Advance Care Planning Conversations - What they are and why they matter
by Katila Farley, RN CMOM
More than 90 percent of Americans believe it is important to discuss the treatment and palliative options they would choose to pursue if they were to become incapacitated by medical issues in the future, according to The Conversation Project’s 2018 National Survey. Yet, they also report that only 32 percent have actually conducted these conversations.
Why? Most people don’t know where to begin. Some don’t even fully understand what advance care planning (ACP) entails.
Advance care planning ensures the patient's future care wishes are known in the event they are unable to communicate due to a health condition. These advance directives are written healthcare instructions that give patients the opportunity to identify who they want to make decisions for them if necessary and also which medical treatments they do or don’t want.
As a Primary Care Provider, it’s important to consider implementing this as a part of your regular practice not only for your patient’s wellbeing, but also for many cost benefits.
One of our Executive editors and writers, Dr. Jon Hart, breaks down how ACPs are reimbursed.
He says,
“Medicare pays for ACP as either an add-on element of a patient’s AWV (with no added copay for the patient) or as a separate Medicare Part B medically necessary service when there’s been a change in patient status (patient copays apply).
From a fee-for-service perspective, the activity adds reimbursement revenue for the physician. When documented properly as part of the AWV and more than 15 minutes is spent on the task by the office staff, ACP adds $85 to the reimbursement of the AWV service with no added copay by the patient.”
Additionally he writes, “a 2018 study by William Bond MD MS, looked at the impact of ACP on medical expense.They found that ACP increases documentation of advanced directives and was associated with a reduction in overall costs of $9,500 per patient per annum when ACP was performed in the last 12 months of life.” You can read more of his financial breakdown here.
Now that we’ve established why it matters, let’s dive into some basic questions.
When do you conduct an ACP conversation?
It is recommended to conduct this conversation during the patient’s annual wellness exam (AWV). This is due to the fact that many insurance carriers will bundle this effort and waive a co-pay/co-insurance. However, there is no specific time in which it should be done, and it is wise to make these decisions when sound mind and judgment exist. Many times adults will make these wishes known around the time they execute a will, get married, have a terminal illness, or have a major life change. Decisions around an ACP can be changed throughout one’s life.
How do you conduct an ACP?
The ACP is done by conversing in a face-to-face visit with a provider. The conversation does not have to include the execution of a living will. However - it is important to capture the name and phone number of their healthcare agent. This process is important to ensure family members and medical staff know their wishes. Additionally, there is no specific diagnosis that is required to conduct an ACP.
Who can have the conversation?
A billing provider that can conduct billable visits within their scope of practice. This is broken down for you by CMS here: MLN909289 – Advance Care Planning (cms.gov).
Why take the time to have the conversation?
It is incredibly important to secure a healthcare proxy in the event the patient is unable to make decisions. Ultimately it helps provide better outcomes for a patient and generates additional revenue to support care coordination efforts in the clinic.
What are the minimum requirements for ACP?
A billable patient encounter
Documentation showing evidence of an advanced care planning conversation and the patient's wishes.
To bill, you must include the total time used to work on only this process. This can include the teams' effort during the course of the face-to-face visit as long as the focus is on the ACP. When you perform another service concurrently as a time-based service, don’t include the time spent on the concurrent service with the time-based service.MLN909289 – Advance Care Planning (cms.gov)
Over the next month, we will be breaking down the specifics on Advanced Care Planning conversations and why they are important to your practice as a primary care provider. Please reach out to us with any questions or thoughts as you consider implementing this important conversation to your patient care.
