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Interprofessional Collaboration on Behalf of Older Persons With Compromised Decisional Capacity: Developing and Implementing Core Professional Competencies. Marshall B. Kapp, JD, MPH Florida State University Tallahassee, FL [email protected]. Introduction. - PowerPoint PPT Presentation
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Interprofessional Collaboration on Behalf Interprofessional Collaboration on Behalf of Older Persons With Compromised of Older Persons With Compromised Decisional Capacity: Developing and Decisional Capacity: Developing and Implementing Core Professional Implementing Core Professional CompetenciesCompetencies
Marshall B. Kapp, JD, MPHMarshall B. Kapp, JD, MPHFlorida State UniversityFlorida State University
Tallahassee, FLTallahassee, [email protected]@med.fsu.edu
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Introduction Issues arise about cognitive and
emotional decision making capacity of older persons in many contexts.
Balance between autonomy and protecting against risk of harm requires accurate capacity assessments.
Interprofessional (medicine & law) collaboration often is desirable.
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“Capacity determination is a complex, cross-disciplinary process that ideally involves a range of professionals. It requires knowledge of medicine, ethics, and the law.”
– (Skelton, Kunik, Regev, & Naik, 2010)
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AgendaStrategies for developing core
educational competenciesPublic policy as facilitator of such
developmentPublic policy addressing
impediments to implementation of core competencies
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Compromised Decisional Capacity
Lots of decisionsPresumption of autonomous decision
makingProblem of decisional incapacity– Affects individual, plus those who have
or are contemplating personal or professional relationships with the individual
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Capacity is decision-specificCapacity depends upon ability to:–Make and communicate a choice– Give reasons for the choice– Factually understand the alternatives– Appreciate the personal consequences
of the choice
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Need for Professional Involvement in Capacity Assessment
Attorneys (ABA Model Rule of Professional Conduct 1.14) and physicians independently
Attorneys and physicians collaborativelyPoor educational preparation for this task*But see Amer. Bar Assn. & Amer. Psychological Assn.,
Assessment of Older Adults with Diminished Capacity: A Handbook for Lawyers (2005) and British Medical Association and Law Society, Assessment of Mental Capacity: A Practical Guide for Doctors and Lawyers, 3rd ed. (2010).
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Delineating Professional Competencies
Competency-based professional education– Outcome/skills oriented, not focused on
process inputs or recitation of information– Premise: Teaching can improve performance– Assessing decisional capacity is a core
competency that attorneys and physicians should be able to demonstrate
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Delineating specific competencies– Build on General Competencies of
Accreditation Council for Graduate Medical Education (ACGME)Interpersonal and Communication Skills
– “…work effectively as a member or leader of a health care team or other professional group.”
Professionalism
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– Build on Interprofessional Education Collaborative (IPEC) (organizations of health education institutions), Core Competencies for Interprofessional Collaboration Practice (2011). Did not address working with attorneys.Core competencies:
– Values/ethics– Roles/responsibilities– Communication– Teams and teamwork
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Roles of Public Policy Encouraging and Facilitating the Development
and Implementation of Core Competencies– Government grants (e.g., NIA, HRSA, AoA) to
support educational innovations, at least demonstrations, leveraged with private foundation support
– Medicare payment to physicians for interprofessional capacity assessments under Part B, factor cost of this service into payment rate offered by CMS to Medicare Advantage plans
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Integrate expectation of interprofessional capacity assessments into legal standard of care for physicians through Clinical Practice Guidelines (whose development and dissemination is supported through grants from the Agency for Healthcare Research and Quality [AHRC]). Integrate expectation of interprofessional capacity assessments into legal standard of care for attorneys through changes in ABA Model Rules of Professional Responsibility.
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– Government or private grants (e.g., HRSA) to support and encourage certain medical specialty boards to incorporate demonstration of relevant core competencies into specialty certification examinations.
– Government or private grants to support and encourage organizational and state Bar legal specialty designation boards to incorporate demonstration of relevant core competencies into specialty certification processes.
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Removing or Mitigating Barriers to Implementation of the Core Competencies– Clarify/modify Health Insurance Portability and
Accountability Act (HIPAA) to facilitate information exchange and interprofessional communication involving medical information
– Clarify/modify ABA Model Rules of Professional Responsibility to facilitate information exchange and interprofessional communication involving information known by the attorney
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Discussion?