Atrius Health Submits Comments on Proposed End-of-Life and Palliative Care Regulations

| Posted On Nov 26, 2013 | By:

In 2009, the Massachusetts Expert Panel on End of Life Care, established by the Executive Office of Health and Human Services (EOHHS), conducted a comprehensive review of the issues surrounding end-of-life care both nationally and in the Commonwealth. It concluded that Massachusetts residents nearing the end of their lives often do not receive the care that they want or need and are unaware of the full range of care options, including hospice and palliative care services. As a result, the Legislature included new requirements for clinicians as part of Chapter 224 of the Acts of 2012 that directed the Department of Public Health (DPH) to pass regulations for health care facilities.

On November 21, 2013, Dr. Eliza Shulman, Chief of Geriatrics at Harvard Vanguard Medical Associates, testified on behalf of Atrius Health at a public hearing by (DPH) on proposed regulations that would require health care practitioners in licensed hospitals, clinics and skilled nursing facilities to provide information to appropriate patients regarding palliative and end-of-life care options.

Atrius Health submitted comments in support of the proposed regulations and believes the regulations are a good first step to ensure that patients nearing the end-of-life understand the full range of care options available to them. We also support the necessity for health care providers and health care systems to develop policies to support patient’s treatment decisions.

Over the past year, many Atrius Health clinicians have devoted considerable resources to identify those patients who should be advised by their clinician of advanced care planning options. Once these appropriate patients are identified, the clinician initiates a discussion, materials related to end-of-life and palliative care are given to the patient for review and the discussion is recorded in the patient’s electronic medical record.  

Atrius Health, as well as other organizations and patient advocacy groups, recommend that DPH consider several changes in its proposed regulations. Our recommended changes include the following:

  1. Further define the term “appropriate patient” as “diagnosed a terminal illness or condition which can be reasonably expected to cause the patient’s death within 12 months whether or not treatment is provided”. We also recommend materials be made available to family members and/or caregivers where appropriate and not just limit the distribution of these materials to the patient.
  2. Eliminate the requirement that hospitals, clinics and skilled nursing homes provide a “pamphlet” to patients, and instead allow the use other forms of written communications that would not be as limiting.
  3. Finally, we recommend that DPH not require providers distribute the Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST) form to patients as part of this new requirement.  We believe the attending health care practitioner should be able to determine the appropriate time to review the MOLST form with their patients.

We believe these new requirements will help the residents of the Commonwealth become better informed of their end-of-life care options and provide better communication about their preferences to their health care providers.

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