1. + State Policy Issues: 2015 Alison Haddock, MD, FACEP Assistant Professor, Baylor College of Medicine Trustee, National Emergency Medicine PAC (NEMPAC)

2. + Disclosures None Employed at Baylor College of Medicine

4. State Legislative and Regulatory Committee

8. TODD MAISEL / NY DAILY NEWS

9. + End-of-Life and Palliative Care

10. + Costs of End-of-Life Care

11. + Opportunity of Palliative Care Improve quality Decrease costs RCTs of palliative vs usual care at end-of-life Gade, 2008: save $4,855 per palliative pt Brumley, 2007: save $7,552 Greer, 2012: save $2,282 Non-monetary benefits Patient satisfaction Quality of life Survival?

12. + IOM Report: September 2014

13. + Recommendation #1 Government health insurers and care delivery programs as well as private health insurers should cover the provision of comprehensive care for individuals with advanced serious illness who are nearing the end of life. Comprehensive care should be seamless, high-quality, integrated, patient-centered, family- oriented, and consistently accessible around the clock; consider the evolving physical, emotional, social, and spiritual needs of individuals approaching the end of life, as well as those of their family and/or caregivers; be competently delivered by professionals with appropriate expertise and training; include coordinated, efficient, and interoperable information transfer across all providers and all settings; and be consistent with individuals’ values, goals, and informed preferences.

14. + IOM & POLST Encourage states to develop and implement a Physician Orders for Life-Sustaining Treatment (POLST) paradigm program in accordance with nationally standardized core requirements.

19. 2014 IOM: Dying in America

20. + POLST & Oregon Experience Fromme, 2014 studied Oregon deaths in 2010 & 2011 58,000 deaths; 31% had POLST form in registry Scope of Treatment: 66% comfort measures only (CMO) 27% limited interventions 6% full treatment Only 6% of CMO patients died in hospital vs 44% of full treatment patients 34% of those with no POLST form in registry

21. + POLST in Texas Program not yet mature No standard form

22. + Psychiatric Boarding

26. + Behavioral Health Care in EDs Identified as one of top three challenges Some EDs not well equipped to handle patients Cannot offer treatment or monitoring over time Exacerbate existing crowding issues Community MH/SA resources insufficient Access for uninsured & Medicaid pts

27. + WA Experience: Case 2013: 10 patients sue WA state for being involuntarily held in ED and acute care medical beds awaiting psychiatry care WA-ACEP (and WSMA, WSHA, WSNA, W- ENA) filed amicus briefs in support August 2014: state Supreme Court upholds Difficult to uphold without violating EMTALA SOURCE: Seattle Times October 5 th, 2013

28. + WA Experience: Results $30 million in emergency funding of state psych hospital beds Plan for 150 additional state funded beds New certificate-of-need approvals for psych beds Clear definition of “single bed” certifications Future possibilities: Increased use of telemedicine Additional mental health resources

29. + Next Steps

30. + Contact: Alison Haddock ajh2003@gmail.com