State Strategies to Promote Advance Care Planning in Light of the Pandemic
University of Michigan’s poll on health aging found out 59% of the elderly discussed advance care planning with their family or friends. A third discussed advanced care within 90 days of the Covid-19 pandemic. However, about 50% of the older adults did not complete the required legal documentation.
State policymakers can implement strategies to ensure systematic documentation and use of these tools to promote good care. They also implement them to avoid unwanted and costly treatments for individuals with serious illnesses. The state strategies below support advanced care planning.
Provider licensure, regulation, and guidance
States can disseminate guidance for the providers by fostering advanced care planning. They can also adopt practices in payment and licensing regulation. For example, licensing regulations by Maryland hospitals outline staffing and other hospital standards. They include completing MOLST (Medical Orders for Life-Sustaining Treatment) forms in adherence to the state law.
The New York health department permitted the use of MOLST form to assist healthcare providers in implementing patient wishes concerning life-sustaining treatments.
Reimbursement
A State Medicaid program can refund for any advance care. They return through HCPCS and CPT. In addition, research by NASHP identified codes that providers can use for billing key services.
States may provide providers with additional guidance on using codes as they are helpful tools for tracking service occurrence and supporting best practices. California in its policy guidance provided billing code examples for palliative care service and advanced care planning.
Value-based purchasing
Federal regulations require states to ensure the information on exercising the right to advanced directive reaches those who enroll for Medicaid-managed care plans. However, some states surpass the baseline requirement by encouraging advance care planning using value-based payment.
Illinois is a part of the state Financial Alignment Demonstration. Its Medicaid managed care framework includes HEDIS (Healthcare Effectiveness Data &Information Set). Care for the elderly measure works out a percentage of enrollees aged 66 and above who received 4 essential services within a measurement year.
Registries
A number of states created repositories for keeping patients POLST forms fort health care providers to find them when needed. For example, Oregon owns a statewide POLST registry. The registry within Oregon Health Authority is a public health registry. OHSU Department of Emergency Medicine operates it on contract. POLST order requests have reached their highest since the offset of the pandemic.
ASHP supports state policymakers to enhancing care of patients with severe illnesses. It has documented policy activities in US states and drafted recommendations to enable them in advancing healthcare.