ArticleJournal of the American Geriatrics Society2020
Regional Variation in Billed Advance Care Planning Visits.
Article in Journal of the American Geriatrics Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
7 citing papers in PubMed.
- A Causal Machine Learning Framework for Estimating the Impact of Cancer Diagnosis on Receipt of Advance Care Planning.Health services research · 2026Article
- External validation of a proprietary risk model for 1-year mortality in community-dwelling adults aged 65 years or older.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Utility of advance care planning billing codes: a cross-sectional analysis of U.S. hospitalists' documentation.BMC research notes · 2025Article
- The COVID-19 Pandemic and Goals-of-Care Conversations in Veterans Health Administration Clinics.JAMA network open · 2025Article
- American Geriatrics Society position statement: Making medical treatment decisions for unrepresented older adults.Journal of the American Geriatrics Society · 2025Article
- Hospital and Temporal Variations in Limitations of Care Among Hospitalized Patients with COVID-19: A VIRUS Registry Retrospective Cohort Study.Palliative medicine reports · 2025Article
- Advance directives prior to COVID-19 diagnosis in a United States national healthcare system.PloS one · 2025Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
BACKGROUND/
objectiveAdvance care planning (ACP) is associated with improved patient and caregiver outcomes, but is underutilized. To encourage ACP, the Centers for Medicare & Medicaid Services implemented specific ACP visit reimbursement codes in 2016. To better understand the utilization of these ACP reimbursement codes, we explored regional variation in billed ACP visits.
designWe performed a retrospective cross-sectional analysis using a randomly sampled 5% cohort of Medicare fee-for-service (FFS) beneficiaries' claims files from 2017. Region was defined by hospital referral region.
settingNational Medicare FFS.
participantsA total of 1.3 million Medicare beneficiaries aged 65 years and older. MEASUREMENT: Receipt of billed ACP service, identified through Current Procedural Terminology code 99497 or 99498. Proportion of beneficiaries who received billed ACP service(s) by region was calculated. We fit a multilevel logistic regression model with a random regional intercept to determine the variation in billed ACP visits attributable to the region after accounting for patient (demographics, comorbidities, and medical care utilization) and regional factors (hospital size, emergency department visits, hospice utilization, and costs).
resultsThe study population included about 1.3 million beneficiaries, of which 32,137 (2.4%) had at least one billed ACP visit in 2017. There was substantial regional variation in the percentage of beneficiaries with billed ACP visits: lowest quintile region, less than 0.83%; subsequent regions, less than 1.6%, less than 2.4%, less than 3.3% to less than 8.4% in the highest quintile regions. A total of 15.4% of the variance in whether an older adult had a billed ACP visit was explained by the region. Although numerous regional factors were associated with billed ACP visits, none were strong predictors.
conclusionIn 2017, we found wide regional variation in the use of billed ACP visits, although use overall was low in all regions. Increasing the understanding of the drivers and the effects of billed ACP visits could inform strategies for increasing ACP.
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