Crack the Code: Mastering ACP Regulations!

Part Five of Our Six-part Series: Confronting Advance Care Planning Misconceptions

In this installment of our riveting ACP Controversy series, we delve deep into the labyrinth of regulatory mandates for advance care planning (ACP) – for many a complex yet crucial area often navigated with trepidation. Here we’ll present the challenges, then present technology solutions and strategies to facilitate compliance.

Understanding regulatory mandates for ACP completion and use.

The path towards value-based care requires healthcare payers and providers to truly comprehend and fulfill the actual priorities and preferences of the people they serve. Congress, acknowledging this necessity, passed the Patient Self-Determination Act of 1990. The Act mandates healthcare institutions, including hospitals, nursing homes, home health agencies, health maintenance organizations, and hospices, to inquire about existing advance directives and respect these patient wishes, particularly in terminal illness scenarios where decision-making capacity is compromised.

Further, the Centers for Medicare and Medicaid Services (CMS) have structured incentives within public and private insurance plans to stimulate advance care planning. These initiatives are particularly targeted at critical junctures, such as the time of enrollment or annual wellness visit.

The logic is simple: If we want to champion value-based care, we must, at every opportunity, solicit, understand, and deliver on patient values.

ACP: Why it’s a priority for healthcare payers and providers.

ACP's significance in value-based care models has been surging since 2016 and has rapidly gained momentum with the recent CMS mandates. A critical component of these mandates is the Wellness and Health Planning (WHP) ACP requirement, which compels value-based insurance design (VBID) plans to provide an evidence-based strategy to:

1. Ensure all members/enrollees are offered ACP promptly,
2. Track and measure strategy effectiveness, and
3. Engage network providers in ACP.

Moreover, Medicare Advantage Organizations (MAOs) are required to establish policies and procedures to educate members about their rights for treatment decisions and creating ACP documents, as well as promote community awareness.

CMS has also streamlined its legacy quality programs for fee-for-service providers under the Merit-Based Incentive Payment System (MIPS). The MIPS Measure 047 Advance Care Plan allows clinicians to submit performance data on key ACP factors, including ACP documentation in medical records, designation of a surrogate decision maker, and patient engagement in ACP discussions.

The digital approach to meeting CMS ACP requirements.

To meet CMS requirements, healthcare payers and providers must make strategic investments in electronic infrastructure. Innovative leaders are now employing technology to help patients appoint a healthcare agent, share their values, and provide crucial contact information. In fact, ADVault's MyDirectives for Clinicians and MyDirectives Reports & Analytics™ tools offer the vital performance data to monitor ACP program effectiveness and compliance.

However, the digital path to compliance isn't without its pitfalls. Recent audits by the Office of Inspector General (OIG) revealed substantial non-compliance among Medicare providers when billing for ACP services, that lead to an estimated loss of $42.3 million during 2019 alone. The OIG has since recommended that CMS educate providers on ACP documentation and time requirements, as well as recoup payments for services paid in error.

Complex compliance calls for best practice software solutions.

ADVault's advanced software solutions offer a comprehensive package for navigating the complex ACP compliance landscape including reports and analysis, management dashboard, compliance and reimbursement reports, data exporting, and eligibility file integration.

Through detailed transaction-level data recording, time-tracking for CPT billing codes, and rigorous reporting mechanisms, the software simplifies compliance with Medicare and healthcare payer mandates. What’s more, it further boosts Five-Star/Quality Ratings by improving patient and family satisfaction scores.

There's never been a better time to embrace advance care planning – not just as a regulatory mandate but as an ethical imperative, a cornerstone of value-based care, and an opportunity to genuinely respect and deliver on what patients’ value most.

The ACP journey: a farewell and an invitation.

Advance Care Planning, a critical component of person-centered care, ensures medical treatment decisions align with individuals' preferences and values. Our practical guidance aims to empower healthcare payers, accountable care organizations (ACOs), medical practices, hospitals, healthcare systems, and post-acute, long-term care (PALTC) providers to promote effective ACP strategies that measurably lead to improved patient outcomes, enhanced communication, and greater satisfaction.

We hope our insights and actionable steps have equipped you to integrate ACP into your organization and champion informed decision-making. Remember, thoughtful ACP discussions and documentation empower individuals to voice their healthcare wishes, even when they cannot advocate for themselves.

Stay tuned for our recap of the ACP controversies blog post series in the Tech-Powered Advance Care Planning: A Healthcare Game-Changer. Be sure subscribe to our blog for updates, and don’t hesitate to reach out with any questions or for further support in your ACP ventures. Together, we can create a future where advance care planning is the norm, not the exception.