Dr. Peter Jaggard discusses the new ACP Product Series

April 25, 2018


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Traditional advance directives like the living will and power of attorney express patient choices in general terms for their medical care. More recent directives, such as physician order for life-sustaining treatment (POLST), are actually medical order sets for reflecting what the patient's preferences for care are.

What we have designed in the Advance Care Planning Tool Kit is an additional reference and resource for documenting the content of the discussion between a patient and a physician regarding their goals, their values, and their preferences for medical treatment; and it is a much more substantive document which explores the patient's situation that reflects their preferences for care. The tool kit also includes a discussion guide which prompts the physician with a set of questions and reflections to clarify the patient's preferences and goals of care in their own words as much as possible.

Our overall desire with this tool kit is to document and clarify the patient's preferences. It can be billed in the course of an annual wellness visit or in the course of a regular nursing home visit as a separate service as long as both elements are met. The advantage for the patient in an annual wellness visit is that they are not responsible for the co-pay for the advance care planning part of this visit.

This service can be performed by a physician, or nurse practitioner, or a physician assistant.

Everything in advance care planning matters. During an advance care planning visit we might explore what the circumstances are leading to the discussion:

  • Does the patient give consent to the visit?

  • Does the patient have capacity for having this discussion?

  • What are the medical fact?

  • What are the options for treatment?

  • What prior directives have been made?

Although all of these are important, the most important consideration is clarifying and articulating, in the patient's own words, what their values are and what their preferences for treatment are.

We all know there is a critical need to promote patient-centered advance care planning, but advance care planning must be more than just checking a series of boxes on a form. Patients have a right and a need to have a meaningful and substantive discussion of advanced care planning with their physician. This discussion guide and documentation template offers a framework for conducting and documenting the conversation.

AMDA will be making this resource available to its members as soon as possible, and AMDA is exploring collaboration with outside entities, perhaps in some licensing agreements, or other means of introducing this tookit to the healthcare delivery system in such a way that patient preference will be documented and available thru the digital space as easily as possible.

I would anticipate that CMS will be looking at what impact these advance care planning visits have on actual decisions, and whether they reflect actual patient preference.

We believe this advance care planning resource tool is well designed to continue improvements in care planning as we move forward, and encourage its distribution.