Journal of Hospital Medicine
Amber E Barnato, MD, MPH, MS; A James O’Malley, PhD; Jonathan S Skinner, PhD; John D Birkmeyer, MD
Advance care planning (ACP) is the process where- in patients, in discussions with their healthcare providers, family members, and other loved ones, make individual decisions about their fu- ture healthcare or prepare proxies to guide future medical treatment decisions.1,2 In 2016, the Centers for Medicare and Medicaid Services (CMS) began paying providers for ACP by using billing codes 99497 (first 30 min of ACP) and 99498 (additional 30 min of ACP). According to the CMS, during the first year after the billing codes were introduced, 22,864 providers billed for ACP conversations with 574,621 patients.3 While all adults are eligible, common triggers for ACP in- clude advanced age, serious illness, and functional status changes that confer an increased risk of dying. We explored the early uptake of the ACP billing code in a large national physician practice that provided mandatory education in use of the ACP billing code, offered a small financial incentive for ACP documentation, and primed physicians to reflect on the patient’s risk of dying in the next year at the time of hospital admission.