Advance Care Planning (ACP) adoption has been slow because clinicians don’t have ample time or are uncomfortable with the topic; patients tend to associate ACP with end-of-life.
Today, however, ACP has evolved into a reimbursable priority that benefits adults of any age, as well as their families and providers. Certainly, the COVID-19 pandemic demonstrated the value of preparation when patients unexpectedly can’t speak for themselves.
Considering that studies show that up to 75% of patients will need someone to make medical decisions for them in the future, now may be the right time to integrate ACP into your standards of care.
What is Advance Care Planning?
Advance Care Planning is about more than completing an advance directive and choosing a healthcare proxy. It’s a meaningful way to help patients have a voice in their healthcare.
The process helps adults of any age and health status identify, document, and share their personal values, life goals, and preferences regarding their current and future medical care.
When done proactively, and updated as medical conditions or preferences change, ACP empowers everyone – patient, family, proxy, and providers – to make sound decisions with less stress and greater confidence.
Reimbursement coverage supports an integrated approach to Advance Care Planning
According to the Centers for Medicare & Medicaid Services, ACP can be billed as an optional element of a Medical Wellness Visit, which includes the Annual Wellness Visit (AWV).
ACP is covered for patients without a co-pay when offered with a Medicare Wellness Visit. When ACP is furnished as an element of the AWV in a Rural Health Clinic or Federally Qualified Health Center, only one visit is paid.
Other AWV requirements regarding ACP can be found here.
Advance care planning can also be provided as its own standalone service. It can be billed using CPT code 99497 for the first 16 to 30 minutes (with 16 minutes of this time focused on discussing ACP documentation).
CPT code 99498 can be used for each additional 30 minutes with at least 16 mins that:
- Records that the ACP conversation was voluntary on behalf of the patient
- Encapsulates what was talked about
- Record who was present for the conversation
- Note the length of time for the consultation
Why Advance Care Planning is worth prioritizing for patients, families, and providers
Contrary to common belief, patients have voiced that they value the opportunity to speak about issues that are important to them.
Plus, studies show advance care planning can yield many benefits for the patient, their family, clinicians, and provider organizations, including:
- Preserve a patient’s wishes and preferences regarding medical treatment
- Empower physicians and families to make confident, patient-driven decisions
- Decrease the stress, burden, and grief of medical decision-makers
- Decrease physician moral distress around starting or stopping treatment
- Improve physician-family relations, communication, and satisfaction through patient-informed guidelines
ACP can decrease the total cost of care
Some studies have also shown that Advance Care Planning significantly improves multiple outcomes, particularly for patients with serious illnesses, including:
- Reduced hospitalization at the end of life
- Fewer intensive treatments at the end of life
- Higher satisfaction with the quality of care received
- Lower stress, anxiety, and depression in surviving relatives
- Reduced cost for end-of-life care without increasing mortality
ACP can improve adherence to patient desires
Research has found that Advance Care Planning can improve adherence to the patient’s desired medical care at the end of life.
A randomized controlled trial of patients aged 80 or older found that patients who participated in Advance Care Planning and died within six months were nearly three times more likely to have their desires known and followed (86% vs. 30%).
Family members of patients who had ACP and died experienced significantly less stress, anxiety, and depression. This corresponded with assessment scores three times lower than families of the patients who did not receive ACP.
Patient and family satisfaction was also higher in the intervention group.
Patient and care team education are critical to ACP implementation
Misunderstanding abounds related to ACP.
A 2021 study asked 921 adults over age 55 the following seven questions (see table below) and only 11.9% of participants answered all seven correctly. Approximately 25.6% answered three or more correctly, which was assessed as a low knowledge level.
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Source: J Pain Symptom Manage. 2021 Oct; 62(4): 778–784.
It is critical that patients understand the purpose and procedure of ACP. For their families, it’s key to understand their role in supporting their loved ones.
Accurate ACP knowledge is vital to patient and family participation
Systematic research reviews reveal that ACP patient education leads to improvements in patient-surrogate-clinician congruence on desired medical care.
Seventy-five percent of studies show a positive impact on surrogates’ satisfaction with their loved one’s care, and 100% of studies find that ACP education and participation improve patient-surrogate-clinician communication.
Care team training improves ACP adoption and patient participation
Building care team knowledge and skills around the ACP process has been shown to improve adoption and positively impact outcomes.
A 2020 study looked at the consequences of educational interventions, clinic workflow redesign, and quality improvement coaching on the frequency of ACP activities.
The study found that providers were more than twice as likely to conduct ACP discussions with their patients following training on ACP approaches and techniques. Patients were also 1.4 times more likely to have an ACP document in their electronic medical records.
ThoroughCare’s integration with Honor My Decisions makes ACP easier
ThoroughCare helps healthcare organizations coordinate care in collaboration with patients. Through our integration with Honor My Decisions, ThoroughCare offers specialized tools for end-to-end advance directive planning, document creation, and ongoing updates.
Specifically, ThoroughCare, leveraging Honor My Decisions, enables providers and their care teams to:
- Engage patients: Start ACP conversations, including during an Annual Wellness Visit.
- Document end-of-life care wishes: Easy-to-use questionnaires guide the process and help create advance directives that are legally binding in all 50 states and territories.
- Identify patient values and priorities: Create a video living will and access end-of-life values and priorities exercises to enhance advance directives and guide productive healthcare proxy conversations.
- Share ACP documents: The platform provides 24/7 secure, online access to advance care plans, wallet cards, and QR codes for care team members, patients, their families, and proxy or power of attorney.
- ACP education: Fully inform the patient and their family on what ACP entails and how it could benefit them through materials that support different learning styles, preferences, and health literacy levels, such as videos, audio, printed worksheets, and handouts.
- Care team training: Access comprehensive staff training and facilitated ACP session delivery tools.
ThoroughCare equips providers and families to make informed, patient-compliant medical decisions
ACP has become a provider priority, supported by reimbursement and research. By using ThoroughCare, care delivery organizations can confidently provide ACP guidance as a covered service.
Clinicians can support their patients’ wishes for medical care when provided consistently across adult patient populations and feel confident when guiding medical decision-making.
