• Elizabeth A Luth, Adoma Manful, Joel S Weissman, Amanda Reich, Keren Ladin, Robert Semco, and Ishani Ganguli.
• Rutgers University, New Brunswick, NJ, USA. eal133@ifh.rutgers.edu.
• J Gen Intern Med. 2022 Nov 1; 37 (15): 386938763869-3876.

BackgroundMedicare introduced billing codes in 2016 to encourage clinicians to engage in advance care planning (ACP) and promote goal-concordantend-of-life care, but uptake has been modest. While prior research examined individual-level factors in ACP billing, organization-level factors associated with physician practices billing for ACP remain unknown.ObjectiveExamine the role of practices in ACP billing.DesignRetrospective cohort study analyzing 2016-2018 national Medicare data.ParticipantsA total of 53,926 practices with at least 10 attributed Medicare beneficiaries.Main MeasuresOutcomes were practice-level ACP billing (any use by the practice) and ACP use rate by practice-attributed beneficiaries. Practice characteristics were number of beneficiaries attributed to the practice; percentage of beneficiaries by race, Medicare-Medicaid dual enrollment, sex, and age; practice size; and specialty mix.Key ResultsFifteen percent of practices billed for ACP. In adjusted models, we found higher odds of ACP billing and higher ACP use rates among practices with more primary care physicians (billing AOR: 10.01, 95%CI: 8.81-11.38 for practices with 75-100% (vs 0) primary care physicians), and those serving more Medicare beneficiaries (billing AOR: 4.55, 95%CI 4.08-5.08 for practices with highest (vs lowest) quintile of beneficiaries), and larger shares of female beneficiaries (billing AOR: 3.06, 95% CI 2.01-4.67 for 75-100% (vs <25%) female ).ConclusionsSeveral years after Medicare introduced ACP reimbursements for physicians, relatively few practices bill for ACP. ACP billing was more likely in large practices with a greater percentage of primary care physicians. To increase ACP billing uptake, policymakers and health system leaders might target interventions to larger practices where a small number of physicians already bill for ACP and to specialty practices that serve as the primary source of care for seriously ill patients.© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.

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