Talking about advance care planning may not be the easiest thing to do, but it is a critical discussion to have with your patients.
Voice Your Choice can support advance care planning in your practice or institution by providing tools and resources to get the conversation started and help your patient complete their advance care plan.
Voice Your Choice also provides multilingual patient resources including webinars, guides, and resource sheets in English, Spanish, Chinese, French, Korean, Russian and Vietnamese.
These “mini” webinars last between 5-10 minutes and provide information and tools to support you and your patients in advance care planning.
What does Voice Your Choice mean by the term advance care planning?
Advance care planning is thinking about, and documenting, preferences concerning the care and medical treatments a person would want to receive if they become unable to speak for themselves during a medical emergency or serious illness. Advance care planning also includes choosing a health care agent. An advance directive—a term providers may be more familiar with—is a document that contains advance care planning information. For more information about advance care planning, click here.
What is the benefit of creating an online advance care plan through Voice Your Choice?
Online advance care planning enables an advance directive to be more accessible in an emergency and portable across sites of care. The online platform used by Voice Your Choice has been approved by the State of Maryland and is integrated with CRISP – Maryland’s health information exchange. With an online advance care plan, a patient’s loved ones no longer have to worry about locating the plan during a health care crisis. Online advance care planning is available 24 hours a day, 7 days a week making it easy to make changes. And in Maryland, online advance care plans do not need two witnesses, making the process contact free. There is no cost to create an advance care plan online with the Voice Your Choice program. For more information about the benefit of online advance care planning, click here.
Who can be a health care agent?
In Maryland, a health care agent must be at least 18 years old and cannot be the patient’s own doctor. Aside from these two requirements, anyone the patient feels can speak for them if they cannot speak for themselves during a health care crisis can be their health care agent. A health care agent could be a spouse, family member, friend, neighbor, or whomever the patient trusts to speak for them. A health care agent should be someone who knows the patient well and understands their wishes. Health care agents can advocate for a patient ONLY when the patient is unable to speak for themselves, and health care agents cannot make any financial decisions on behalf of the patient. For more information about who can be a health care agent, click here.
What is the difference between an advance care plan and a MOLST?
An advance care plan (sometimes called a living will or advance directive) is a legal document that provides general information about what type of care and treatments an individual would want if they became unable to speak for themselves due to a medical emergency or a severe illness. An advance care plan legally designates a health care agent and is signed by the individual completing the form. It is a good idea for all adults to have an advance care plan.
A portable medical order, called a “MOLST” (Medical Orders for Life-Sustaining Treatment) in Maryland, is a medical order that is appropriate for individuals with a severe illness or frailty nearing the end-of-life. MOLSTs must be followed in all medical settings and by emergency medical services personnel. A health care provider fills out and signs a MOLST form. For more information about the difference between an advance care plan and a MOLST form, click here.
How do providers access an online advance care plan in a medical crisis?
In Maryland, health care providers can access online advance care plans created through Voice Your Choice in CRISP – Maryland’s health information exchange. CRISP allows hospitals and health care providers to have easy access to advance care plans in an emergency and makes the plan mobile across different types of care settings. Outside of Maryland most hospitals and a significant number of providers have access to the online platform. For detailed information on how to find an advance care plan in CRISP click here.
Will I be reimbursed for having advance care planning conversations with my patients?
Yes. Medicare reimburses providers for their time talking to patients about advance care planning under CPT codes 99497 and 99498. Reimbursement is for in-person, telehealth, and telephonic visits. You will be compensated for your time, regardless of whether or not the patient completes an advance care plan but the conversation must be documented in the chart. Most commercial insurers also cover advance care planning conversations as well. For more information about reimbursement for advance care planning conversations, click here.
HOW DO I HOLD A CONVERSATION ABOUT ADVANCE CARE PLANNING WITH MY PATIENTS?
Advance care planning conversations can begin by talking about who would speak for the patient during a medical emergency if they were not able to speak for themselves. The next step would be to support the patient in determining their health care treatment preferences based on their values, health status, treatment outcomes, and any faith or religious beliefs. For more information about how to hold high quality and effective advance care planning conversations, click here.
MY PATIENTS ARE MOSTLY YOUNG AND HEALTHY, WHY DO THEY NEED AN ADVANCE CARE PLAN?
Any person may be in a position where they cannot speak for themselves. Accidents or serious illnesses—such as COVID-19—can affect a person at any time. Having an advance care plan in place ensures that you, and your patients, are prepared for a health care emergency. For more information about the importance of advance care planning for all ages, click here.
What if a person changes their mind about what they want after completing the online advance care plan?
The online advance care planning platform is available 24 hours a day, seven days a week. Unlike paper advance care plans that must be destroyed and recreated if altered, online advance care plans can be changed at any time. As an extra safety precaution, there is a document history that tracks all changes. For more information about completing or updating an online advance care plan, click here.
Does the online advance care plan need to be witnessed or notarized?
In Maryland, the advance care plan that is completed via the online platform does not require a witness or a notary to be valid. The patient will, however, need to validate their identity
MY PATIENT HAS AN EXISTING ADVANCE CARE PLAN, CAN THEY STILL USE THE ONLINE PLATFORM?
Yes. The online platform allows individuals to upload an existing paper advance care plan. The platform also provides the opportunity to upload, store, and share other documents such as a MOLST, personal papers, notes to loved ones, or videos in a secure format. There is no cost to upload an existing advance care plan to the online platform. For more information about uploading existing document, click here.
Where can I find help for my patients to create an online advance care plan or upload an existing paper plan?
Voice Your Choice has a complete set of online resources, including materials translated into six languages, that can help support you and your patients with online advance care planning or uploading an existing advance care plan. The resources include pre-recorded webinars, step-by-step guides, documents with additional information, and answers to frequently asked questions. To access community resources, click here. To access provider resources, click here.
Should I create an advance care plan for myself?
Absolutely! Health care providers serve our community everyday by being on the front line and are at risk for exposure to communicable diseases. It is critical to designate someone to speak for you if you cannot speak for yourself during a medical emergency. To view an advance care planning webinar created for medical providers, click here. There is no cost to create an online advance care plan through the Voice Your Choice platform.