Medicare Reimbursement for Advance Care Planning and Presence of Advance Directives: Evidence from Health and Retirement Study- Medicare Linked Data

• In Event: Comparative Insights on Care Provision, Access, and Costs in Aging and Chronic Illness

Abstract

Advance Care Planning (ACP) is the process of discussing and recording patient preferences for goals of care. In 2016, the Centers for Medicare & Medicaid Services (CMS) began paying for ACP discussions, allowing healthcare providers to be compensated for these important conversations. Our prior work finds that ACP reimbursement increases utilization of hospice services prospectively among critically ill Medicare beneficiaries. However, the mechanism underlying this relationship is not clear. We hypothesize that ACP reimbursement affects care near end of life through increasing use of advance directives (AD), including durable power of attorney and living will. This study examines the associations between receiving billed ACP services and presence of AD among Medicare beneficiaries aged 65 and older. We use nationally representative Health and Retirement Study data linked with Medicare claims from 2012-2020. We estimate multivariable logistic regressions to examine the associations between receiving any billed ACP services and presence of any durable power of attorney and living will. We find that receipt of billed ACP services is associated with significant increases in the presence of living will, after conditioning on factors that could influence provider propensity of initiating ACP conversations: age, sex, race/ethnicity, diagnosis of Alzheimer’s disease and related dementias and number of chronic conditions. ACP is not associated with the appointment of a durable power of attorney. Our findings suggest that increased adoption of living wills to document patient care preferences may be an important channel through which ACP reimbursement affects care near the end of life. 

Authors

• Zilin Cheng, University of Washington
  Presenting Author

• Jing Li, University of Washington
  Non-Presenting Co-Author