Advance Directives: Ensuring Compliance with CMS 2025 (W5032)-Advance Directives: Ensuring Compliance with CMS 2025 Presentation

Advance Directives: Ensuring Compliance with CMS 2025 Presentation

Pdf Summary

This comprehensive presentation by Laura A. Dixon, Esq., a healthcare legal and risk management expert, focuses on advance directives (AD) and compliance with Centers for Medicare & Medicaid Services (CMS) regulations in healthcare settings, particularly hospitals and critical access hospitals (CAHs). <br /><br />Advance directives are legal documents that enable patients to express their healthcare preferences in case they become incapacitated. Types include living wills, durable power of attorney for healthcare (DPOA), Do Not Resuscitate (DNR) orders, organ donor cards, psychiatric advance directives, and visitation directives. State laws, federal laws including the Patient Self Determination Act (PSDA), CMS hospital Conditions of Participation (CoPs), and Joint Commission standards govern their use. Hospitals are required to inform patients of their rights to make ADs, document ADs in medical records, comply with patient wishes, and educate staff.<br /><br />Key legal cases such as Karen Ann Quinlan, Nancy Cruzan, and Theresa Schiavo highlight patients' rights to refuse life-sustaining treatment and the complexities in honoring ADs. Failure to comply with ADs can lead to significant legal liability, demonstrated by a $16.5 million malpractice verdict for disregarding an AD.<br /><br />CMS surveyors assess hospital compliance by reviewing policies, patient notifications, medical records, staff education, and honoring of ADs. Hospitals must provide notices in understandable language and offer interpreter services if needed. Conscience objections by staff or institutions are permitted only under specific conditions and must be clearly communicated without discriminating against patients.<br /><br />The presentation also details professional position statements on handling DNR orders in perioperative and anesthesia settings, emphasizing respect for patient autonomy, clear communication, documentation, and individualizing resuscitation efforts. POLST/MOLST forms are discussed as medical orders reflecting patients’ wishes across care settings.<br /><br />Medicare reimburses physicians for advance care planning discussions, which have increased significantly, helping improve patient-centered care outcomes, reduce unnecessary interventions, and support dying in preferred locations.<br /><br />The appendix provides numerous resources and links for further education on advance directives, legal guidance, and professional standards to ensure healthcare providers comply with regulations while respecting patient rights and preferences at end of life.

Keywords

Advance Directives

CMS Compliance

Healthcare Law

Patient Self Determination Act

Living Wills

Durable Power of Attorney

Do Not Resuscitate Orders

Hospital Conditions of Participation

Medical Ethics

Advance Care Planning