PMDA Public Policy Update - Part 2 September 29, 2006

1. PMDAPublic Policy Update - Part 2September 29, 2006 Thomas Lawrence, MD Co-Chair, Public Policy Committee

2. 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.”

3. 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.

4. 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

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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

13. 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

14. 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 Public Policy Committee

15. 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

16. Please send us your public policy concerns. lawrencet@mlhs.org naceda@upmc.edu