In normal times, Advance Care Planning (ACP) is already part of high-quality primary care. During the COVID 19 public health emergency, it is crucial that providers add it to their planned movement to virtual care. While many areas have yet to see large numbers of COVID-19 infections, the threat of this virus spreading through any community will remain until we have a vaccine. For older patients and those with chronic conditions, this means preparing for the possibility of serious illness for the next year or more.
 
While people are sheltering in place, it is a good time to reach out and let patients know you are available for telehealth visits, for acute problems and to manage chronic conditions. Using these visits to check in with all older patients to review goals of care and advance care planning will provide guidance to physicians and family alike if your patient gets hospitalized with COVID-19. There is no co-insurance fee if this is done during the annual wellness visit and the fee can also be waived if provided via telehealth.
 
Patients can be assured that ACP is truly a gift to loved ones and family members who will be relieved to know this has been discussed and wishes have been documented. Otherwise, the burden is on loved ones, who will likely feel overwhelmed.

Wondering how to approach this and where to begin? First let the patient know you are reviewing this with all your patients at higher risk from this virus because of age or chronic/serious conditions. Then ask if the patient is ok to talk about their wishes with you. Using open ended questions, you will quickly get a sense of how much they have been thinking about this and if they have strong feelings about the care they would or would not want to receive. For many patients, you may be the first to ask them about how they are doing and any fears they are having during this stressful time. Expect emotions and acknowledge that this may be hard to talk about.

Some suggested basic questions adapted from vitaltalk:

  • How are you doing with all of this?
  • What have you been thinking about COVID-19 and your situation/health?
  • Is there anything you want us to know if you get COVID-19 and get very sick?
  • Who is your backup person to help make decisions for you if you can’t speak? (Do they have an AHCD?)
  • We’re in an extraordinary situation. Given that, what matters most to you (about any part of your life and about your health care)?

ACP conversations can be furnished as part of any telehealth E&M visit and billed as a separate service as long as 16+ minutes are spent on this in fee-for-service clinics. Rural health clinics and FQHCs can bill this as a standalone telehealth visit. 
 
Find more information at https://www.vitaltalk.org/.

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