Paying for advance care planning in medicare: Impacts on care and spending near end of life.

ABSTRACT: Spending at end of life (EOL) accounts for a large and growing share of healthcare expenditures in the US, and often reflects aggressive care with questionable value for dying patients. Using a novel instrumental variables approach, we conduct the first study on the causal effect of Medicare reimbursement for advance care planning (ACP)-the process of discussing and recording patient preferences for goals of care-on care utilization, spending, and mortality outcomes for critically ill Medicare patients. We find that billed ACP services substantially increase hospice use and hospice spending within a year, accompanied by corresponding increase in one-year mortality. The impacts of ACP services on hospice use and spending are especially prominent among patients with dementia and those of low

SUBMITTER: Chen AJ 

PROVIDER: S-EPMC11631671 | biostudies-literature | 2024 Dec

REPOSITORIES: biostudies-literature