MOLST: Our Medical, Ethical & Legal Responsibility to Improve Quality and Honor Preferences

Wednesday, November 2, 10:45 a.m. - 12:00 p.m.

View the session here.

Notes from session:

MOLST Powerpoint Slides here.

Session Title & Description here.

Presenter: Patricia Bomba MD, MACP, FRCP

Founder, NY MOLST & eMOLST Programs

Founder & Emeritus Chair, MOLST Statewide Implementation Team

Co-Founder, National POLST

MOLST is a set of medical orders and key pillar of palliative care for seriously ill individuals who have advanced illness or multiple comorbidities. The goal is to improve the quality of life and reduce suffering for individuals with intellectual/developmental disabilities (I/DD), the same as the general population.  Unfortunately, completion of MOLST and the SCPA 1750-b process outlined on the OPWDD Checklist is most often completed in the hospital when people with I/DD experience serious acute medical events superimposed on advanced illness. Intensive care often requires feeding tubes, tracheostomies, dialysis and other extraordinary interventions that often prevent them from returning to their previous living arrangements and experiencing a quality of life consistent with what matters most to the individual.

The presenter will explore some of the challenges encountered when balancing the burden of intensive medical care with the quality of life and offer potential solutions:

• Designing and implementing a systematic approach to advance care planning for all individuals with I/DD starting at 18 years of age
  • Identifying individuals with the capacity to choose a health care agent and ensuring proper completion of health care proxies
  • Defining and documenting the individual’s values, beliefs, goals and “what matters most”
• Recognizing the complexity of medical decision-making and fostering a model of shared decision-making that ensures the voice of the individual is heard
• Incorporate supported decision-making when regulations are finalized
• Identify individuals appropriate for MOLST before acute hospitalization is required

Objectives

1. Identify opportunities to improve use of MOLST for Individuals with I/DD
2. Demonstrate how elements of the standardized 8-Step MOLST protocol are effectively used
3. Recognize how, when, and why the OPWDD legal requirements checklist must be completed
4. Explain how eMOLST ensures quality, patient safety and accessibility

About Dr. Patricia Bomba:

Dr. Patricia Bomba is a nationally & internationally recognized palliative care/end-of-life expert, previously served as vice president and senior medical director of geriatrics and palliative care at Excellus BlueCross BlueShield (BCBS). Dr. Bomba founded the New York Medical Orders for Life-Sustaining Treatment (MOLST) & eMOLST programs. At the request of the commissioner of the New York State Department of Health, she developed and served as chair of the MOLST Statewide Implementation Team; she currently serves as the Emeritus Chair. Prior to working at Excellus BCBS, Dr. Bomba spent four years in academic medicine and nearly two decades in private practice focused on the care of frail older adults and patients with multiple co-morbidities. She developed the first physician-nurse practitioner practice model in a long term care setting in Rochester in 1983.

She is a founding member of National POLST, serves on the Executive Committee of the Plenary Assembly, chairs the Public Policy Committee and previously served on the Leadership Council.  She served on the Institute of Medicine’s Committee that produced Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, the NASEM Roundtable on Quality Care for People with Serious Illness, NCQA’s Geriatric Measurement Advisory Panel (GMAP) and the Medical Society of the State of New York Ethics Committee.

Dr. Bomba is author of several articles on issues related to advance care planning, palliative care, elder abuse and end-of-life concerns. She has spoken extensively regionally, statewide, nationally and internationally to professionals, community groups and professional organizations on issues related to advance care planning, MOLST, palliative care, pain management, elder abuse and other geriatric topics. Dr. Bomba earned a bachelor’s degree from Immaculata College and graduated from the University of Virginia School of Medicine. She completed her residency in Internal Medicine at the University of Rochester. Dr. Bomba is board certified in Internal Medicine, with Added Qualifications in Geriatric Medicine. She attended the Executive Development Program at the Wharton Business School.