Physician-Patient Care Planning Discussions on the Rise!

On January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began reimbursing physicians for advance care planning conversations with patients, family members or their surrogates who are Medicare beneficiaries. Physicians can get reimbursed for an initial 30 minute face-to-face conversation using CPT Code 99497,  and additional 30 minute conversations using CPT Code 99498. Now that the first year of the CMS program is complete, the results are in for Massachusetts.

"Statewide the trend of physician-patient advance care planning conversations continues to climb and is very encouraging", says Dawn Hobill, MHA, Program Administrator, Care Transitions, New England Quality Innovation Network-Quality Improvement Organization (NE QIN-QIO).  The NE QIN-QIO, an Honoring Choices Alliance Partner, has reviewed the Massachusetts data on the use of CPT code 99497, the initial 30 minute care planning conversation. From Jan-March 2016 when the program commenced, to Jan-March 2017, the NE QIN-QIO graph shows nearly a 200% increase in patient discussions that were billed to Medicare. See the NE QIN-QIO graph here.

The Massachusetts data reflects the nationwide results of physician-patient planning conversations.  CMS reports over 570,000 Medicare beneficiaries nationally made advance care planning appointments with their physicians. Although this number represents only 1% of the Medicare population, it's a very promising start to foster and credit the importance of care planning conversations.