Important medicare policy change for your clients and your firm

By: Randi Siegel

Beginning in 2016, Medicare will pay doctors to have conversations with their patients about their advance care planning. This change opens the door for you to work more directly with your clients’ doctors -- good news for your clients and your practice. We thought you might appreciate a summary of this new Medicare benefit so that you can help your clients, and also make the most of this new opportunity.

  • Medicare will now separately reimburse doctors for advance care planning conversations with patients. Physicians were previously disincentivized to have these important, yet often time-consuming, conversations with patients (your clients) due to a lack of compensation.
     
  • ACP discussions are voluntary. Either the patient or the physician can bring up the subject, but the patient can choose if they want to engage in the conversation.
     
  • ACP discussions are for explaining and discussing advance directive documents, including standard forms. If your clients have already completed their advance directives, their physician should ask them for a copy. If your client is enrolled in DocuBank, they can use their DocuBank card to have a copy immediately sent to the doctor’s office. When you register a new client in DocuBank, you can have them send the advance directives directly to doctor’s office, which is even more valuable to local doctors in light of the new Medicare ACP payments. This is a great marketing tool for your firm, and a valuable service for your client and their physician. Hint: Make sure your firm name appears on the advance directives you create.
     
  • ACP is about discussing the patient’s wishes – WHATEVER THEY MAY BE. The goal of the ACP conversation is for the patient and the doctor to explore and understand the patient’s goals for their care. This could mean a discussion about the patient wanting every possible treatment in order to extend their life as long as possible no matter what, or it might be about the patient preferring to be kept as comfortable as possible in the case of a terminal illness. Of course, there may be a myriad of other scenarios and choices in between, which is what makes the conversation so important!
     
  • ACP is about knowing whom the patient wants to make decisions for them, and can include what happens to their body after they pass away. Your clients need to name a surrogate decision maker because sometimes the state’s statutory default decision maker will not make wishes consistent with what your client would want.
     
  • It is appropriate for a physician to ask your client if they have an advance directive or have had “the conversation,” even if they are healthy. ACP discussions may become a part of Medicare’s “Annual Wellness Visit.” These discussions have been recognized by the medical profession as a component of high quality care.
     
  • There is no co-pay for ACP conversations during a Medicare Annual Wellness Visit.  If the conversation comes up during the Annual Wellness Visit, the patient does not have a co-pay. If the patient has the conversation during another appointment, they may have a co-pay depending on their Medicare plan.
     
  • ACP conversations can be with the doctor or with a non-physician who is supervised by the doctor. Some patients may have a better relationship or feel more comfortable having the conversation with a physician’s assistant or nurse practitioner.
     
  • Regardless of what choices the patient makes, research has shown that ACP increases patient and family satisfaction and reduces the emotional distress on caregivers. Many clients may avoid these discussions with doctors or their family because they can be painful or awkward. But, the evidence suggests that having these conversations is a tremendous gift for loved ones.

If you’d like a version of this post in Q&A format that is already edited specifically for clients, contact us.

April 1, 2016 | Advance Care Planning News, DocuBank

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