

Given the public interest in ACP, which COVID-19 has boosted in some regions, the researchers said health care organizations should address barriers to ACP in the outpatient setting, where it can occur before health issues arise.

Despite Big Buildup, Few Benefit From Medicare’s Advance Care Planning Coverage (JAMA Network, May 26, 2021)

Wouldn’t it be a perfect world if prior to someone needing “our care” in a rehab center or assisted living community, that they would have already had these discussions with their physicians? Whereupon admission, unsolicited, they hand you their ACP documents for your files? Ah yes, that would be wonderful! Let’s hope this new drive to encourage ACP participation makes a difference for our residents and staff! Stay informed, stay well and stay tuned!