PAR Advance Directives and Patient Consent 1 — Questions and Answers
Question 1: What is an advance directive?
- A billing document submitted to insurance prior to service
- A legal document expressing a patient's healthcare wishes if they become unable to make decisions (Correct answer)
- A hospital policy outlining treatment protocols for emergency cases
- A physician's standing order for routine patient care
Correct answer: A legal document expressing a patient's healthcare wishes if they become unable to make decisions
An advance directive is a legal document that outlines a patient's healthcare preferences and designates a decision-maker in the event they lose decision-making capacity.
Question 2: Which federal law requires hospitals participating in Medicare and Medicaid to inform patients of their rights regarding advance directives upon admission?
- HIPAA (Health Insurance Portability and Accountability Act)
- EMTALA (Emergency Medical Treatment and Labor Act)
- PSDA (Patient Self-Determination Act) (Correct answer)
- ACA (Affordable Care Act)
Correct answer: PSDA (Patient Self-Determination Act)
The Patient Self-Determination Act (PSDA) of 1990 mandates that healthcare facilities receiving Medicare/Medicaid funding must inform adult patients of their rights to make healthcare decisions and ask about existing advance directives.
Question 3: What does a Do Not Resuscitate (DNR) order specify?
- The patient refuses all medical treatment while hospitalized
- Cardiopulmonary resuscitation (CPR) should not be attempted if the patient's heart or breathing stops (Correct answer)
- The patient wishes to be transferred to a different facility if their condition worsens
- The patient declines surgical intervention under any circumstances
Correct answer: Cardiopulmonary resuscitation (CPR) should not be attempted if the patient's heart or breathing stops
A DNR order is a physician's order, based on patient or surrogate wishes, that instructs medical staff not to perform CPR in the event of cardiac or respiratory arrest.
Question 4: What is a living will?
- A financial document directing how a patient's assets should be distributed after death
- A type of health insurance policy that covers end-of-life care costs
- A written statement detailing the medical treatments a patient wants or does not want under specific conditions (Correct answer)
- A contract between a patient and physician outlining ongoing care responsibilities
Correct answer: A written statement detailing the medical treatments a patient wants or does not want under specific conditions
A living will is an advance directive in which a competent person documents the specific medical treatments they want or do not want if they become incapacitated and face a terminal condition or permanent unconsciousness.
Question 5: What is the primary role of a Patient Access Representative (PAR) when a patient arrives without an advance directive?
- Refuse admission until the patient completes an advance directive
- Provide the patient with written information about their right to create an advance directive (Correct answer)
- Contact the patient's next of kin to create one on the patient's behalf
- Notify the attending physician that no advance directive exists before treatment begins
Correct answer: Provide the patient with written information about their right to create an advance directive
Under the PSDA, PARs must provide patients with written information about their rights to execute advance directives; they cannot require patients to have one as a condition of admission.
Question 6: A Durable Power of Attorney for Healthcare (DPOA-HC) allows a designated agent to:
- Manage the patient's financial accounts and medical billing during hospitalization
- Make legally binding healthcare decisions on behalf of an incapacitated patient (Correct answer)
- Override a physician's treatment recommendations regardless of the patient's condition
- Access the patient's medical records without HIPAA authorization
Correct answer: Make legally binding healthcare decisions on behalf of an incapacitated patient
A DPOA-HC designates a healthcare proxy or agent who is legally authorized to make medical decisions on behalf of a patient who has lost decision-making capacity.
Question 7: When must a hospital document in a patient's medical record that advance directive information was provided?
- Only if the patient requests documentation
- At every subsequent visit after the initial admission
- Upon admission, as required by the Patient Self-Determination Act (Correct answer)
- Only when a patient has an existing advance directive on file
Correct answer: Upon admission, as required by the Patient Self-Determination Act
The PSDA requires that documentation of advance directive information given to the patient be included in the medical record at the time of inpatient admission.
PAR Advance Directives and Patient Consent 1
What is an advance directive?