Clinician Use of Advance Care Planning Billing Codes among Privately Insured Patients in 2016.
Clinician Use of Advance Care Planning Billing Codes among Privately Insured Patients in 2016.
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2016 年临床医生在私人保险患者中使用预先护理计划计费代码。
DOI：
10.1089/jpm.2019.0285
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发表时间：
2019
影响因子：
2.8
通讯作者：
Harhay,MichaelO
中科院分区：
文献类型：
--
作者：
Ashana,DeepshikhaC;Halpern,ScottD;Umscheid,CraigA;Kerlin,MeetaPrasad;Harhay,MichaelO
尊敬的编辑：2016年1月，医疗保险和医疗补助服务中心推出了两个程序代码，允许临床医生为提前护理计划(ACP)开具账单。1在这项研究中，我们描述了2016年临床医生在其私人保险患者中使用ACP代码的模式。我们使用Optus©Clinformatics®数据集市进行了回溯性队列分析，其中包含美国一家健康保险公司1370万名成员的商业和联邦医疗保险优势索赔。我们包括2015年和2016年有医疗保险的患者，并根据包含代码99497或99498的索赔确定临床医生为ACP开具账单。我们发现，在991,064名临床医生中，只有7139名(0.7%)在2016年提交了ACP索赔。每名临床医生在ACP账单上遇到ACP的中位数为2次(四分位数范围1-6)。尽管初级保健临床医生提交了所有ACP索赔的69.0%，但姑息和老年内科医生使用该代码的比例最高(分别为12.4%和8.8%)(表1)。虽然82.5%的ACP索赔是在门诊提交的，但姑息治疗临床医生在住院比在门诊环境中提交的ACP索赔更多(分别为72.7%和6.8%)。即使在肿瘤学家和肾病学家等经常护理重病患者的专家中，代码的使用也很少。在我们机构，这项服务的平均报销是100美元，对于能够为输液、透析和其他高收入服务收费的医生来说，这可能是一个不充分的激励。事实上，姑息治疗医生的采用率最高，他们同样照顾许多重病患者，但他们使用更有利可图的账单代码的机会通常较少。或者，对代码的早期了解可能是
Dear Editor: In January 2016, the Centers for Medicare and Medicaid Services launched two procedure codes that allow clinicians to bill for advance care planning (ACP). 1 In this study, we describe patterns of ACP code use by clinicians among their privately insured patients in 2016. We performed a retrospective cohort analysis using the Optum© Clinformatics® Data Mart, which contains commercial and Medicare Advantage claims for 13.7 million members of a health insurer in the United States. We included patients with medical coverage in 2015 and 2016, and we identified clinicians billing for ACP based on claims containing code 99497 or 99498. We found that among 991,064 clinicians, only 7139 (0.7%) submitted an ACP claim in 2016. The median number of ACP encounters per clinician billing for ACP was 2 (interquartile range 1–6). This may be due to limited opportunities for ACP among their patients, or inconsistent use of a novel billing code that has not yet been integrated into their routine practice.Although primary care clinicians submitted 69.0% of all ACP claims, code use was highest among palliative and geriatric medicine physicians as a proportion of total clinicians within that specialty (12.4% and 8.8%, respectively)(Table 1). Although 82.5% of all ACP claims were submitted in outpatient clinics, palliative care clinicians submitted more ACP claims in inpatient hospital rather than ambulatory settings (72.7% vs. 6.8%, respectively). Code use was infrequent even among specialists such as oncologists and nephrologists who routinely care for seriously ill patients. At our institution, the average reimbursement for this service is< $100, which may be an insufficient incentive for physicians who are able to bill for infusions, dialysis, and other high-revenue services. Indeed, adoption was highest among palliative care physicians, who similarly care for many seriously ill patients, but who typically have fewer opportunities to use more remunerative billing codes. Alternatively, early knowledge of the codes may have been