Advanced Care Planning

Question 1

List the places where a patient’s advanced care plans may be documented.

Answer 1

•	Often documented in writing:
o	Advance directive 
o	Living will
o	Electronic health record
o	Physician orders for life-sustaining treatment (POLST) or medication orders for life sustaining treatment (MOLST)

Question 2

State the purpose of the Patient Self Determining Act.

Answer 2

• Passed 20 years ago; Requires most health care facilities to inform adult patients about their rights to execute an AD
• Since passed, estimates of completed advance directive among adults in the IS range from 5-15% – however 28% of home health care patients, 65% of nursing home residents, and 88% of hospice care patients had at least one AD on record.

Question 3

Identify a family’s areas of unmet needs regarding a loved one’s end-of-life care.

Answer 3

• Symptom management
• Communication from physicians about medical decision making
• Emotional support for themselves
• Respect for their dying family member

Question 4

State what Medicare will reimburse regarding end-of-life planning.

Answer 4

• Medicare part B allows for 30 min discussion for advance care planning (ACP) in clinic or hospital – or will pay up to $75 for 30 additional minutes of consultation
• ACP may be reimbursed if conducted as part of an annual wellness visit

Question 5

List the minimum documentation required for seeking Medicare reimbursement for advance care planning.

Answer 5

• A person designated to make decisions for the patient if the patient cannot speak for him or herself
• The types of medical care preferred
• The comfort level that is preferred
• Patient consent for ACP performed as part of an annual wellness visit (Required for Medicare Advantage only)