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AWV Advanced Care Planning
AWV Advanced Care Planning

How to Complete the Advanced Care Planning Portion of the Annual Wellness Visit

Joel Barnes avatar
Written by Joel Barnes
Updated over a week ago

Article Section Links:

Navigate to the AWV Exam Page:

Search for the patient on the dashboard by First Name, Last Name or Patient EHR ID.

Once the patient search page loads click the the patient's EHR ID, patient name, or "View" button located underneath the "Actions" column.

On the patient view page, select the "Programs" tab and view the "AWV" option.

Under the "Current Annual Wellness Visit" section, click the "Open AWV Page" button highlighted below.

Starting a Patient's Advanced Care Planning Portion:

Once on the patient's AWV exam page, click the empty bubble located above the "Advanced Care Planning" section. Users can also select the green "Start The Next Step" button located at the bottom of the page to navigate to the next portion of the patient's AWV.

The patient reported answers from the patient questionnaire will appear on the right hand side of the "ACP" screen.

Note: Make sure the patient understands that there is no copay if they participate in the ACP during their Annual Wellness Visit.

If the patient wishes to complete the ACP at a different time, they should be notified that they may have a co-pay. Click the blue button labeled "Patient will Begin ACP at a Later Date".

Note: The red "Patient Declines ACP Counseling" button and orange "Not Needed / Not Eligible" button are both additional options a user may choose when bypassing the ACP section.

Another Note: Once the ACP is declined the ability for the patient to take the ACP will be revoked. However, the patient will have the opportunity to take it again next year.

Beginning the ACP:

If the patient wishes to continue with the ACP during their AWV simply click the "Patient Consents to ACP Counseling - Begin Now" button.

Whenever you begin a patient's ACP it will appear below your patient reported answers section. Scroll down the page to view the patient's ACP questions.

Canceling The ACP Once Started:

If at any time you would like to cancel the ACP click the "Cancel ACP" drop-down button, and select the reason why the patient if declining the ACP.

Completing the Patient's ACP:

The first question a user will come to in a patient's ACP is for selecting the types of topics discussed with the patient. The options listed are:

  • Purpose of Advanced Care Planning

  • Practical applications in the future (examples of situations based on the beneficiary's current medical conditions)

  • Reversibility of decisions made - responsible party

  • Explanation of Living Will

  • Explanation of Durable Power of Attorney (POA)

  • Do Not Resuscitate (DNR)

  • Organ and Tissue Donation

  • ICDs and pacemakers

Note: Select all topics covered during the patient's ACP.

The next four questions of the ACP (Numbers 2-5), are open ended. As shown below, click within a target text box and begin typing to record the patient's answers to each question.

Once all ACP answers have been recorded, click to select how much time was spent completing the patient's ACP in question 6.

Note: If a user has spent 30 minutes completing the ACP with the patient, just the first checkbox should be selected. If the user spent 60 minutes completing the patient's ACP both the first and second checkbox should be checked (if 90 minutes, all three should be checked).

When question 6 is completed, the user should then record the date in which the ACP was finished, click within the "Date Completed" box to select a date from the dropdown calendar.

Next, click to select the date in which the user completed the ACP with the patient.

Note: The current date will automatically be highlighted/selected in blue within the calendar.

Once the completed date is recorded, click within the "Provider for the ACP" dropdown.

Now, begin typing or click within the dropdown list to select the user who provided the patient's ACP.

Finishing the ACP:

Whenever you have finished the ACP discussion with the patient, make sure to choose the correct billing codes in question "6". Then, mark the section as completed by choosing the provider and date in which the ACP was completed, and click "Save and Complete".

Note: If you would need to change the date of the ACP the option to do so is located next to the "Save and Complete" button.

ThoroughCare will ask you if you are sure you want to complete the ACP. Click "OK" to continue.

Once the ACP discussion is finalized, a green checkmark will appear within the "Advanced Care Planning" bubble.

For more information on finishing the patient's ACP, not discussed in this article, chat with a ThoroughCare professional by clicking the blue chat bubble in the bottom right hand corner of every ThoroughCare screen!

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