The Bundled Payments Care Improvement (BPCI) Advanced Model rewards healthcare providers for delivering care more efficiently, supports care coordination, and demonstrates the delivery of high-quality care. This creates an incentive, encouraging providers to work together to improve care to Medicare beneficiaries across 32 clinical episodes. This includes seven quality measures, with one of those measures being advance care planning – NQF #0326.
What is Advance Care Planning?
This is a lifelong process of personal reflection to determine and document future care preferences. This empowers the individual to direct care they may or may not want to receive should they be unable to speak for themselves. While advance care planning is important for all, it is most important for the high-risk populations – those who are 65+ and those who are seriously ill.
With Model Year 4 starting in January 2021, advance care planning will be a quality measure. Here are 6 things you should know.
Advance Care Planning Was A Selected Quality Measure Because of Its Impact on Treatment
Advance care planning was selected for BPCI Advanced as many beneficiaries end up hospitalized for life-threatening illnesses, and having accurate care plans can help prevent unnecessary hospital admissions and aggressive treatment. Aside from this, true patient-centered care means discussing and knowing one’s values. This happens during one or multiple conversations. Once these conversations occur, it should result in an actionable advance care plan that truly reflects that individual’s values and wishes.
Medicare Pays for Advance Care Planning as Part of the Annual Wellness Visit or a Medically Necessary Service Under Medicare Part B
Medicare will pay for this as either an optional element during an Annual Wellness Visit (AWV) or a medically necessary service under Part B. There is no limit to the number of times a patient can have an advance care planning conversation, but it is important to note that when this conversation does happen outside of the AWV, cost sharing does apply to the beneficiary.
There Are Multiple Qualifying CPT Codes
There are 2 CPT billing codes that can be used:
99497 – ACP including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.
99498 – ACP including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (list separately in addition to code for primary procedure).
There are also 2 CPT II tracking codes that can be used:
1123F – ACP discussed and documented – advance care plan or surrogate decision-maker was documented in the medical record.
1124F – ACP discussed and documented in the medical record – Beneficiary/patient did not wish to or was unable to provide an advance care plan or name a surrogate decision-maker. If patient’s cultural and/or spiritual beliefs preclude a discussion of advance care planning, submit this CPT II code.
Physician and Non-Physician Providers May Bill for Advance Care Planning Services
Physicians are not the only providers who can bill for conversations. Non-physician providers can also bill if their scope of practice includes advance care planning. These services can also happen in a facility or non-facility setting. It is also not limited to particular specialties.
Advance Care Planning Can Happen Face-to-Face or via Telehealth
It is no surprise (or maybe it is?) that CMS loosened telehealth restrictions during the Public Health Emergency (PHE), and in fact has extended it through January 20, 2021. Physicians are also able to conduct telehealth consults in states where they are not licensed.
When we did a lookback (February 2020 – May 2020) on our healthcare partners we noticed some interesting shifts due to COVID-19. When we looked at digital document creation, we saw an increase in documents being created by Preparers – those clinicians who can engage an individual in conversations, fill out a document, but cannot sign that particular document, such as a POLST. In February 2020, we saw 14% of documents in our system were started by Preparers. By May 2020, it rose to 27%. As telehealth consults became more prevalent, clinicians were able to leveraging Vynca for telehealth consults, as our digital completion process made it possible to complete questions and collect all appropriate signatures.
Advance Care Planning Can (and Should) be Offered to All Medicare Beneficiaries
Approximately 1 in 3 adults has a completed advance directive. There is no significant difference in completion rates when comparing healthy individuals to those with serious illness. This creates an opportunity for improvement. Although it is not required, advance care planning should be discussed during the AWV. While the beneficiary can always decline, we recommend this become a standard in the AWV. There are so many benefits to everyone when there is a high-quality conversation and documents available to help guide care.
Vynca solutions and services help engage beneficiaries in high-quality conversations and efficiently document these conversations, which can help organizations increase ACP CPT code drops, resulting in increased revenue. More conversations result in more documents, increasing the likelihood of a document being available to help guide care. Since documents are digitally available in all care settings, this helps reduce unnecessary ED visits and hospitalizations at end of life. The result of all of this – increased shared savings. How did you do in this quality measure?