2. Advance Care Planning: Learning Opportunities for Primary Care Practitioners

3. End of Life Care Program Person-centered care honoring individual preferences Sarah Lawrence established End of Life Care Program on person-centered foundation Dignity in health care at all ages, stages of life Increase knowledge of, advocacy for, and access to comprehensive care Provide in-depth training in advance care planning

4. Advance Care Planning

5. Purpose of the presentation New CPT Codes 99497 and 99498 Opportunity 1: One-hour webinar with Patricia Bomba, MD, FACP – advance care planning in your practice; March 22 Opportunity 2: Advance Care Planning for Primary Care Practitioners – a four-course certificate

6. Medicare Part B ACP Reimbursement—Jan 1, 2016 The News Advance care planning for patients Medicare reimbursements for eligible practitioners What does that mean? ACTIVE Codes 99497 and 99498 are now ACTIVE on the 2016 fee schedule Eligible practitioners are physicians, physician’s assistants, nurse practitioners, licensed clinical social workers

7. Advance Care Planning Codes What do practitioners talk about? Quality of life expectations through transitions in health Patient’s preferences for treatment and options for achieving goals Advance care planning tools – e.g., living wills, health care proxies, and more Advance care planning forms

8. Other ACP Characteristics Who starts the conversation? Patient can initiate conversation Physician can initiate when there has been a change in status or a transition in care Advance care planning is voluntary, patient’s discretion Face-to-face only; no telemedicine Patient must be present unless he or she lacks capacity

9. Incorporating ACP into the Practice

10. Medicare Support for ACP Why are there two codes? 99497 applies to the first 30 minutes of an advance care planning discussion 99498 applies to each additional 30 minutes (in conjunction with 99497) Codes do not exclude other members of a practice from taking part, but Billing practitioner must “manage, participate and meaningfully contribute to the provision of these services”

11. Medicare Support for ACP When can the codes be used? Same day as other evaluation/management (E/M) visits, transitional care management (TCM), or chronic care management (CCM) visit Annual Wellness Visit (AWV) – no cost sharing No active clinical management takes place No limit on number of times matter is discussed cannot Codes cannot be used in certain critical care and intensive care situations

12. Advance Care Planning Conversations What if I can’t answer all my patient’s questions? CMS.gov National Hospice and Palliative Care Organization American Academy of Hospice and Palliative Medicine End of Life Care Program Compassion and Support at the End of Life

13. CPT Codes for ACP and POLST Live Webinar with Patricia A. Bomba, MD, FACP March 22, 2016 11:00AM-12:00PM Eastern Time Registration at End of Life Care Program End of Life Care Program

14. CPT Codes for ACP and POLST Patricia A. Bomba, MD, FACP Expert in palliative and end of life care Member, National POLST Paradigm Task Force What will be covered Advance care planning spectrum How and when to use Codes 99497 and 99498 Advance directives (general principles and legal forms) Overview: National POLST protocols

15. Certificate: Advance Care Planning for Primary Care Practitioners

16. Contribute to comprehensive care culture through education Encourage expression of patient wishes throughout care journey Focus on key skills for practitioners Aid in delivery of service consistent with Medicare Part B

17. ACP for PCPs: The Courses Four one-hour online courses emphasizing advance care planning in the office setting Why Advance Care Planning and Skills for Performing It The Patient and Legal Aspects of ACP From Quality of Life Conversation to Completing ACP Forms Putting ACP Into Practice – A Live, Remote Simulation All four courses comprise the certificate

18. ACP for PCPs: The Teachers Seasoned faculty with broad experience Health law Patient representation, advocacy Medical family practice Medical practice education

19. More about the Certificate When is the certificate program available? Courses available online beginning in April 2016 SLC sponsoring CME, Nurse CE and MSWCE units through joint providership with National Hospice and Palliative Care Organization (NHPCO) Descriptions, fees, and registration information at End of Life Care Program (https://www.sarahlawrence.edu/ce/eol.html)https://www.sarahlawrence.edu/ce/eol.html

20. Contact: Rebecca O. Johnson Associate Program Director Graduate and Professional Studies rjohnson@sarahlawrence.edu (914) 395-2316 End of Life Care Program Sarah Lawrence College

21. quality of life through the end of life “…a person-centered, family-oriented approach that honors individual preferences and promotes quality of life through the end of life should be a national priority.” Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life Institute of Medicine, 2014