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Advance care planning is a term used to describe when a person prepares for future management of serious or terminal illness, including developing an advance care directive or what is sometimes is called a living will.

Beginning in January of 2016, Medicare made it possible for certain clinicians to bill for their work for patients to develop advance care plans.

Despite the new billing option, uptake has been quite slow.

In health care, we often use financial incentives to motivate behavior change. You might have expected that simply creating a payment option for advance care planning would make it happen.

Keren Ladin from Tufts University joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the reasons Medicare's payment policy has not led to the greater pursuit of advance care planning.

Ladin and coauthors published a paper in the January 2022 issue of Health Affairs examining the limited use of advance care planning billing codes among clinicians. Their qualitative study revealed a number of potential explanations for low use that can help us  understand why a seemingly simple payment change doesn't automatically yield a desired result.

Barriers to use of the advance care planning billing codes include institutional practices, concerns about the effects on patients and more.

If you enjoy this interview, order the January 2022 Health Affairs issue.

Pre-order the February 2022 Racism and Health issue.

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