Effective January 1^st, allied health professionals are able to take an expanded role in end-of-life planning. California has updated its Physician Orders for Life-Sustaining Treatment (“POLST”) form, a document used to record a person’s wishes regarding the provision of life sustaining treatment for use in the event of future incapacity. The update allows nurse practitioners and physician assistants to execute a POLST under the supervision of a physician, and adds a signature line for them to do so.

In substance, the new POLST form is identical to the current form. It provides a means for representing a person’s wishes for his or her care in the event of incapacity or inability to communicate, and is treated as a medical order. The form is intended to communicate the extent of life-sustaining treatment that the patient wishes to receive, and to prevent unwanted interventions. It addresses the provision of cardiopulmonary resuscitation (CPR) if the patient is found with no pulse or breathing (Section A), the degree of medical intervention if the patient is found with a pulse or still breathing (Section B), and the patient’s preferences regarding artificially administered nutrition (Section C). A “health care provider” ( defined as any licensed health care professional) must explain the form to the patient or a legally appointed decision maker who can convey the patient’s wishes. A health care provider also must complete the form.  Although the law does not require it, this presumably will be the same individual who provided an explanation of the form.

Until this revision, only a physician could sign a POLST. Now a nurse practitioner or physician assistant can do so if acting under a physician’s supervision within their scope of practice. A POLST will be treated as a medical order, whether signed by a physician, a nurse practitioner, or a physician assistant. The POLST form remains the same, except for the addition of a new signature line labeled “Physician / Nurse Practitioner / Physician Assistant” and a line for identifying the supervising physician of any nurse practitioner or physician assistant who has signed the form.

Before a nurse practitioner or physician assistant may execute a POLST, even under supervision of a physician, it must be within their scope of practice. The Coalition for Compassionate Care of California recommends that nurse practitioners’ standardized procedures and physician assistants’ Delegation of Services Agreements be amended to include language clarifying that the individual is authorized to discuss preferences for treatment options in the event of a serious illness with patients or their decision makers, and to sign POLST forms which are consistent with patients’ medical condition and preferences.

Providers billing Medicare should also be aware that new billing codes (99497 and 99498) have been added for advanced care planning. Those codes may be used by licensed health care practitioners, including physicians and non-physicians, whose scope of practice and Medicare benefit category include the described services.

Copies of the updated POLST form may be downloaded from www.caPOLST.org or purchased from MedPass at http://med-pass.com. While the form will be honored on any color paper, it is recommended that the form be copied or printed on 65# Ultra Pink card stock to distinguish it from other medical forms and to make it easily identifiable by the providers who may be called upon to honor it.