Viewpoint: Why providers struggle to adopt new Medicare codes

A minority of primary care practices have filed claims for two services that Medicare recently rolled out codes for, according to a Nov. 9 athenaInsight analysis by freelance technology writer Chris Hayhurst.

During the second quarter of 2017, 17 percent of primary care practices filed claims for advanced care planning, a set of services related to end-of-life care that Medicare introduced CPT codes for in 2016, according to an analysis of claims on the athenahealth network. Only 10 percent of primary care practices billed for chronic care management, which Medicare rolled out codes for in 2015.

"Most practices that are billing for these services started to do so within the first few months of the codes being offered," Josh Gray, vice president of research at athenahealth, told Mr. Hayhurst. "But since then, the adoption rate has dropped off considerably. Most of the claims we see are coming from relatively few providers."

A key challenge healthcare providers face when adopting a new code is finding the least burdensome way to integrate the service into their workflows. For example, offering routine advanced care planning services would require training designated clinicians on sensitive end-of-life conversations.

"We're billing for chronic care management, and overall I'd say it's been an asset to our practice, but we're not quite there with advance care planning," Thomas Wiggins, MD, owner of Anchorage, Alaska-based Medical Park Family Care, told Mr. Hayhurst. "The time we'd have to spend meeting Medicare's guidelines is too much considering what we'd get in return."

To access Mr. Hayhurst's analysis, click here.

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