Compassion and Support
JUNE 2016
South Korean Officials Praise NY MOLST and eMOLST

In a historic example of international cooperation and education, a delegation representing the South Korean government met this week with New York-based experts who have developed, implemented and raised community awareness of advance care planning programs and tools. Discussions centered on the state’s Medical Orders for Life Sustaining Treatment (MOLST) initiative that helps patients with advanced chronic illness and frailty maintain control of health care decisions regarding life-sustaining treatment. Also receiving attention was the innovative web-based application, eMOLST, which assists healthcare professionals in documenting MOLST discussions electronically. Designed by Excellus BlueCross BlueShield (BCBS), eMOLST is the only such system in the nation.

The delegation traveled to Albany on Monday June 13 to meet with representatives from the New York State Department of Health and Improving Healthcare for the Common Good (IPRO) to discuss the public-private partnership that supports NY MOLST. State and regional experts from across New York traveled to LeadingAgeNY headquarters in Albany for a special two-hour luncheon hosted by Excellus BlueCross BlueShield and IPRO. The Korean delegation discussed the purpose of the visit and had an opportunity to share cultural differences and commonalities in facing the challenges in improving the quality of care seriously ill persons receive near the end of life.

The South Korea Parliament enacted the Act for Korean Life-Sustaining Treatment Plan, which is similar to MOLST, and Korean Advance Directives, which take effect in February 2018. Officials from South Korea are learning from New York and intend to develop regulations and a national implementation plan based on MOLST and eMOLST implementation, clinician training and public education.

Clare Bradley, M.D., M.P.H., is chief medical officer of Improving Healthcare for the Common Good (IPRO). “We are very excited that IPRO's community-wide approach to advance care planning, with the critical support of Dr. Bomba, is being highlighted in this international forum,” Bradley said. “New York’s eMOLST and MOLST programs, which are already national models, are now international models for how healthcare professionals can help their patients receive high quality end-of-life care that is aligned with their values, beliefs and goals for care.”

On Tuesday June 14, Stephen Sloan, Executive Vice President and Chief Administrative Officer, welcomed the visitors and addressed the role of Excellus BCBS, “We’ve deliberately chosen a path to become a powerful voice that urges our members and the community at large to express their wishes with their families and physicians, and that those family members and physicians should respect their wishes.” Meetings throughout the day focused on the functions required for supporting the NY MOLST, IT support, and a site visit with key executive, clinical and IT staff at St. Ann’s Communities, the first long term care system in NY to implement NY MOLST and NYeMOLST.

Featured Resource: NYSeMOLSTregistry.com

eMOLST guides physicians and other clinicians through a standardized communication process and electronically documents the goals for care discussion and clinical process, as outlined in the 8-Step MOLST Protocol. eMOLST is available at NYSeMOLSTregistry.com.

New York has had an operational secure web-based eMOLST application and electronic registry since 2011. Interest in eMOLST is growing statewide with the move to value-based, population health models as exemplified by New York’s Delivery System Reform Incentive Program (DSRIP.) The purpose of DSRIP is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years.

MOLST FAQ: Can eMOLST be used as a measure for NCQA PCMH Recognition Program?

YES. Use as a measure would address PCMH 6A2 for one of two preventive care measures or PCMH 6B2 for one of two utilization measures affecting health care costs. It would not be accepted for both.

Additional questions about PCMH or other Recognition Program requirements can be submitted to NCQA.org. Once a category is selected, the question is triaged to the appropriate staff for response.


eMOLST Champion: Orange Regional Medical Center

Orange Regional Medical Center (ORMC) in Middletown, NY provides healthcare for nearly 450,000 residents in the Hudson Valley as part of the Greater Hudson Valley Health System. ORMC has been working with eMOLST for nearly two years with the leadership of Marianne Walker, Dr. Emma Fattakhov, Regina Toomey Bueno and a large implementation team.

They have used a phased approach to eMOLST implementation by starting with the palliative care team, led by Dr. Fattakov, and moving forward with the ICU, hospitalists, the emergency department and then specialists from across the hospital. More than 1600 professionals now have access to the eMOLST application, including numerous community providers with privileges at ORMC. Importantly, providers were also instructed that all orders to withhold or withdraw life-sustaining treatment should be completed in eMOLST to guarantee accuracy and availability across all care settings.

ORMC has also set an important standard for what seriously ill patients and their families should expect as they approach the end of life: honest conversations, delivered with compassion and goals-based discussions that result in actionable eMOLST orders that must be followed everywhere. eMOLST guarantees accuracy, is accessible 24/7 and must be followed everywhere.

With the implementation of eMOLST ORMC has demonstrated its commitment to high quality, patient-centered care consistent with patients’ values, beliefs & goals. They are a leader in their region, sparking interest in eMOLST from other hospitals as well as nursing homes, hospices, primary care offices, specialty practices, and the regional NYS OPWDD office.

Bill Introduced to Establish a Statewide eMOLST Registry

Senator Rich Funke and Assembly Majority Leader Joe Morelle, have introduced measures (S.7883/A.10644) establishing a statewide registry for collecting, maintaining and ensuring availability of eMOLST forms. This registry will help ensure the most current electronic eMOLST forms is available in an emergency so end-of-life preferences will be followed as he or she moves through the health care system, facility to facility, physician to physician.

If passed, Bill S7883 (Funke)/A10644 (Morelle) would make changes to public health law, so that the words "Medical Orders for Life Sustaining Treatment (MOLST)" would exist in PHL. The bill also establishes an eMOLST registry. This registry would require practitioners who complete a MOLST form to submit to the eMOLST registry within 14 days.

“By ensuring statewide access to eMOLST forms throughout the healthcare community we, can take an important step toward improving end-of-life care and ease the burden placed on patients and their loved ones at an otherwise difficult and emotional time," Morelle said. "I thank Excellus BlueCross BlueShield and IPRO for their efforts to raise awareness and expand access to these valuable tools, and for their continued commitment to improving patient care and outcomes."

“My careers in journalism and public service have reinforced the importance of clear communication and there’s no time when that’s more important than in end-of-life planning,” Funke said. “I am proud that our legislation would standardize a statewide registry for e-MOLST to ensure that a patient’s wishes are crystal clear and widely available, no matter who is providing care or where it is being provided. I thank Majority Leader Morelle for his partnership and Dr. Bomba for her leadership as we push to advance this common sense proposal.”

New York’s eMOLST is easy to use, improves clinical and legal outcomes, and provides a community solution to ensure medical orders, and a copy of the doctor and patient discussion, are available in an emergency. This week’s meeting with The South Korea delegation clearly establishes New York as a leader in end-of-life care planning.

The introduction of this bill is a huge step forward and your help is needed! Please encourage state lawmakers to pass (S.7883/A.10644) establishing a statewide registry. Please send a letter of support for Bill S7883 (Funke) / A10644 (Morelle) to your local Senators and Assembly Members. If you do, please also send a copy to me at patricia.bomba@lifethc.com. Here is a draft letter of support.

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