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Transparency key to delivering Advanced Directive

Patient Access Weekly Advisor, February 13, 2008

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It all comes back to the front end in the healthcare revenue cycle. It is certainly true with Advance Directive forms. The forms, to be completed by patients in case they are unable to make medical decisions for themselves, most often are presented by patient access staff members. But any lack of communication among access, nursing, and case management staff members can lead to unnecessary confusion and headaches come compliance checks.

Mandatory requirements from CMS, including the Fair Patient Billing Act, are on the minds of access managers lately. The goal is to comply and present Advance Directive forms in the most patient-friendly, transparent way. The responsibility lies with access staff members to ask whether patients have or need a form.

"My staff are informed during training on how to ask," says Vonda DeLorenzo, patient registration supervisor at Central Michigan Community Hospital in Mt. Pleasant. "For example: 'I see that you don't have an Advanced Directive for Healthcare. Would you like a copy?' "

And what if a patient asks about the form? DeLorenzo says they explain it as if it were a "living will," although Michigan doesn't recognize that term.

"It is where you set up in advance your medical wishes should you become incapacitated and are unable to speak for yourself regarding your medical care," DeLorenzo adds. "You usually appoint an advocate who will act on your behalf, and [he or she has] to agree to act on your behalf. We try to keep it short and sweet and not spend too much time on it. Very few people are interested. You always get the one who wants to know if they are going to die today."

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