POLST & Public Policy: The Changing Landscape Judy
POLST & Public Policy: The Changing Landscape Judy Thomas, JD Chief Executive Officer Coalition for Compassionate Care What Is POLST? A physician order recognized throughout the health care system
Brightly colored, standardized, and portable document that transfers with the patient Enables individuals to choose medical treatments they want to receive and identify those they do not want Provides direction for health care providers during serious illness Why POLST (vs AHCD)? Age 18
Complete an Advance Directive C O Update Advance Directive Periodically N V E
R S Diagnosed with Serious or Chronic, Progressive Illness (at any age) A Complete a POLST Form T
I O N Treatment Wishes Honored POLST Updates Revised Form Effective October 1, 2014
Preliminary data POLST in SNFs Status of POLST registry Revised POLST Form The National POLST Paradigm recommends periodically updating the form based on feedback from usage in the field.
Guiding Principle for Revisions: Changes made must provide substantial and significant improvement or clarification to the form. POLST Form 2014 Key Changes Section B: Medical Interventions
Section C: Artificially Administered Nutrition Section D: Information and Signatures California: POLST Progress POLST Train-the-Trainer: Over 1,000 trained as POLST educators
The California POLST: 11 languages as well as Braille Over million forms distributed in the state POLST in Skilled Facilities California nursing home residents = 296,276 POLST completed = 181,410 (63%) Minimum Data Set (MDS) 3.0 (resident assessment form for SNF) includes questions about POLST usage
Source: 2011 Nursing Home Minimum Data Set www.cdph.ca.gov/programs/Inc/pages/mds.aspx POLST in California Hospitals 65% of hospitals have a formal POLST policy 87% of hospitals have blank POLST forms available for patients 84% have POLST education for staff
POLST in Assisted Living Facilities 85% had a specific place to keep the POLST (2012 survey assisted living facilities in the California Assisted Living Association) 74% of facilities had implemented POLST education for staff 75% admitted at least one resident who
had a completed a POLST National POLST Paradigm Programs www.polst.org *As of September 2014 Developing Programs Mature Programs Endorsed Programs
Regionally Endorsed Program Programs That Do Not Conform to POLST Requirements No Program (Contacts) Whats Next: A POLST Registry? Fulfill promise to honor wishes Quality
Research Advance Care Planning System Why is POLST Ripe for a Registry? Targeted to those likely to need medical intervention Designed for use in split second Standardized form
Healthcare provider involved in completion Theres a community the owns POLST Lessons from Oregons POLST Registry Oregon has legislative mandate On healthcare provider To submit form Whats it Take to Make a Registry Work?
IT Solution Day-to-day Operations Pilot Community(ies) Mechanism for Statewide Spread POLST Registry Legislation SB 19 (Wolk) Requires the State (CHHS) to establish an electronic POLST registry
Including rules for operation in compliance with HIPAA Healthcare provider assisting patient with completing POLST must submit form Unless patient chooses not to have it submitted EnactedLegislation 2014 Legislative Session Effective January 1, 2015
Right to Know AB 2139 (Eggman) Notification When a healthcare provider (physician, surgeon, PA, NP) makes a diagnosis that a patient has a terminal illness Requires provider to notify patient (or patients agent) of the right to receive comprehensive information and counseling regarding legal end-of-life options Notification may be provided at time of diagnosis or subsequent visit
Right to Know (cont.) AB 2139 (Eggman) Provision of Information Upon request of patient (or agent) provide comprehensive information and counseling regarding legal end-of-life options Including hospice, prognosis, refusal / withdrawal, diseasetargeted treatment, pain and symptom management, advance directive May be verbal or written, can use fact sheets / websites, can occur over time, culturally sensitive
Can transfer patient to someone else to provide the information CPR in Assisted Living AB 2044 (Rodriguez) Have at least 1 staff person trained in CPR and first aid on duty and on premises at all times Does not require staff to perform CPR on residents who request to forego resuscitation, as indicated by a POLST or DNR
A Watershed Moment for Palliative Care SB 1004 (Hernandez) Establish Standards & Provide Technical Assistance for Medi-Cal Managed Care Plans to ensure delivery of Palliative Care Services. Covered services include, but are not limited to Hospice Services Provided Concurrently with Curative Treatment Hospice Services Provided Regardless of Prognosis Other Services Determined to be Appropriate Establish Guidance on the Medical Conditions and Prognoses that render a
beneficiary eligible for the palliative care services Palliative Care Defined In Legislative Intent SB 1004 (Hernandez) Specialized medical care and emotional and spiritual support for people with serious advanced illnesses. Relief of symptoms, pain, and stress of serious illness.
Improvement of quality of life for both the patient and family. Appropriate care for any age and for any stage of serious illness, along with curative treatment. Key Issues to be Determined Potential population (conditions) Types of services and providers Performance and outcome measures
Fiscal model(s) Preparing for SB1004 One size doesnt fit all: different types of Medi-Cal and different delivery systems Palliative Care providers Health Plans Populations Covered: Implications Fee-for-service Medi-Cal
Medi-Cal Managed Care Types of Medi-Medi Dual coverage: Special Needs Plan Medicare Advantage Cal MediConnect (Duals demonstration project) Non-managed Medicare with Medi-Cal How Can Palliative Care Providers Prepare?
Develop a plan Talk to health plans about payment options Hire
Train DHCS Palliative Care Efforts
SB 1004 Stakeholder Process Pediatric Palliative Care Waiver Section 2703 Health Homes 1115 Waiver Renewal: Workforce Development Increased Provider Training Delivery System Reform Incentive Payments
(DSRIP) 2.0 Coordinated Care Initiative Pending Legislation Legislative Session February 27 Bill introduction deadline Spring House of origin Summer Opposite house Fall Governors Signature
January - Effective POLST Signature AB 637 (Campos) Currently POLST must be signed by a physician Would authorize nurse practitioners and
physician assistants to sign POLST Acting under the supervision of physician And within scope of practice Advance Directives AB 791 (Cooley) Amends Medi-Cal Health Information
Technology Plan Establish process for Completing & printing advance healthcare directive on-line Upload and store AHCD Display AHCD to authorized users Right to Try SB 149 (Stone)/AB 159 (Calderon)
Would permit making a investigational drug, biological product, or device available to terminal-ill patients Would allow, but does not require, health insurance to cover cost
Would prohibit disciplinary action against physician CCCC Position on Physician Assisted Death The Coalition for Compassionate Care does not
take a position on physician assisted death. We are devoted to improving care. Work on systemic and meaningful solutions. Believe that access to quality palliative care would mean vast majority of people would not seek hastened death. End of Life Option Act SB 128 (Wolk & Monning) Request
By Qualified Individual (CA resident, self administer) For Prescription for Aid-in-Dying To Attending physician Format of Request Two oral requests (15+ days apart) Written request Signed & Dated Witnessed (competent, voluntary, not coerced) Two witnesses (not attending physician and not more than one that is
(a) related or (b) own, operate, employed at health facility) End of Life Option Act Attending Physician Determines Competent Terminally ill (6 months) Voluntary Qualified individual
Discuss Diagnosis, prognosis, potential risks, probable result, possibility of not taking the medication, alternatives or additional treatment Counsel on importance of having another person present when taking meds & not taking medication in public End of Life Option Act Attending Physician Refer to consulting physician Diagnosis, prognosis, competent
Refer to counseling if appropriate Ensure No coercion, informed consent, right to rescind Comply with documentation requirements FederaPlo cily: Heath
lcareReform In the last Congress: The Patient Centered Quality Care for Life Act The Palliative Care and Hospice Education and Training Act New Congress = starting over again Federal Policy Value-based purchasing and
alternative payment Reducing readmissions Integration of palliative care = powerful strategy for success under health care reform Hospital Value Based Purchasing FY 2015 Clinical Processes
of Care Patient Experience of Care Efficiency Outcome
Medicare Physician Fee Schedule Effective January 1, 2015 Will pay for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions New current procedural terminology (CPT) for advance care planning Testing New Models
Chronic Care Management Oncology Care Model Concurrent Care Model Institutes of Medicine Five Key Recommendations Comprehensive care delivery system Clinician-patient communication & advance care planning Professional education & workforce
development Policies & payment reform Public education & engagement Q&A Post questions in the chat or Q&A box to the right of your screen. 7th ANNUAL SUMMIT APRIL 14-15, 2015
SACRAMENTO, CALIFORNIA COALITIONCCC.ORG/SUMMIT Robert M. Arnold, MD Diana Dooley Christine, Ritchie, MD, MSPH, FACP, FAAHPM
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