Advance Care Planning Member Survey Yields Policy Input

Greater physician and nurse practitioner engagement is needed to ensure effective advance care planning that honors patients' goals for care, noted LeadingAge NY members in response to a recent survey of advance care planning issues and challenges. LeadingAge NY circulated the survey in order to respond to the Department of Health's (DOH) Request for Information (RFI) on Advance Care Planning. LeadingAge NY members also highlighted challenges they encounter when advance care planning documents such as Non-Hospital Do Not Resuscitate orders and Medical Orders for Life Sustaining Treatment (MOLST) do not accompany patients as they transition from one setting to another. Challenges may also arise when documents are transferred with the patient from another setting, and they contain errors that call into question their validity.

Based on the concerns expressed in the survey, LeadingAge NY recommended the following to DOH: 

• Update the MOLST form to reflect the change in law that permits nurse practitioners to sign MOLST orders and to reflect changes in the clinical elements of the form recommended by the statewide MOLST implementation team.
• Provide financial support for the adoption of eMOLST, a software application that leads clinicians through the proper completion of MOLST forms and stores the completed forms in an electronic registry. This would help providers to create legally compliant forms and enable them to retrieve the most up-to-date orders when patients transfer between settings.
• Establish an advance care planning policy team within DOH that meets regularly, updates and disseminates information to the public, and responds to questions from consumers and providers.
• Ensure that conversations conducted by qualified health care professionals about advance care planning are billable services covered by Medicaid. In January 2016, the Centers for Medicare and Medicaid Services (CMS) approved two new CPT codes, 99497 and 99498, to allow physicians to be reimbursed for having an advance care planning conversation with their Medicare patients. It is not clear that these codes are also available for services provided to beneficiaries of Medicaid only.
• Promote greater public awareness and support education of providers, including physicians, to ensure effective advance care planning that supports consumer preferences.
• Allow providers to honor resident preferences at the end of life by expanding access to hospice in assisted living facilities.

The complete text of LeadingAge NY's response to the RFI is available here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838