Advance Care Planning for Medicare Patients Positive Impacts on Patient Care, Managing Patient Transitions, New Revenue Streams and Improving the Patient Experience Steve Jackson, CEO 941.993.3993 sjackson@HonorMyDecisions.com

Advance directives Doing what you can to ensure your medical wishes are followed when you can’t speak for yourself. Healthcare Surrogate Designating a person to make medical decisions for you when you cannot make them yourself. Living Will Documenting the medical treatments and interventions you do (and don’t) want to guide doctors and your surrogate.

Why CMS wants more advance directives Young employees Less stress, anxiety, depression after death of loved one Greater satisfaction with end-of-life experience Improved quality of life Families have less stressful experiences Less spending on unwanted medical care Provide only medical care that is wanted Young employees Providers reduce costs, improve results Deliver better quality of patient care Lower rates of ventilation, resuscitation Earlier hospice enrollment Fewer hospitalizations; days in the hospital People get the care they want

New CPT® codes in 2016 cover ACP CPT codes 99497 and 99498 No place of service or physician specialty limitations and no specific diagnosis needed. May be provided by physicians or using a team-based approach under the order and medical management of the beneficiary’s treating physician. Can be billed on the same day or a different day as most other E/M services as well as during the same service period as transitional care management services or chronic care management services or within global surgical periods. No current limits on the number of times the ACP service can be provided to the same beneficiary during a specific time period. However, CMS has indicated an expectation of seeing a health care status change and/or change in a person’s end-of-life care wishes for multiple billings. HMD can help with documentation requirements. For more information see Centers for Medicare & Medicaid Services’ “Frequently Asked Questions about Billing the Physician Fee Schedule for Advance Care Planning Services” (July 14, 2016) Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf

Medical Practice Program (HMD-MPP) Improve patient care Deliver an exceptional profit stream Increase patient engagement Support QPP and other reporting

Transformative add-on example Leverage existing Medicare visits, increasing value for both you and your patient: Annual Wellness Visit $172*/20 min once per lifetime $111*/20 min each year thereafter Advance Care Planning $85*/first 30 min, $75*/next 30 min as many times as needed Bundle AWV with ACP and increase the percentage of eligible beneficiaries served Increase revenue by 77% by adding ACP Drive repeat business (CPT code 99498) Keep the patient close to the practice with HMD co-branding and messaging * National average reimbursement, actual amount varies by region.

Easy to implement with great returns HMD-MPP is a turnkey program that includes: Training for you and your staff to guide service delivery and maximize patient engagement and outcomes while meeting Medicare requirements. Session documentation and billing support to ensure successful reimbursement. Co-branded support materials for your website or patient portal to help promote the ACP service and its value (including short videos). Provider portal link to EMR with process flow management (2Q17).

Easy to implement with great returns HMD-MPP app includes: Legal advance directive forms for all 50 states plus U.S. territories that are completed via an easy-to-use questionnaire. NIST-compliant digital signatures (including public/private key pairs) as well as electronic signature options. HIPAA-compliant data storage and transmission. Patient educational materials within the app to aid informed decision-making. Targeted, co-branded trigger emails to ensure patients finish their advance directives and share them with you and their loved ones. 24/7 secure, online access to completed advance care plans.

Why Honor My Decisions? ALPHA-1 Foundation issues grant to research ethical, legal, social aspects of advance care planning issues. Honor My Decisions app for iPad® tested and launched for public and commercial use. 2012 2015 2016 Web and iPhone® versions launched along with additional planning tools. 2005 2014 The problem with Advance Directives “is the medium, not the message.” – Ray Moseley, PhD First consumer prototype created under the direction of two prominent bioethicists. Dr. Kenneth Goodman Dir. Miller School of Medicine’s Institute for Bioethics and Health Policy University of Miami Dr. Ray Moseley Associate Professor of Bioethics University of Florida iPad and iPhone are trademarks of Apple Inc., registered in the U.S. and other countries.

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