9 Tips for ACP Discussions

By Dr. Beth G. Hodges

Here are some tips for successful navigation of Advance Care Planning (ACP) discussions:

1. Keep a stock of the available tools, such as the Five Wishes booklet or my personal favorite, the 7 Steps to Advance Care Planning booklet (which comes in English and Spanish). One of these or something similar should be sent home with the patient to review and (hopefully) complete.
   
   
2. Train a staff member on the talking points of how to fill out the paperwork and get it notarized, and where to store it. (Hint: NOT in a bank safe deposit box!)
   
   
3. Accustom your staff to asking patients when rooming them if they have a living will or healthcare power of attorney. Patients who do should be encouraged to bring a copy to the office for their chart. If they don’t, they should be asked if they want to start that discussion at today’s appointment or take some paperwork to review and return to discuss it at a separate visit.
   
   
4. Your staff should become so used to asking this question that they stop getting self-conscious about the topic. Normalizing the discussion is critical. It also may help to reassure nervous patients that this topic is brought up with EVERYONE, not just them.
   
   
5. Have one or two staff meetings in which your staff can practice with one another, so they feel more comfortable bringing up the topic. The second meeting should be after starting the process and involve them sharing early experiences—what went well, what they think works best.
   
   
6. Consider nominating an Office Champion for this initiative, and charge that person with assisting other staff members.
   
   
7. Recognize that two legal documents can be completed: a North Carolina Living Will (a person’s end-of-life care preferences) and an NC Healthcare Power of Attorney (the designee for decision making and an alternate if the patient cannot speak for themself).
   
   
8. If combined, the time you and your staff spend all total reaches or surpasses the halfway mark for a 30-minute discussion (16 minutes or more), you can bill 99497 in addition to your office visit. If the conversation is extensive, in addition to the office visit (or is the main purpose for the visit), and surpasses the 45-minute mark, you can bill 99498. It is advisable to document the number of minutes and the bare bones of the discussion in case of an audit. Furthermore, there is actually no limitation on the number of times this discussion can be billed in a given year, as it is recognized that end-of-life issues can be complex and changeable. These discussions can also take place in an appropriate virtual format.
   
   
9. Reach out to providerconcierge@htanc.com to request information on obtaining the NC Advanced Care Planning booklet, or to schedule an ACP in-service at your practice.
   
   

Dr. Beth Hodges is a family practice and palliative care/hospice physician in Asheboro, N.C., as well as a part-time medical director for HealthTeam Advantage.