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Advance care planning in Medicare: an early look at the impact of new reimbursement on billing and clinical practice
  1. Gawin Tsai1 and
  2. Donald H Taylor2
  1. 1 Duke University, Duke Clinical Research Institute, Durham, North Carolina, USA
  2. 2 Duke University, Sanford School of Public Policy, Durham, North Carolina, USA
  1. Correspondence to Dr Gawin Tsai, Duke University, Duke Clinical Research Institute, 2400 Pratt Street #6551, Durham 27705, North Carolina, USA; gawint{at}


Objective In this study, we examined the US Medicare programme’s (government-funded social insurance for the elderly or disabled) new reimbursement for advance care planning (ACP) that began on 1 January 2016. This single-centre study addressed whether clinicians who have ACP conversations with patients will use the new reimbursement code and if the new reimbursement is successful at motivating clinicians to have more ACP conversations with patients.

Methods This is a multimethod study. To gain a general sense of ACP practice and code visibility, we first surveyed 493 clinicians in a large academic medical centre (20% response rate). Then, for more in-depth answers and to illuminate the reasons behind survey findings, we conducted semistructured interviews with 28 physicians.

Results We found that while clinicians are open to using the reimbursement codes, organisational barriers such as low visibility and documentation make it difficult for clinicians to bill for ACP. Moreover, structural and professional factors have rendered Medicare’s ACP reimbursement largely ineffective at motivating healthcare providers to perform more ACP conversations during the first 3 months of this policy.

Conclusions It does not appear that Medicare’s reimbursement of ACP has made a significant, direct impact on ACP billing or practice during the policy’s first 90 days. However, there is a symbolic role that this change can serve, and the policy could have more impact as its existence becomes more widely known. Barriers to ACP that we identify should be addressed directly to expand the use of ACP.

  • advance care planning
  • health policy
  • palliative medicine

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  • Contributors Study concept and design: GT and DHT. Acquisition, analysis, or interpretation of data: GT. Drafting of manuscript: GT. Critical revision of manuscript for important intellectual content: GT and DHT. Obtained funding: DHT.

  • Funding The project described was supported by Grant Number 1C1CMS331331 from the department of health and human services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the US Department of Health and Human Services or any of its agencies.

  • Competing interests None declared.

  • Ethics approval Duke Medicine Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.