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HEALTHCARE JOURNAL OF BATON ROUGE I  JUL / AUG 2020 41 she develops a terminal condition and is incapacitated. It can be completed at any time, and should be reevaluated period- ically, especially when a person’s health situation changes. A healthcare power of attorney is a document indicating the per- son should make medical decisions in the event the patient loses capacity to make his or her own choices. This person should be knowledgeable about the patient’s medical condition and preferences. The LaPOST (Louisiana Physician’s Orders for Scope of Treatment) is a list of physician orders specific to resuscitation preferenc- es and interventions for patients in the last few months of life. For a patient who has no medical problems, a Healthcare Power of Attorney (HCPOA) may be the only ad- vance directive needed. For any adult patient who is diagnosed with cancer, an HCPOA may be the first step. As the disease develops and the prog- nosis becomes clearer, more specific opin- ions may form leading to the creation of a living will. When it becomes certain that a patient is entering into the terminal phase of the disease, being even more specific with a physician’s order is important, and that is where the use of the LaPOST doc- ument is helpful. The bottom line is that normalizing this process provides the best care for patients. n Mary C. Raven, M.D. , is board certified in both internal medicine and palliative medicine. She is director for the Outpatient Palliative and Sup- portive Care Clinic at Mary Bird Perkins – Our Lady of the Lake Cancer Center. She specializes in symptom management, as well as communi- cation about treatment goals and advance care planning. She currently serves on the Colorectal, Head & Neck and Lung Multidisciplinary Care Teams (MDC) at the Cancer Center. A recent study from the Journal of Pain and Symptom Management showed that patients who have engaged in ACP with their provider, or completed an advance directive, are less likely to receive life pro- longing treatments at the end of their lives. ACP not only improves the quality of care at the end of life by honoring a patient’s wishes, but it also has the potential to low- er unnecessary cost. Given the fact that 80 percent of patients who die each year are Medicare beneficiaries, Medicare has be- come the primary insurer of patients in the last year of life. One-fourth of all Medicare expenditures occur during this time. In 2016, in acknowledgment of the im- portance of ACP, and to address the con- cern about time constraints associated with ACP conversations, Medicare began paying clinicians for conducting ACP dis- cussions. Current Procedural Terminology (CPT) codes 99497 and 99478 were intro- duced. They can be billed alone or in ad- dition to the Evaluation and Management (E/M) charge for the visit. With regard to the concern about caus- ing psychological harm by having these conversations, evidence shows that pa- tients do not have any lasting psycho- logical damage from discussing these important subjects. Additionally, patients often feel a lack of control over their lives while living with a serious illness such as cancer. The ACP process can empower patients by allowing them the opportu- nity to control these important aspects of their care. Therefore, physicians should be encouraged to have open and honest communication with their patients. In fact, this is how the very best care is provided. Palliative care providers are valuable in the outpatient oncology arena by offering expertise in communication, prognostica- tion, and support to the primary oncolo- gy team as they have these conversations with their patients. All adults, whether they have cancer or not, should have some form of advance di- rective. It is simply part of being prepared for the unexpected. If there is nothing else we have learned through the COVID- 19 pandemic, it is that uncertainty is a part of life. ACP addresses this uncertainty and gives the patient security in knowing that in the end, things will be carried out in the best way possible. The reality is that if a patient becomes incapacitated, without an advance directive, it becomes the families’ responsibility to make difficult end of life decisions during a time when emotions are high. This is often a fact that patients do not consider. Families who have engaged in conversations about this ahead of time tend to be better prepared than those who do not. It can remove significant family member burdens when they do not have to guess what their loved one would want, and instead becomes a matter of honoring the individual’s previously stated desires. Still, this discussion should begin with the healthcare provider. While patients and families want to discuss end of life deci- sions, they rely on the physician’s expertise to guide them and start the conversation. In Louisiana, there are three main types of advance care planning documents: a living will, a healthcare power of attor- ney, and the LaPOST. The living will is a document that articulates a patient’s preferences for care in the event he or Mary Raven, MD Internal Medicine & Palliative Medicine Mary Bird Perkins–Our Lady of the Lake Cancer Center