ACP American College of Physicians - Internal Medicine - Doctors for Adults

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Annual Wellness Visit to Provide Personalized Preventive Plan Benefit

Annual Wellness Visit Benefit Overview

Does ACP support advance care planning as a voluntary element even though it is not identified as a component of an AWV service?

Yes. ACP support for voluntary advance care planning played a role in the CMS decision to include it as an optional AWV element prior to withdrawing it in early January 2011. Specifically, ACP believed that the CMS failure to include it as an element in its July 2010 proposed 2011 AWV service rules was an oversight and the College urged CMS to add it as a voluntary component when setting the final 2011 rules. The ACP reasoned that it is appropriate for physicians to engage competent adult patients in a discussion of their values and preferences and to establish and maintain advance care plans. The College noted that studies show that patients who engage a physician in advance care planning experience less anxiety and are more likely to continue the dialogue with family and other caregivers. It pointed out that Congress recognizes the appropriateness and value of these discussions as it explicitly included advance care planning as a required component of the Initial Preventive Physical Examination/Welcome to Medicare visit. CMS accepted the recommendation from ACP and others and listed voluntary advance care planning as an element when it released the final 2011 AWV rules in November 2010. ACP is disappointed that decided to withdraw the reference to voluntary advance care planning in early January 2011. The College does, however, understand the CMS rationale—that the agency provided insufficient opportunity for robust public debate by failing to mention it as an element in its July 2011 AWV proposed rules. The College looks forward to additional discussion of the appropriateness of advance care planning and end-of-life care issues. In the meantime, ACP encourages internists to engage in advance care planning if the physician and the patient determine it is beneficial.

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