Transforming End of Life
Quality care at the end of life (EOL) should involve honoring a person’s preferences, values, and beliefs; be based on evidence-based medicine; and allow for sound, informed medical decisions made collaboratively and deliberately among the individual, family/caregiver, and healthcare professionals. Substantial evidence shows that the treatment people receive is, more commonly, different—and often times more aggressive—than the care they desire at the EOL. Conversely, some individuals, particularly those with disabilities, find that the healthcare system, and sometimes their families, undervalue their quality of life and, as a result, withhold life-prolonging treatments that they would want to receive (Report to Congress 2008).
The Institute of Medicine identified a need for public education and engagement about EOL care planning at several levels: 1) societal: to build support for public and institutional policies that ensure high-quality, sustainable care; 2) community and family: to raise awareness and elevate expectations about care options, the needs of caregivers, and the hallmarks of high-quality care; and 3) individual: to motivate and facilitate advance care planning (ACP) and meaningful conversations with family members and caregivers (IOM 2014).
Medical Orders for Life-Sustaining Treatment (MOLST) is designed to improve the quality of care people receive at the EOL. MOLST is New York State’s Physicians Orders for Life-Sustaining Treatment (POLST) Paradigm Program. These programs are based on effective communication of patient wishes, documentation of medical orders on a brightly colored form to ensure visibility, and a promise by healthcare professionals to honor these wishes.
eMOLST is a secure web-based application that allows enrolled users to complete the MOLST form, MOLST Chart Documentation Form (CDF) and mandated Office for Persons with Developmental Disabilities (OPWDD) Checklist for persons with developmental disabilities who lack capacity. CDFs document the MOLST discussion including the patient’s values, beliefs, and goals for care; the ethical framework for medical decisions regarding withholding and withdrawing life-sustaining treatment; and legal requirements. Forms are created as pdf documents that can be printed for the patient and paper-based medical records, stored or linked to/from an electronic medical record (EMR), and become part of the NYS eMOLST registry. eMOLST includes programming to eliminate errors; guides conversations among clinicians, the patient or medical decision-maker, and family members; and incorporates the ethical framework and legal requirements for making decisions regarding cardiopulmonary resuscitation (CPR) and life-sustaining treatment, and documentation of the discussion.
AQIN-NY (IPRO) will educate New York’s Medicare beneficiaries and their families/caregivers on the importance of ACP, terminology used by medical professionals, and how to communicate with healthcare professionals about their EOL wishes as well as prepare documentation to ensure they are properly carried out. This intervention will apply the ACP programs Community Conversations on Compassionate Care and What Matters Most? to educate beneficiaries about planning for their medical care and prepare them for the possibility of being unable to make their own care decisions as, for example, they enter the advance stages of chronic illness.
AQIN-NY will also provide technical support to hospitals, skilled nursing facilities (SNFs), home health agencies (HHAs), hospices, emergency medical services (EMS), and physician practices for adoption, training and implementation of MOLST and eMOLST.
Materials from Past IPRO Events
Digital Transformation of New York MOLST: An End of Life Care Transition Program (eMOLST Application Demonstration) - 02/02/16
This webinar provides an overview and demonstration of eMOLST, (Medical Orders for Life Sustaining Treatment) provided by Dr. Patricia Bomba, Chair of the MOLST Statewide Implementation Team & eMOLST Program Director. eMOLST is the secure web-based application that allows enrolled users to complete the MOLST form, MOLST Chart Documentation Form (CDF) detailing the effective communication of patient / resident wishes and documentation of medical orders for healthcare professionals to honor these wishes. The eMOLST application simplifies and improves the workflow around completing the information required for a legal medical order with automated user feedback for quality review and notification of missing information and training tools for users. At the end of the process a DOH-5003 MOLST form and the appropriate MOLST Chart Documentation Form for adults, minors, or persons with developmental disabilities are created.
Health Management Associates "Value Based End-of-Life Care: Having the Conversation Nobody Wants to Have Benefits Everybody" Webinar Replay
During this webinar, HMA experts Sukey Barnum (https://www.healthmanagement.com/our-team/staff-directory/name/sukey-susannah-barnum/) , Laurie Lockert (https://www.healthmanagement.com/our-team/staff-directory/name/laurie-lockert/) , and Suzanne Mitchell, MD, build the case for value-based end-of-life care and planning, and provide a roadmap for health plans and providers looking to launch end-of-life care policies and educational programs.
Listen to the replay and understand:
- The drivers accelerating the need for value-based end-of-life care and planning.
- The business case, examples and challenges for developing and implementing value-based end-of-life care programs, policies, and initiatives.
- The added complexities of end-of-life-care and planning for special populations such as people with serious mental illness, and the benefit of using trauma informed care models for such end-of-life care and planning.
Link to Recorded Webinar and Presentation Materials:
New CPT Codes for Advance Care Planning and MOLST Discussions Webinar – 02/02/16
Effective January 1, 2016, new Current Procedural Terminology (CPT) codes have been established for advance care planning and end-of-life/MOLST discussions with patients and families. This webinar, hosted by Dr. Patricia Bomba, Vice President and Medical Director for Geriatrics at Excellus BlueCross BlueShield and Chair, MOLST Statewide Implementation Team & eMOLST Program Director, reviews the required elements of these conversations and how to bill accurately for them. Additional information on the new CPT codes is posted to the CMS Web site at:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9271.pdf . Please consult your insurance carriers, provider relations representatives and refer to your individual fee schedules to address questions about these CPT codes and associated reimbursement.
Link to Recorded Webinar
IPRO Care Transitions Learning & Action Network Learning Session: Medical Orders for Life Sustaining Treatment (MOLST) Webinar Part II – Overview of Compassion & Support Website Resources
IPRO Care Transitions Learning & Action Network Learning Session: MOLST Webinar Part I – Overview of eMOLST Tool
10/9/2012 & 10/23/2012
Integrating Medical Orders for Life Sustaining Treatment (MOLST) Into a Community-wide Approach to Advance Care Planning
Compassion and Support At The End of Life - http://www.
United Hospital Fund Next Steps in Care - http://www.nextstepincare.org/
Institute for Healthcare Improvement: The Conversation Project - http://theconversationproject.org/
Gitenstein Institute for Health Law and Policy at the Maurice A. Deane School of Law at Hofstra University and the North Shore-LIJ Health System Conversations Health And Treatments (CHAT) Project - http://www.thechatproject.org
CDC Healthy Aging At Home - http://www.cdc.gov/aging/advancecareplanning/index.htm