In its 2022 update to the Healthcare Effectiveness Data and Information Set (HEDIS®), the National Committee for Quality Assurance's (NCQA) included a few new measures. We recently examined one such measure: "Deprescribing of Benzodiazepines in Older Adults" (DBO).
In this new blog post, we take a closer look at another of the added HEDIS measures, which concerns advance care planning (ACP), and do so with a focus on the role medication management and medications play in improving performance of this measure.
HEDIS Measures 2022: Understanding ACP and the Importance of Medication Management
Here are seven things to understand about the new advance care planning HEDIS measure and the significance of medications and medication management.
1. What is advance care planning?
The American Academy of Family Physicians provides a helpful, simple definition of advance care planning: "Advance care planning is the face-to-face time a physician or other qualified health care professional spends with a patient, family member, or surrogate to explain and discuss advance directives."
This definition brings in another term worth defining: "advance directives." Advance directives, notes MedlinePlus, are "legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on." In other words, as Medicare notes, "Advance directives explain how you want medical decisions to be made when you're too ill to speak for yourself."
2. Description of the Advance Care Planning HEDIS measure
The description of the new ACP HEDIS measure is as follows: "The percentage of adults 66–80 years of age with advanced illness, an indication of frailty or who are receiving palliative care, and adults 81 years of age and older who had advance care planning during the measurement year."
3. ACP HEDIS measure's applicable population
The new Advance Care Planning HEDIS measure applies only to the Medicare population.
4. Intent of the Advance Care Planning HEDIS measure
In describing the intent of this new HEDIS measure for 2022, the NCQA states, "Advance care planning is associated with improved quality of life, increased provider trust and decreased hospitalization. This measure will allow plans to understand if advance care planning is provided to beneficiaries who are most likely to benefit from it."
5. Advance care planning is not new to HEDIS
Advance care planning was previously included in HEDIS. Organizations were supposed to capture it as one of four indicators in the Care for Older Adults (COA) HEDIS measure. The other three indicators:
- Medication review
- Functional status assessment
- Pain assessment
As NCQA noted, the new, standalone ACP HEDIS measure is an administrative-only measure that "expands advance care planning to all Medicare Advantage plans and transitions away from the more resource-intensive hybrid reporting methodology."
The ACP indicator was removed from the COA measure for HEDIS measurement year 2022 with the approval of the new Advance Care Planning HEDIS measure.
6. Advance care planning has substantial benefits
Organizations should strive to improve the frequency that they provide advance care planning and the level of detail of advance care plans as ACP can deliver significant value to patients. The American Medical Association notes, "Although often thought of primarily for terminally ill patients or those with chronic medical conditions, ACP is valuable for everyone, regardless of age or current health status. Planning in advance for decisions about care in the event of a life-threatening illness or injury gives individuals the opportunity to reflect on and express the values they want to have govern their care, to articulate the factors that are important to them for quality of life, and to make clear any preferences they have with respect to specific interventions."
Organizations providing ACP can bill Medicare for the service using the following CPT codes:
- CPT 99497 — Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
- CPT 99498 — Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)
As the Centers for Medicare & Medicaid Services states, there are no limits on the number of times an organization can report ACP for a given patient in a given time period.
7. Where medication management factors into ACP
On the surface, medication management seem to play a fairly small role concerning advance care planning. After all, the key components of ACP, according to the book "Internal Medicine Issues in Palliative Cancer Care," are as follows:
- Understanding, reflecting, and discussing the individual's health state and care options in the context of his or her values and goals.
- Formulating and documenting a plan.
- Communicating the plan to involved loved ones and the medical team.
- Reviewing the plan periodically to ensure that it remains consistent with values and goals, especially with changes in health conditions.
- Enacting the plan under the appropriate circumstances.
But medications must be taken into consideration to effectively complete some of these components. First, it's best that an advance care plan includes information about the patient's current medications and their purposes. These details are important as a patient's family and care provider team will benefit from a complete understanding of the patient's current health situation if the patient becomes unable to make their own medical decisions.
Second, medication management should be a topic of discussion during development of the advance directive. Patients should identify whether they want to continue receiving their medications. If a patient is considering stopping one or more medication, they should understand the likely short- and long-term effects of doing so.
Third, during the development of a "living will" as part of the advance directive, patients should indicate what emergency treatments they would want to receive to keep them alive and comfortable, which could include pain medications and other drugs. Important considerations here include possible side effects, costs, and likely effectiveness of those drugs. Medications can take on particularly important roles during end-of-life care.
Improving Advance Care Planning With Pharmacists
One cannot adequately plan for their own care without considering their medications and how their regimen might change in the event of a life-changing illness or injury, or old age. Involving a pharmacist when advance care planning discussions concern medications and medication management can help ensure patients are in the best position to make sound, informed decisions. In addition, pharmacist involvement can help a patient more effectively explain to family members — who may eventually be tasked with carrying out instructions on behalf of the patient — why the patient has made those decisions.
Pharmacists are particularly well-suited to be involved in advance care planning not only because of their medications expertise. The key ACP components outlined above are similar to those associated with comprehensive medication management (CMM). Pharmacists who have experience with CMM can help their fellow care team members ensure the components for ACP are followed and completed appropriately, thus supporting the efforts of their organizations to achieve higher HEDIS quality scores while better meeting the needs of patients.
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