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Department of Population and Quantitative Health Sciences

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Geriatrics | Health Communication | Health Policy | Health Services Administration | Health Services Research


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 and 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 and 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.


Medicare, Chronic kidney disease, Frailty, Disabilities, End of life care, Health care policy, Health services research, Verbal communication

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Copyright: © 2020 Reich et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI of Published Version



Reich AJ, Jin G, Gupta A, Kim D, Lipstiz S, Prigerson HG, Tjia J, Ladin K, Halpern SD, Cooper Z, Weissman JS. Utilization of ACP CPT codes among high-need Medicare beneficiaries in 2017: A brief report. PLoS One. 2020 Feb 5;15(2):e0228553. doi: 10.1371/journal.pone.0228553. PMID: 32023311; PMCID: PMC7001931. Link to article on publisher's site

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PloS one

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.