Central PA Medicine Spring 2018 - 18

daup h i n cm s .org

FEATURES

Involvement of physicians in ACP is
important.
As a recent article in The Economist (April
29-May 5, 2017) said, "Death is inevitable. A
bad death is not." In a study with the Kaiser
Family Foundation, The Economist reports
that there is a "huge gap between what people
want from end-of-life care and what they are
likely to get." Having conversations is an
essential activity to closing this gap. The role
of physicians is critically important.

Starting a conversation is easier than
you think!
A physician conversation may start with the
question, "Do you have an Advance Directive?"
If they do, secure a copy for the medical record.
If not, it is useful to ask about the patient's understanding of ACP and any positive or negative
experiences of end-of-life care. By asking the
patient to describe what an acceptable quality
of life is for them, it is possible to get some
idea of where the tipping-point is between
wanting life-sustaining care and choosing
Physicians with the time can bill Medi- comfort care. For a fairly healthy patient this
care for having ACP conversations.
may be a general discussion, for a patient with
You may be unaware that physicians (and multiple co-morbidities it may be more detailed.
healthcare credentialed staff working under Once the patient is aware of the decisions that
the physician's direction) can use CPT code might have to be made if they were not able
99497 to bill for 30 minutes of face-to-face to make or communicate their wishes, explore
conversations with patients, family members, who they want to name as their agent. The
and/or agents. For additional 30-minute final task is to have the patient complete an
conversations, use code 99498. For these Advance Directive document. There are many
codes there is no copay for patients.
options and most hospitals have a sample form
with instructions. The document should be

signed and witnessed. A sample of the Bucks
County Health Improvement Partnership
Advance Directive form is available on our
website, BCHIP.org.
ACP is a gift to your family.
With ACP (1) patients get the care they
want, (2) family members are more satisfied
with the care received (because they know the
plan), (3) care providers are spared decision
conflicts, and (4) survivors experience less
depression and return to their lives more
easily. In addition, costs are less because there
tend to be fewer trips to the ER, fewer days
in the ICU, earlier enrollment in Hospice,
fewer in-hospital deaths, and a better quality
of life as the end approaches. Physicians are
uniquely positioned to help their patients
make this gift a reality.

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18 Spring 2018 Central PA Medicine


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Table of Contents for the Digital Edition of Central PA Medicine Spring 2018

Central PA Medicine Spring 2018 - 1
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