Category Archives: News

WV Center for End-of-Life Care: West Virginia Touted for Its Successful Program

Journal of Clinical Ethics Recognizes Advantages of POST Over Advance Directives: West Virginia Touted for Its Successful Program

In the most recent issue, the Journal of Clinical Ethics published a Legal Briefing on POLST: Physician Orders for Life Sustaining Treatment. The authors, Thaddeus Mason Pope, JD, PhD Director of the Health Law Institute and Associate Professor of Law at Hamline University School of Law, Saint Paul, Minnesota and Melinda Hexum, MS, second-year law student and Associate Editor of the Hamline Law Review, noted that there are at least fourteen different names for similar forms used throughout the United States. Originally called Physician Orders for Life-Sustaining Treatment (POLST) in Oregon, there are many different acronyms including MOLST (Medical Orders for Life-Sustaining Treatment) and four other acronyms based on scope of treatment rather than on life-sustaining treatment. Idaho, Indiana, South Carolina, Tennessee, and Virginia call their form POST as does West Virginia. Louisiana calls their form La POST and Alaska, Colorado, Kentucky, New Mexico, and North Carolina call their form MOST (Medical Orders for Scope of Treatment). The authors regard POST programs as a “national phenomenon.” As of September 2012, at least 46 states or communities had a POST program of some form. The authors note that advance directives have had limited success. They recognize several advantages of POST forms over advance directives.

  • It is signed by a healthcare provider. There is no need for interpretation and translation. It is an immediately actionable medical order.
  • It is easy to follow because it is on a single-page, standardized form.
  • Unlike Do Not Resuscitate (DNR) orders, POST addresses not just CPR but an entire range of life- sustaining interventions.
  • POST is transportable. It is a brightly colored clearly identifiable form that remains in the patient’s chart and travels with the patient from hospital to nursing home to ambulance to the patient’s home.

The authors also note that POST protects and promotes patient autonomy better than advance directives in four ways.

  • POST is created with a healthcare provider at or near the time when an acute or serious condition develops. POST has a greater chance of being more informative, more relevant to the specific medical situation at hand.
  • Since the form is highly visible, portable, and travels with the patient’s medical records it is more likely to be available when a decision must be made.
  • Since it is written in precise medical language, it is better understood.
  • Since it is signed by a health care provider, it has a greater chance of compliance by other providers.

The authors observe that POST is more than a form; it is a tool providing a framework for end-of-life care conversations between patients, families, and healthcare providers. Providers are encouraged to discuss specific scenarios and treatment options. Patients and families have the chance to ask questions and make their wishes known. In short, it gives patients more control of their end-of-life care. With POST, “healthcare providers know immediately what patients do and do not want, and they can provide treatment and care consistent with these preferences.”

West Virginia recognized 

The authors identify four states as having particularly better established POST programs: West Virginia, Oregon, New York, and California. They observe that in these four states the POST form and program have achieved broad clinical acceptance; use of POST is particularly well documented in West Virginia and Oregon since investigators in both states have published research reporting the vast majority of nursing facilities and hospices in the states use the POST form. These states have also ensured the sustainability and refinement of their programs through the maintenance of effective statewide and local coalitions and through obtaining significant financial support.

In a section in the article on statutory recognition of POST, West Virginia is cited as an example of a state whose laws provide more detail regarding the POST form but with enough leeway to allow the form to evolve without amending state law.

In the section in the article on electronic registries, West Virginia and Idaho are commended for having state registries that contain not only POST documents but also advance directives and other healthcare documents. At the end of the review on POST forms, the authors conclude:

“POST helps patients. It documents a patient’s wishes for life-sustaining treatment in the form of a medical order. It streamlines the transfer of patient records between facilities. It clarifies treatment intentions and minimizes confusion about patient preferences. It assists physicians, nurses, emergency personnel, and health care facilities in promoting patient autonomy. It optimizes comfort care of patients.”

The authors also observe that POST programs are driving other healthcare-related reforms. Most notably is greater attention to advance care planning. Because the POST form requires the patient to express his or her preferences with regard to not only CPR but also a desired level of medical intervention, completion of the POST form is promoting conversations which are helpful to patients and families to ensure the patient’s wishes are respected and families are not burdened with making decisions unaware of their loved one’s wishes.

It is gratifying to see the recognition by The Journal of Clinical Ethics of the advantages of the POST program and to see that West Virginia identified as one of the leading states in this national phenomenon!

Thaddeus Mason Pope and Melinda Hexum, “Legal Briefing: POLST: Physician Orders for Life-Sustaining Treatment,” The Journal of Clinical Ethics 23, no. 4 (Winter 2012): 353-76.

 

www.wvendoflife.org

Toll-free number
877-209-8086

WV e-Directive Registry
FAX 304-293-7442

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Innovation to Improve Health Care Quality and Reduce Costs: The Benefits of Palliative Care

Dr. Alvin H. “Woody” Moss, Director WV End of Life Center, will provide participants should be able to –
1.       Describe the elements of palliative care
2.       Discuss how to have “the conversation” with patients and families
3.       Explain how goals of care clarification improves patient care and reduces costs
4.       Demonstrate knowledge of the system in West Virginia to identify and respect patients’ end-of-life wishes
5.       Distinguish the role of hospital palliative care teams, the POST form, and the e-Directive Registry in the system.

This Webinar is approved for 1 AAFP Prescribed credit.

The FREE Webinar is available at http://www.screencast.com/t/2ktIjxeK.

To receive CME you must complete the survey at https://www.surveymonkey.com/s/QJVNTPY

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DHHR approves improved definition for Opioid Drug Products

 DHHR approved the West Virginia Academy of Family Physicians letter  which recommended a new improved definition for Opioid Drug Products. DHHR has modified its proposed rule on Pain Management Clinics to include it.
WVAFP  appreciate the support by the Board of Medicine,the State Medical Association, and the Primary Care Association on the WVAFP proposal.

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West Virginia e-Directive Registry Access: Common Questions

West Virginia e-Directive Registry Access:
Common Questions
Eight organizations have now completed the three documents necessary to access the WV e-Directive Registry (Registry).  As facilities have begun to process these documents, questions have arisen.  We would like to share the answers we have given in the hope that they may clarify some issues for other organizations.
1. Who in our organization will need to have access to the Registry?
Organizations will need to determine who has a patient care need to access the Registry on an individual basis. This might include social workers, care managers, admission clerks, medical records clerks, and emergency department staff.  These are generic categories as different organizations have different names for job titles.  It might also be helpful if the administrators of these departments have access.  Remember that all shifts will need to be covered.  In short, whoever would be accessing patient medical records upon admission, while caring for a patient, or in an emergency situation should have access.    The Authorized Administrator can add other job classifications or persons if it becomes necessary at a later date.
2. Who should the Authorized Administrator be?
The Authorized Administrator should be someone in your organization (usually in Information Technology) who has the job of assigning usernames and passwords for other roles.  They would also need to be someone who deletes accounts when an employee leaves your organization.
3. Will every employee needing access have their own username and password?
Yes. Every person that accesses the Registry need to be assigned their own username and password.
4. Have you written a generic Registry policy?
Since each organization is different, we have determined that this would not be helpful.  We are suggesting that organizations start with their own Information Technology policy.  We would be happy to review any policy that is written.
5. Can we set up Registry access for our corporation as a whole?
If your organization operates in more than one location such as a hospice serving more than one county or a nursing home that is part of a chain, Registry access may be set up on a corporate level.  How that access will function depends on your corporate structure.  We would be happy to work with your corporate office.
For the most current information about the Registry or to obtain the three agreements necessary for your organization to access the Registry, visit the Center website at www.wvendoflife.org/e-Directive-Registry.
Toll-free number
WV e-Directive Registry

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December & January Webinars

December Webinar

Title:    Understanding Telemedicine:mHealth’s Impact on Healthcare Distribution
Date:   Wednesday, December 12, 2012
Time:   6:00 PM – 7:00 PM EST

Reserve your Webinar seat now at: https://www2.gotomeeting.com/register/733705746

Dr. William C. Thornbury will provide participants with:

  1. Understand telemedicine’s role in the emerging health system transformation.
  2. Appreciate the dynamic change technology will play in health cost containment.
  3. Review a Pilot Study of mHealth in primary care and its implications for health system change

 

January Webinar

Title:    “Extreme Makeover – PCMH Edition”
Date:   Tuesday, January 22, 2013
Time:   1:00 PM – 2:00 PM EST

Reserve your Webinar seat now at: https://www2.gotomeeting.com/register/256270298

Dr. John L. Bender with Marmont Family Medicine (http://www.miramont.us) will provide participants with how to:

  1. Recognize how NCQA recognition makes it possible to improve safety, efficiency, patient outcomes and profitability in the ambulatory care environment
  2. Illustrate the link between NCQA recognition and a successful Meaningful Use implementation strategy
  3. Summarize the business case for improved workflows, clinical quality and metrics (aka Registry Reporting)

 

After registering you will receive a confirmation email containing information about joining the Webinar.

System Requirements
PC-based attendees – Required: Windows® 7, Vista, XP or 2003 Server
Mac®-based attendees – Required: Mac OS® X 10.5 or newer
Mobile attendees – Required: iPhone®, iPad®, Android™ phone or Android tablet

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2012 Pfizer Teacher Development Award – Dr. Jason A. Hudak

HUNTINGTON — Dr. Jason A. Hudak, a three-time Marshall University graduate, has been selected as a recipient of the 2012 Pfizer Teacher Development Award, given to only 13 physicians nationwide by the American Academy of Family Physicians Foundation.

The Pfizer award is presented to community-based, new physicians who combine their clinical practice with part-time teaching of family medicine. Hudak has a private practice in Barboursville and serves as volunteer clinical faculty member with the Joan C. Edwards School of Medicine.

“I was really surprised to receive this award,” Hudak said, in a news release. “As a new volunteer faculty member, I was learning to teach just as much as the students were learning to learn. It’s been an unexpected blessing.”
Hudak graduated from Marshall with his undergraduate degree in 2001 and then with his medical degree in 2005. He completed a residency in Family Medicine in 2007.

Hudak was nominated by colleagues in the Marshall Department of Family and Community Health, including Dr. Mitch Shaver, who is residency director for the department.

This is the second time a Marshall University Family Medicine residency graduate has received the Pfizer Teaching Development Award. Last year, Dr. Scott Davis was also recognized.

Hudak will be honored at the organization’s Scientific Assembly meeting later this year in Philadelphia.

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WVAFP Appoints Insurance “Agent-of-Choice”

Effective September 1, 2012, the West Virginia Academy of Family Physicians (WVAFP) has appointed the West Virginia Medical Insurance Agency (WVMIA) as its insurance agent-of-choice.

WVAFP Executive Director, Gerry Stover, indicates that the appointment of WVMIA, which is a wholly-owned subsidiary of the West Virginia State Medical Association (WVSMA), is a benefit to WVAFP members for two reasons:  (1) it will provide unparalleled service to our membership from an insurance agency whose only clients are physicians and (2) it will create educational funding for the WVAFP.  He said “I certainly recommend that members of WVAFP contact the WVMIA for assistance with any or all of their insurance needs.”

The WVMIA is managed by Steve Brown, who has worked in insurance regulation, has handled insurance claims, has been an underwriter for medical professional liability insurance and is a former hospital risk manager.  Stover said “with this background, Steve Brown certainly has the ability to advocate for our physician membership.”  Brown said “we look forward to working with the WVAFP and its individual members.  Our only clients are doctors and we strive to assist their insurance needs with products specifically designed to meet those needs.”  He mentioned specifically the property- casualty products of The Hartford, which have been designed with specific terminology and coverages for medical practices, and Ameritas Life Insurance Corporation which has a disability insurance product which has a 15% discount for members of the WVAFP.

For additional questions or to determine how best to utilize the services of the WVMIA contact Steve Brown, agency manager, at 1-800-257-4747 ext 22 (304-925-0342 ext 22); e-mail steve@wvsma.org or by cell at 304-542-0257 or visit the WVMIA web-site at www.wvmia.com.  Also see the WVAFP web-site for more information (www.wvafp.org).

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2012 Family Doc Award

James L. Comerci, MD, FAAFP is the 2012 recipient of the Family Doctor of the Year Award from the West Virginia Academy of Family Physicians(WVAFP).

The award honors an outstanding, community minded family physician that provides compassionate, comprehensive care.  Candidates are nominated for their service as role models, professionally and personally, in their communities, to other healthcare professionals, physicians in training and medical staff.

Sarah Chouinard, MD, President of the West Virginia Academy of Family Physicians stated, “ Dr Comerci has shown an impressive commitment to digitizing his practice, to quality improvement, and to keeping current with the business of medicine. He has been a leader in our state for pushing the agenda for implementing electronic health records. As a private doc, there are barriers to implementing technology, and Dr Comerci has demonstrated that with hard work, those barriers can be eliminated. He is the obvious choice for the award because he is has taken the initiative to stay on the innovative edge of medicine and has made sure that WV stays in the game as health care changes for family physicians”.

Founded in 1948, the WVAFP represents 1,000 physicians, family medicine resident physicians and medical students in the state of West Virginia.  It is the largest medical society in West Virginia devoted solely to primary care.

To learn more about the specialty of family medicine, the AAFP’s positions on issues and clinical are, and for downloadable multi-media highlighting family medicine, visit www.aafp.org/media.  For information about healthcare, health conditions and and wellness, please visit the AAFP’s award-winning consumer Web site, www.FamilyDoctor.org

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WVAFP Installs 60th President

Dr. Sarah Chouinard takes the Presidential Oath. Installation was presented by Dr. Thomas Weida, AAFP Past Speaker at the 60th Annual Scientific Assembly

Dr. Sarah Chouinard, newly installed WVAFP President

Newly installed WVAFP President Dr. Sarah Chouinard thanks outgoing President – Dr. Michael Gibbs for his outstanding job over the past year

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AAFP Office Champion Quality Improvement Program

The AAFP is recruiting 50 family medicine practices for a quality improvement project that will train staff to integrate tobacco cessation activities into daily office routines. All applications will be considered; however, the project is targeting states which have a smoking prevalence rate of greater than 20 percent.

Each participating practice will designate an Office Champion to lead the project, as well as a physician who will ensure that the Office Champion receives the support he or she needs. The program will educate Office Champions through an online training module, live teleconferences, and a practice manual. There is no travel involved and all but 1 of the teleconferences can be done anytime. The Office Champions will be required to submit an implementation plan to the AAFP and track and report results.

Practices that complete the program will receive $2,000 to cover administrative costs, plus materials for patients and recognition for practices. Participating sites will also be recognized in an advertisement in American Family Physician and on the AAFP website.

The deadline to apply is May 8, 2012. Participating sites will be announced in late May, and project implementation and evaluation will take place from June through November, 2012.

To learn more visit www.aafp.org/online/en/home/clinical/publichealth/tobacco/officechampions.html and/or email gerry.stover@wvafp.org

To apply download application by clicking here and/or email gerry.stover@wvafp.org.

This project is supported by Pfizer Inc.

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