Advance Care Planning: The Crisis That Is Leaving Money On The Table and Patients In Limbo

By Christopher Hughey

Today’s blog is by Fast Layne Solutions CEO Christopher Hughey. You can follow him on LinkedIn.

Five-minute read.

“Crisis” and “American healthcare” are two terms we hear used together all too often these days, whether it’s the unsustainable rate of inflation of costs, number of uninsured, or the strain that the pandemic is putting on our resources. 

But there’s another crisis broiling in our healthcare system today, and it gets zero attention in the mainstream press. Even within medical circles, it is generally ignored. It’s the crisis of Americans lacking advance care plans. 

Perhaps part of the problem is that it isn’t the most exciting subject. Who wants to listen to a podcast about a legal document? It’s not exactly the stuff of great ratings. But exciting or not, it needs our attention.

First of all, what do we mean by advance care planning (ACP)? In simplest terms, it’s just the process of making sure that patients’ wishes about their own healthcare are respected when they can’t speak for themselves. Straightforward enough, right? But since every state and territory has its own laws on the subject, creating a plan is tricky.

So why is it a crisis? Because as of 2017, a study found that only about a third of all Americans had even bothered trying to get such a document in place. And of those who did, many do not have valid ones for a number of reasons (not properly executed, created in another state and thus potentially invalid in their current state, out of date, invalid health proxy choice, the list goes on). And for those relatively few Americans who actually do have valid plans in place, many are in the form of paper documents gathering dust in a lockbox in their closet, and their families may be completely unaware of their existence. If you are in a car accident and unable to speak for yourself, what purpose does your ACP serve if the staff at the hospital and your family do not even know it exists?

The Centers for Medicare & Medicaid Services (CMS) recognized this problem for the crisis it is after they studied this issue years ago. They identified how much cost this lack of ACPs was costing the system and how much strain it was putting on families trying to make difficult end-of-life decisions. So they came up with a solution: get primary care doctors involved to make sure patients have these critical documents. That’s why, starting almost exactly five years ago, they decided to start reimbursing doctors to ensure patients got ACPs in place.

And the initiative was a complete and utter failure. Why? Because they told doctors that they themselves had to personally oversee this process. If you are a PCP doctor reading this, you are justifiably laughing at the notion that for a reimbursement of around $86, you are personally going to sit with a patient in a room and create a legal document. So in year two, CMS changed the rule and simply said that doctors must be the ones to order the ACP. For Medicare, any actual planning session carried out the day of a patient’s annual wellness visit would have the copay waived. Anyone, including non-medical staff, could do the actual session facilitation, as long as the supervising physician could be made available for any follow-up questions. 


Had CMS then initiated a major public education campaign to help Medicare patients aware of the need for ACP and to get doctors on board for ordering them, the ACP crisis might now already be a thing of the past, at least among older patients. But CMS being CMS, they didn’t. So here we are, four years later, and we haven’t seen much progress. 

Companies like Fast Layne Solutions are trying to change that, not just to address this as a healthcare crisis, but also to further our mission of helping independent physicians thrive. Which brings us back to the title of this blog: not only is the low adoption rate of ACP a healthcare crisis for patients; it’s a contributing factor to the financial crisis facing independent doctors, because it’s yet another example of how they are collectively leaving literally billions of dollars on the table in reimbursements. Companies like ours can offer cloud-based ACP solutions on a no-touch basis for independent doctors’ patients, to be billed through the practices such that the practices are reimbursed before they even owe us for the sessions. The result? The doctor’s practice is getting reimbursed for CPT codes 99497 and 99498, and patients are getting these critical planning documents stored on the cloud where they and their providers can access (and, as needed, update) them at any time. Even CMS is delighted, because they have the data to prove that when patients have ACPs, both they and the healthcare system save time, money, and stress. It is a win-win-win.

So are you leaving your patients in limbo and leaving piles of money on the table? Then reach out to us and let’s fix it.

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