PMDA Public Policy Update Part 2 September 29, 2006

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PMDAPublic Policy Update - Part 2September
29, 2006

• Thomas Lawrence, MD
• Co-Chair, Public Policy Committee

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PMDA Strategic Planning 2006Political Action
Action Plan

• Pick 1 or 2 key issues that PMDA can own and
  educate others about.
• Develop Talking Points on specific key topics.
• Develop and disseminate news releases on key
  issues.
• Invite politicians/groups to PMDA meetings.
• Adopt a politician who has an interest in elder
  care issues, owning their attention.

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PMDA Strategic Planning 2006Political Action
Action Plan cont.

• Identify key people in PA constituting a State
  Aging Committee.
• Develop close relationships with organizations
  that have paid lobbyists, to tap into this
  power.
• Educate members about grass roots advocacy.
• Keep members better informed about legislative
  developments.
• Develop LTC physician leaders and membership in
  the Harrisburg area.

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End-of-Life Care Talking Points

• PMDA Survey at AMDA Symposium March 2006
• 14 Attendees completed survey
• 6 Domains of Care Queried
• State Advance Directive Law / OOH DNR Act
• State NH, ALF/PC Regulation Issues
• Political / Legislative Issues
• Facility-based / Administrative Issues
• Clinical Issues
• Other

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End-of-Life Care Talking Points

• PMDA Survey at AMDA Symposium March 2006
• Advance Directive Issues
• EMTs unable to honor Advance Directives/NH DNR
  orders bound to initiate CPR.
• AD/DNR orders not completed in a timely way not
  done in Hosp prior, not done on admission to NH.
• OOH-DNR Order bracelets/necklaces undignified.
• No clear process for ALFs.
• Work to get POLST accepted by the State of PA.

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End-of-Life Care Talking Points

• PMDA Survey at AMDA Symposium March 2006
• Facility Based Issues
• ALFs in Phila. Suburbs lag behind NHs in care.
• Political / Legislative Issues
• Lack of PMDA input in legislative process.
• Verbal order problem for NPs.
• Legal Issues
• General fear of liability in EoL Care in LTC.

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End-of-Life Care Talking Points

• PMDA Survey at AMDA Symposium March 2006
• Decision-making Issues
• Lack of family consensus in EoL care.
• Family conflict burdens LTC facility staff.
• Lengthy family discussions and counseling on EoL
  care issues are not billable to insurance.

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End-of-Life Care Talking Points

• PMDA Survey at AMDA Symposium March 2006
• Hospice Issues
• Payment for physicians and NPs/PAs once enrolled
  in hospice is difficult.
• Timing of referral to hospice is problematic.
• Transition to hospice for resident and family is
  difficult.
• Clinical Issues
• Wound care and feeding tubes in EoL care.

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Working to Expand Out-of-Hospital DNR Orders

• POLST Form adapted from Oregon is being used in
  other States and has been used at selected
  Facilities in Western PA
• www. polst.org
• Development of policy statement on the role of
  life sustaining treatment in LTC
• Continuing education of Pennsylvania Law Makers
  in this area, and establish ongoing relationships
  with Legislators.

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Working to Expand Out-of-Hospital DNR Orders

• POLST Dissemination Initial Steps
• Investigate how other States (West Virginia) went
  about educating Legislators regarding
  limitations of current systems and the benefits
  of POLST.
• Achieve support/collaboration from provider and
  consumer groups.
• Tie the need for change to PA EOLC Task Force
  findings (due to be released soon).
• Develop a PMDA Position Statement on POLST.

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DOH Surveyor Education Project

• Problem
• Surveyor opportunities for education on clinical
  topics in the LTC setting are limited.
• Complex medical issues involving Residents are
  often central in Survey citations of inadequate
  care.
• PMDA members are ideally situated to contribute
  to the clinical education of DOH Surveyors.

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DOH Surveyor Education Project

• Southeastern PA Region
• Lionville Norristown Field Offices
• PMDA member volunteer faculty
• 4 Key Topics - 3 hours
• Malnutrition and feeding tubes
• Pain management
• Polypharmacy
• Pressure ulcers and wound care

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Mentorship Program in LTC Medical Direction

• Mentoring future LTC leaders
• Geriatric Medicine Fellows
• IM/FP Residents
• PMDA committee participation
• Public Policy, Education, Membership
• Benefits of participation

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Public Policy Committee

• David Nace, MD
• Thomas Lawrence, MD
• John Benner, MD
• Bernard Bernacki, MD
• Judith Black, MD

• Kenneth Brubaker, MD
• Maryann Galietta, MD
• Daniel Haimowitz, MD
• David Fuchs, MD
• Barbara Reall, CRNP

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Public Policy New Problems?

• Intersection of Competing Interests
• Government Law Makers, Policy Makers
• Regulators CMS, DOH, DPW, JCAHO
• Insurers Medicare, Medicaid, HMOs
• Providers Facility and Staff
• Physicians / Medical Staff
• Medical Director

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• Please send us your public policy concerns.
• lawrencet_at_mlhs.org
• naceda_at_upmc.edu