Advance Care Planning Among Patients With Advanced Illness Presenting to the Emergency Department

Abstract

Background: Advance care planning (ACP) benefits emergency department (ED) patients with advanced illness. Although Medicare implemented physician reimbursement for ACP discussions in 2016, early studies found limited uptake.

Objective: We conducted a pilot study to assess ACP documentation and billing to inform the development of ED-based interventions to increase ACP.

Methods: We conducted a retrospective chart review to quantify the proportion of ED patients with advanced illness with Physician Orders for Life-Sustaining Treatment (POLST) or coding of ACP discussion in the medical record. We surveyed a subset of patients via phone to evaluate ACP participation.

Results: Of 186 patients included in the chart review, 68 (37%) had a POLST and none had ACP discussions billed. Of 50 patients surveyed, 18 (36%) recalled prior ACP discussions.

Conclusions: Given the low uptake of ACP discussions in ED patients with advanced illness, the ED may be an underused setting for interventions to increase ACP discussions and documentation.

Keywords: Advance care planning; Advance directive; Advanced illness; Emergency department; POLST; Reimbursement.