1. Advance Care Planning in the office is difficult mostly because a. Lack of time38717 b. Reluctance to discuss 38718 c. Don’t know how to38719 d. Lack of reimbursement38720 e. Lack of support38721

2. Dr Jeffrey Yee

6. RESEARCH The impact of advance care planning on end of life care in elderly patients: randomized controlled trial Karen M Detering, respiratory physician and clinical leader1, Andrew D Hancock, project officer1,1 Michael C Reade, physician2, William Silvester, intensive care physician and director121

8. Effects of POLST

9.  Lack of Time  Lack of Understanding ◦ Needs, processes  Reluctance to Discuss ◦ Physicians, care teams, patients, families  Skill Needs  System deficiencies

10.  Initial 6 months ◦ 180 team interactions ◦ 120 attend Part 1 (Advance Directives) ◦ 46 attend Part 2 (POLST)

11.  Initial 6 months ◦ 180 staff interactions ◦ 120 attend Part 1 (Advance Directives) ◦ 46 attend Part 2 (POLST) 29/46 attendees of Part 1 and Part 2 complete Advance Directive and/or POLST

12. Patient Identification through EMR Initial Education provided by MA MD Reinforcement Enrollment in Group session or Individual appointment

13.  Patient Identification ◦ 70 yo; or 60 yo with chronic disease  Initial Education ◦ Staff responsibility ◦ Offer Advance Health Care Directive information or POLST information

15.  Engagement ◦ MD role  Reinforce Need/Education  Provide relevant personal clinical information

17. Must document the length of time of your visit within your note and state that >50% of the time was spent in counseling – Then bill the time-based E/M (CPT) code (e.g., 99213 for 15 minutes, 99214 for 25 minutes) “15 minutes of 25 minute visit spent discussing goals of care/Advance Care Directives as related to their diagnosis and prognosis for CHF.”

19. Power of Attorney for Health Care Health Care Agent/ Decision-maker Instructions For Health Care What do I want? When do I want? Why do I want?

22.  Systematic Approach  Team Roles  Documentation  Engagement  Great Communication

23.  Must be retrievable  Supportive documentation

24.  Engaging the practice

25.  Game Plan – Strategic plan  Decide the formation -Identify patients

26.  Have the equipment – educational materials, forms  Snap the ball/start the play – Help initiate conversation

27.  Timing of conversations ◦ Annual exam ◦ Initiate if involved family members present ◦ Post hospitalization ◦ When other family members/friends ill

28.  Complete documentation  Complete forms  Follow up with appropriate patients  Give the practice feedback

29.  Advance Directives are stable  Physicians can support the conversation  CPT coding  Springboard for other health plans

30.  CaPOLST.org  Caringcommunity.org  Prepareforyourcare.org  Go Wish cards  Woodland Healthcare Advance Care Planning Discussion ◦ 530 668 2600 Ask for “ACP Class” under Internal Medicine