Patricia Simino Boyce
(Lake Success, NY) January 19, 2016 –– IPRO, New York-based leader of the Atlantic Quality Improvement Network (AQIN), has received special funding from the Centers for Medicare & Medicaid Services (CMS) for the “Transforming End-of-Life Care Initiative,” a two-year project that will help inform Medicare beneficiaries and healthcare professionals in Nassau and Suffolk counties about end-of-life advance care planning.
The project will focus on New York State’s Medical Orders for Life-Sustaining Treatment (MOLST) initiative, which aims to improve the quality of care that people receive at the end of their lives by honoring their preferences, values and beliefs through a shared informed decision-making communication process with their families and healthcare professionals.
“In its 2014 report, Dying in America, the Institute of Medicine (IOM) identified a need for public engagement and education about end-of-life care planning,” says IPRO Chief Medical Officer Clare Bradley, MD, MPH. “The report also found it important to motivate meaningful conversations with family members, caregivers and healthcare professionals. We hope to make an impact in both of these areas.”
IPRO will partner in this project with Patricia Bomba, MD, F.A.C.P., Vice President of Geriatrics at Excellus BlueCross BlueShield, who is a nationally recognized palliative care, end-of-life, and elder abuse expert. Dr. Bomba chairs the MOLST Statewide Implementation Team and National Healthcare Decisions Day NYS Coalition, serves as the eMOLST Program Director, and served on the committee that produced the aforementioned 2014 IOM report. Working in collaboration with the New York State Department of Health, Dr. Bomba helped establish MOLST as a statewide program. She has passionately supported the mission of making the state a leader in advocating for facilitated discussions on planning for end-of-life care and for ensuring excellence in the provision of end-of-life/palliative care, serving all segments of the community for nearly two decades.
“Individuals can take control of the quality of their life at the end of life,” says Dr. Bomba. “They should choose how they want to live at the end of their life, who they trust to make decisions if they lose the ability to do so, and have a conversation with their loved ones. Doctors should help initiate discussions with their patients about such decisions.”
IPRO will partner with organizations in Suffolk and Nassau counties to conduct outreach and provide educational sessions for seniors, their families and caregivers to help them better understand how to communicate with their healthcare professionals, how to make informed end-of-life medical decisions, and to ensure that their end-of-life wishes are properly carried out.
“Patients want time with their doctors to talk about end-of-life issues, and clinicians should receive the training for such discussions so they can provide quality end-of-life care consistent with their patients’ values and preferences,” says Dr. Bomba.
Effective January 1, 2016, CMS began to reimburse physicians and other qualified healthcare professionals to have end-of-life discussions with their patients.
The project will also focus on eMOLST, a secure Web-based application that assists healthcare professionals in documenting MOLST discussions, including patients’ values, beliefs, and goals for care, and helps ensure patient access to medical orders and their MOLST discussion. IPRO will provide technical support to healthcare providers throughout the length of the project, in order to facilitate the adoption, training in and implementation of eMOLST.
“New York’s eMOLST is easy to use, improves clinical and legal outcomes, and provides a community solution to ensure the medical orders and a copy of the discussion are available in an emergency,” says Dr. Bomba.
Long Island was selected for focused efforts on end-of life care planning based on IPRO’s review and analysis of 2012 data from the Dartmouth Atlas of Health Care. For more than 20 years, the Atlas has documented variations in how medical resources are distributed and used in the United States. The Dartmouth Atlas uses Medicare claims data for analysis of national, regional, and local healthcare markets, as well as hospitals and their affiliated physicians.
For the state’s Medicare population, Dartmouth Atlas data indicate that in 2012 the Long Island Hospital Referral Region (HRR) ranked highest of all New York State HRRs in hospital admissions within the last six months of life. The Long Island HRR also ranked in the top three HRRs for inpatient days in the last six months of life, admissions to the ICU/CCU during hospital stays in which the patient died, and in the percent of patients who spent seven or more days in an ICU/CCU in the last six months of their lives.
“There is a great opportunity on Long Island to develop a community-wide approach to advance care planning to help Medicare beneficiaries receive high quality end-of-life care that is aligned with their values, beliefs and goals for care,” says Dr. Bradley.
The IPRO-led AQIN is one of 14 Medicare-funded Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) operating across the U.S. To learn more about the AQIN Transforming End-of-Life Care Initiative, contact IPRO Senior Director and Project Lead Sara Butterfield, BSN, RN, CPHQ, CCM at Sara.Butterfield@area-I.hcqis.org or (518) 426-3300, Ext. 104. Visit the AQIN website at www.atlanticquality.org. To learn more about the QIO program, visit www.qioprogram.org. For more information on IPRO, go to: ipro.org. For more information on advance care planning and MOLST, visit www.CompassionAndSupport.org. For more information on eMOLST, go to www.NYSeMOLSTregistry.com.