Have You Been Billing for Advance Care Planning and Advance Directive Discussions?

POSTER

Have You been billing for Advance Care Planning and Advance Directive Discussions? Increase ACP and AD Discussion in Primary Care settings PURPOSE Young Yoon, RN, BSN, FNP-DNP Student • The primary aim was to increase knowledge and comfort of primary care providers (PCPs) in initiating advance care planning (ACP) and advance directives (ADs) discussions • Facilitate PCPs discussions by presenting a evidence-based educational presentation an in a primary care setting • Introduce the CPT codes 99497 and 99498 to PCPs • • • AIMS The CPT code 99497: at least 16 minutes face-to-face interaction discussing diagnosis, prognosis, symptom managements, and AD information. AD completion not required. No specific diagnoses required. 99498: face-to-face interaction from 31 minutes to 60 minutes No limitation on how many times use these codes RESULTS • There is statistically significant difference in PCP’s knowledge (mean 3± 1.27 pre-education, and 4.33 ± 1.03 post-education, Wilcoxson P value RESULTS: =0.046) about ACP and AD after the education • There is clinically significant difference in PCP’s wiliness to use CPT codes after the presentation (mean 1 prior and 2.67 ± 1.51 after the presentation, Wilcoxson P value= 0.059) • There is increase in motivation, comfort, and awareness of ACP after the presentation but neither statistically or clinically significant (Wilcoxson P=0.317, P= 0.157, P=0.157 respectively) • One month after the presentation, there was no difference in actual CPT code usage CONCLUSIONS/IMPLICATIONS BACKGROUND PROCEDURES Benefits of ACP and AD Discussion • • • • • Respect patients autonomy Honor patient’s preferences and choices (“customize” end-of-life care) Increase quality of life Decrease family burden and conflict Reduce overall medical cost in end-of-life Issues with Lack of AD Discussion • • • • • <30% of population and <50% of terminally ill patients have an AD Aging of Baby Boomer Generation (“Silver Tsunami” is coming) Most older adults have one or more chronic illnesses and die from them Lack of AD discussion in primary care settings (only ~ 17%) ~ 2/3 of health care providers are not aware if ADs are present METHODS • Performed systematic literature review • Developed the educational PowerPoint modules • Developed the algorithms for medical assistants GRAPHIC GRAPHIC and PCPs to facilitate ACP and AD discussion • Developed pre and post-educational survey questionnaires to assess the effectiveness of the presentation • Educational PowerPoint module about AD presented to providers and MAs at a University of Utah Community Clinic • Compare the CPT code usage (99497, 99498) one month prior and after the presentation • Survey result showed improvement in knowledge to discuss ACP and ADs and willingness to use the CPT codes after the educational presentation • Lack of use of the CPT codes may indicate that PCPs perceived obstacles bigger than expected or one month follow-up is too short to measure meaningful changes • Except financial compensation, PCPs may require an extra layer of support and training to facilitate ACP/AD discussions ACKNOWLEDGEMENTS • Project Chair: Nancy Allen, PhD, ANP-BC • Content Expert: Holli Martinez, FNP-BC, ACHPN • FNP Program Director: Julie Balk, DNP, APRN, FNP-BC • The assistant dean of MS and DNP programs: Pamela Hardin, PhD, RN, CNE