Nursing & Assisted Living Facility Professional FEBRUARY 2013

Transcription

1 Nursing & Assisted Living Facility Professional FEBRUARY 2013 NEWS AND VIEWS YOU CAN REALLY USE ISSUE 2, VOLUME 3 THE HAT ADVANTAGE by Rebecca Adelman QAPI: PREPARE AND LAUNCH EARLY Nursing homes in the United States will soon be required to develop Quality Assessment and Performance Improvement (QAPI) plans. QAPI, part of the Affordable Care Act Section 6102 (c), is the merger of two complementary approaches to quality management, Quality Assurance (QA) and Performance Improvement (PI). In December, CMS issued a survey and certification letter providing an advance preview of the nursing home QAPI resource called QAPI at a Glance. Please visit SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter pdf. QAPI at a Glance is a step-by-step guide that provides tools and resources to help nursing homes establish a foundation for their QAPI system. This two part article will provide an overview of the Five Elements for Framing QAPI in Nursing Homes, the Action Steps to QAPI and recommendations for preparing for QAPI in the context of the goals and expectations for QAPI and sustainable improvement. Currently, nursing homes follow Quality Assessment and Assurance (QAA) that requires identifying and correcting quality issues. QAPI will shift the focus to organization-wide involvement in continuous improvement activities that are data-driven. With a QAPI regulation in process and the subsequent date for submission of a facility QAPI plan to CMS a year after promulgation of IN THIS ISSUE: PAGE ONE: The HAT Advantage PAGE ONE: Kessler s Corner PAGE TWO: Pathway to Rehabilitation PAGE THREE: Save The Date PAGE THREE: Beating the Ostrich Syndrome the regulation pending, preparing for QAPI may seem like an initiative too far away to be of immediate concern. However, by beginning your preparations for QAPI now, you can also positively position your organization in ways that will have an immediate effect on performance. The Five Elements for Framing QAPI in Nursing Homes CMS has identified five strategic elements that are basic building blocks to effective QAPI providing a framework for QAPI development. Element 1: Design and Scope - A QAPI program must be ongoing and comprehensive, dealing with the full range of services offered by the facility, including the full range of departments. When fully implemented, the program should address all systems of care and management practices. Nursing homes will have in place a written QAPI plan adhering to these principles. Element 2: Governance and Leadership - The governing body and/ or administration of the nursing home develops and leads a QAPI program that involves leadership working with input from facility staff, as well as from residents and their families and/or representatives. The governing body assures the QAPI program is adequately resourced to conduct its work. They are responsible for establishing policies to sustain the QAPI program despite changes in personnel and turnover. The governing body and executive leadership are also responsible for setting expectations around safety, quality, rights, choice, and respect by balancing both a culture of safety and a culture of resident-centered rights and choice. KESSLER S CORNER by Chip Kessler Survive and Thrive! Continued on page 4 These are not the easiest of times for our nation s nursing facilities and assisted living communities you don t need me to tell you this! In addition to the everyday demands of providing top-notch care and services to your residents and families, and the major responsibility this entails, there s now the fact that it seems as if your efforts are being shunned by your own state and federal governments. In my state of Tennessee, there s presently a major push underway to either keep folks out of nursing facilities altogether, or at the very least severely limit how long a Continued on page 4

2 The Nursing and Assisted Living Facility Professional Newsletter welcomes Sheila Capitosti as one of our featured contributors. You ve enjoyed Sheila s prior contributions in these pages and we re thrilled to be able to feature her insights now on a regular basis. Pathway to Rehabilitation Excellence By Sheila Capitosti, RN-BC, NHA, MSHSA Therapy Services and Medicare: What We Know and What We Do Not Therapy providers begin 2013 with a mixture of current processes that have been extended, some new processes that will need implemented and speculation about what may be next related to Medicare services. President Obama has signed into legislation the American Taxpayer Relief Act and the following are the relevant therapy provisions that impact therapy providers in 2013: No 2% sequester cut to Medicare providers The SGR fix is extended through December 31, 2013 The legislation does not preclude the implementation of the 2013 physician fee schedule final rule, so the various code changes within the fee schedule will go forward for 2013 Therapy cap exceptions process is extended through December 31, 2013, including the manual medical review process for outpatient therapy services that exceed the $3700 threshold Multiple Procedure Payment Reduction (MPPR) for therapy is increased to 50% effective on April 1, 2013 Work Geographic Adjustment - The existing 1.0 floor on the physician work index is extended through December 31, 2013 Increase statute of limitations for recovering overpayments - This provision increases the statute of limitations to recover overpayments from three to five years, based on recommendations from the Office of Inspector General (OIG) at the Department of Health & Human Services and saves $0.5 billion Repeals the CLASS Program, which has been dormant for more than a year due to HHS inability to design a financially viable plan, and creates the Commission on Long Term Care to develop a plan for the establishment, implementation, and financing of a high-quality system that ensures the availability of long-term services and supports for individuals The bill includes language to provide new limited protections for beneficiaries from the economic consequences of claims that are denied for not meeting the exceptions criteria (including claims subject to MMR) While Congress has extended the doc fix and the therapy cap exceptions process, including the $3,700 threshold, and imposed the MPPR at 50 percent, Congress will have to come back in two months and address the debt ceiling and the sequester. The legislation delays the sequester for two months, which under current law would have required there to be across-the-board cuts imposed as of yesterday, January 2, This would have resulted in a 9.4% reduction in Defense and an 8.2% cut in domestic discretionary programs. Medicare cuts to providers under the sequester are limited to 2%, and Medicaid is exempt from the sequester. When they address these issues, more offsets will have to be found. So, our sector will be at risk again for cuts. The increase in the MPPR was indeed a disappointment which our provider associations lobbied against, however, the merits of the policy were really not an issue; it was just a way to pay for what the Senate needed to do so we as an industry should be prepared that we have not yet seen the worst. In addition to the American Taxpayer Relief Act, The Middle Class Tax 2 ELITE PEOPLE + ELITE CARE ELITE RESULTSS functionalpathways.com Relief and Jobs Creation Act of 2012 has required implementation of a claims-based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy services. This is designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition and outcomes but ultimately could result in a new way of reimbursing providers for outpatient therapy services. There is a test period that begins January 7, 2013 and ends June 30, 2013 with mandatory reporting becoming effective July 1, Also, the Physician Quality Reporting System (PQRS) changes from an incentive-based program to a penalty program in Therapists in private practice that do not participate in 2013 will have a penalty payment of 1.5% assessed in So, therapists in private practice should be thinking about participating in this program. There are several measures that therapists can report on which actually should be part of the evaluation process and therefore not an increased burden. This only applies to therapists in private practice, not institutional providers. Finally, CMS has announced that they have contracted with Acumen LLC and the Brookings Institution to identify potential alternatives to the existing methodology used to pay for therapy services under the SNF PPS that correlates with the ability to assess patients impairments and functional status. One can only speculate on how long this process will take, but clearly providers should be prepared for reimbursement changes in this arena as well. When it is all said and done, however, the patient s needs must be kept paramount and we must continue to be advocates for reasonable and medically necessary therapy services for the patients in both skilled nursing as well as outpatient therapy environments. Sheila Capitosti is VP Clinical and Compliance Services for Functional Pathways, a leader in contract rehabilitation and therapy services throughout the country. For more information please call or visit

3 Education Arena Beating The Ostrich Syndrome Each month a specific program designed to make you and your fellow staff members take the next step in your professional development at an exclusive discounted investment for readers of Nursing and Assisted Living Facility Professional. The Ostrich- a rather large bird with a habit of sticking its head in the sand to avoid looking at things. It s just human nature to believe that nothing bad will happen, so you re not faulted if you don t wish to dwell on the possibility of a negative incident striking your nursing home or assisted living community. However, the sad fact is that every single day a healthcare venue just like yours has something take place. It may be a case of alleged abuse or negligence by a staff member towards a resident; or a resident s suspicious death; or a lawsuit filed against your facility; or a disaster such as a fire, flood or weather related catastrophe like a hurricane or a tornado hitting your building. The question isn t will one of these events or situations occur but when! And most importantly, how will you and your fellow staff members react? Will you be ready to handle the matter-at-hand in a cool, calm and collected manner will you be ready to deal with families and residents who are looking for answers will you be ready if local authorities have questions will you be ready to handle local (and maybe even national) reporters who are in your face with microphones ready to put the story on the six o clock news or plastered on the newspaper s front page? Or will you shrink when the spotlight s on and do untold damage to your facility s reputation, and maybe your own! That s where The Complete Crisis Communications Plan can be of enormous value to you and your assisted living community or nursing home. Communications pro Chip Kessler joins forces with risk management expert Ric Henry (President of Pendulum, a risk management company serving healthcare clients nationwide) and Tony Treadway (a former television news anchor and now President of Creative Energy a nationally based public relations company). In this three-part DVD series you ll discover: The basics of any sound crisis communications plan The dangers of having a one-size-fits-all mentality regarding crisis communication with family, residents, media, and others Who is the best person to act as your building s spokesperson in a crisis and why this decision is critically important Why the media is drawn to negative stories and what your facility must do to expertly control a reporter s feeding frenzy What kind of person becomes a reporter and why you need to understand this to best be able to deal with media members The most common misconceptions facility staff has about reporters plus the media in general, and why these beliefs will bite you during a crisis What two words you must never say to families, residents, staff, and reporters because if used will GUARANTEE that your facility s viewed as trying to hide something How best to handle things if a family member goes to the media on their own with an issue or problem, and then a reporter or reporters show up at your door What you can do to get back your facility s good name with your present families (and potential future new admitting families) after a crisis has struck 3 Plus you receive The Complete Crisis Communications Plan Study Guide, a giant reference tool which helps you lean how to manage any crisis in a relaxed and confident manner to best show staff, family, residents, and folks in your local region and community that you and your facility are on top of the situation. And you also receive The Complete Crisis Communications Plan Action Document - Chip Kessler s point-by-point directive featuring crisis communications do s and don ts all delivered in one handy sheet for quick use in a flash. For the month of February, enjoy extra special exclusive discounted savings on The Complete Crisis Communication Plan Program. Regularly reduced to three-payment of $ each, readers of Nursing and Assisted Living Facility Professional get an additional $20.00 reduction and invest only $ each on three-monthly payments. Plus if you wish to make a one-time investment (regularly at $359.95) you ll save $60.00 and receive The Complete Crisis Communications Plan at only $ Plus, when you order, you ll receive three additional free bonus gifts worth $ We ll pay your shipping and handling charges, a $25.00 value The audio CD interview Crisis Communication and the Law with noted assisted living and nursing facility defense attorney Rebecca Adelman offering her personal insights on why a sound crisis communications plan can help prevent potential lawsuits from families against your facility, a $49.95 value. Assisted living and nursing facility liability insurance specialist Tra Beicher s audio CD Effective Risk Management through Solid Crisis Communication (a $49.95 value), explaining from an insurance perspective why you must have an effective crisis communications plan in place. Respond at and in the on-line shopping cart comments section key in the words: Newsletter Discount. Please ignore the listed pricing and you ll receive an conformation with your lower investment noted. You may also call toll-free and mention Nursing and Assisted Living Facility Professional to obtain your exclusive discount. SAVE THE DATE! Litigation Risk and Defense Strategies for Long Term Care and Assisted Living Providers, Insurers and Brokers May 2-3, 2013 Peabody Hotel, Memphis, Tennessee Enjoy the Beale Street Music Festival! Hosted by: CRC Insurance Services Cowan & Lemmon, L.L.P. Hagwood Adelman Tipton, PC Extended Care Products Ebanks Horne Rota Moos, L.L.P. Kaufman Borgeest & Ryan, LLP All Roads Lead to Memphis this May for The Risk Management Conference Not to be Missed! If you re interested in attending the free conference, please contact jsuzore@hatlawfirm.com (travel and hotel accommodations not included)

4 The HAT Advantage continued from page 1 Element 3: Feedback, Data Systems and Monitoring - The facility puts in place systems to monitor care and services. Feedback systems actively incorporate input from staff, residents, families, and others as appropriate. This element includes using Performance Indicators (PI) to monitor a wide range of care processes and outcomes, and reviewing findings against benchmarks and/or targets the facility has established for performance. It also includes tracking, investigating, and monitoring Adverse Events that must be investigated every time they occur, and action plans implemented to prevent recurrences. Element 4: Performance Improvement Projects (PIPs) - The facility conducts PIPs to examine and improve care or services in areas that are identified as needing attention. PIPs are selected in areas important and meaningful for the specific type and scope of services unique to each facility. Element 5: Systematic Analysis and Systemic Action - The facility uses a systematic approach to determine when in-depth analysis is needed to fully understand the problem, its causes, and implications of a change. Additionally, facilities will be expected to develop policies and procedures and demonstrate proficiency in the use of Root Cause Analysis. QAA Privileges F520 remains the standard for the QAA committee s discovery and waiver of privilege. According to F520, Records of the committee meetings identifying quality deficiencies, by statute, may not be reviewed by surveyors unless the facility chooses to provide them. The regulation states that the facility is not required to release the records of the QAA committee beyond those that demonstrate compliance with the regulation. There are different types of QA documents that are entitled to privileges and protections. It is critical to have an organized QAPI process to demonstrate that there exists an effective quality assurance process without risking disclosure. Individual states may also have QA privileges to consider. Action Steps to QAPI CMS identifies 12 Action Steps to consider when implementing QAPI. Early understanding of the QAPI principles is essential for effective QAPI training and modifications to existing QAA programs and policies. STEP 1: Leadership Responsibility and Accountability Creating a culture to support QAPI efforts begins with leadership. Support from the top is essential, and that support should foster the active participation of every caregiver. The administrator and senior leaders must create an environment that promotes QAPI and involves all caregivers. the action steps outlined in this guide, you should periodically evaluate QAPI in your organization see how far you ve come. STEP 4: Identify Your Organization s Guiding Principles It is important to lay a foundation that will help you think about what principles will guide your decision making and help you set priorities. STEP 5: Develop Your QAPI Plan Your plan will assist you in achieving what you have identified as the purpose, guiding principles and scope for QAPI. This is a living document that you may revisit as your facility evolves. STEP 6: Conduct a QAPI Awareness Campaign Let everyone know about your QAPI plan often and in multiple ways. Plan ongoing caregiver education. Train through dialogue, examples, and exercises. Be sure consultants, contractors, and collaborating agencies are also aware of your QAPI approach. Convey the message that any and every caregiver is expected to raise quality concerns, that it is safe to do so, and that everyone is encouraged to think about systems. STEP 7: Develop a Strategy for Collecting and Using QAPI Data Your team will decide what data to monitor routinely. Consider clinical care areas, medications, complaints from residents and families, hospitalizations and other service use and resident and caregiver satisfaction, business and administrative processes. STEP 8: Identify Your Gaps and Opportunities This step involves reviewing your sources of information to determine if gaps or patterns exist in your systems of care that could result in quality problems and identifying opportunities to make improvements. STEP 9: Prioritize Quality Opportunities and Charter PIPs Prioritizing opportunities for improvement is a key step in the process of translating data into action. STEP 2: Develop a Deliberate Approach to Teamwork Teamwork is a core component of QAPI and too often it is taken for granted. You will hear and read that you should discuss a situation with your team, or that the opinion of everyone on the team is valued. The word teamwork may have different meanings. Many people work together without being a designated or formal team. STEP 3: Take your QAPI Pulse with a Self-Assessment In order to establish QAPI in your organization, it is helpful to conduct a self-assessment in your organization. As you continue implementing 4 STEP 10: Plan, Conduct and Document PIPs Careful planning of PIPs includes identifying areas to work on through your comprehensive data review which are meaningful and important to your residents. It is important to focus your PIPs by defining the scope, so they do not become overwhelming. STEP 11: Getting to the Root of the Problem A major challenge in process improvement is getting to the heart of the problem or opportunity. Hat Advantage continued on page 5

5 Kessler s Corner continued from page 1 resident can stay in a long-term care facility. The thrust here is to have folks stay in their home (or return home as mandated) to potentially receive some sort of at-home healthcare assistance This is taking place even though many of these good people still need the kind of caregiving services, which are only available in a nursing facility. The bottom line here in my state is that many deserving individuals are being forced to return home, or are being denied the opportunity for nursing facility placement, in what s interestingly called the CHOICES program. Those reading this in the state of Tennessee know exactly what I m talking about and what they re up against. For the rest of you across the country, you re either facing your own nursing facility and assisted living challenges via your state s Medicaid directives (if applicable) concerning new admissions, or very well could be traveling down this path in the near future. It all adds up to this: it s very tough for our nursing and assisted living facility professionals at times to stay positive and upbeat when faced with challenges such as just described. Yet I m here to tell you that you have what it takes to deal with this situation and not only survive but thrive. I don t just say this; I know it! Why? Because I m very familiar with the men and women who report to work each day in our nation s nursing homes and assisted living communities and I know from first-hand experience all about the men and women who work as well in our management companies that own or consult for these healthcare facilities. Together you form one of America s most trusted group of people found anywhere on earth. It s my opinion that folks associated with our nation s nursing facility and assisted living communities, whether directly involved in the caregiving profession or in an advisory capacity, are among the most dedicated of individuals found anywhere. You are a group that has faced many challenges before, yet continue to shine in the face of adversity. For starters, the very field of healthcare you have chosen to become part of; has been frowned upon and put down time and time again. An example here are our group of nurses, who are talented enough to gain employment in a top-flight hospital or other healthcare venues, yet choose to work in an assisted living or nursing facility. Their decision is often ridiculed and openly questioned by well-meaning friends or families members who wonder why someone so skilled selects a mere nursing home or assisted living community to work? The same can be said of the many gifted folks who work in these caregiving venues business offices, or in this form of healthcare administration, or for that matter the ladies and gentlemen who staff nursing home and assisted living management companies couldn t these individuals find a more rewarding career path in that big local hospital or that major physicians consortium? The short answer, quite often, is no! It s because the nursing home administrator wanted to get into this particular branch of healthcare management. Likewise for the assisted living community administrator or executive director. Ditto for the long-term care activities director, social services director, and the housekeeping and directory directors who openly and proudly selected the opportunity to provide service to their fellow human beings, many of whom can no longer care for themselves or need some sort of welcome assistance. You selected this career path because there was something inside of you that wants to be of service. It is part of who you are and what makes you special. It separates you from many others. It is something to be proud of, and not hide when questioned as to why you do what you do. It all adds up to this important fact. It s something that people who look to cast dispersions at those employed in the nursing and assisted living sector don t understand. Likewise for those in state and federal government who seek to make it much more difficult for you to gain new residents and hope you ll just lie down and take it. They all don t realize that you are a very special group of men and women who can look negativity in the eye, deal with it, and come out winners! Yes, these are trying times times that can make you question whether or not it s time to get out and look for other avenues to display your abilities. However, because of who you are and as someone who doesn t back away from challenges, no matter how tough, I m betting on you to succeed! Chip Kessler is General Manager of Extended Care Products. He is the author of two books, the latest of which The No. B.S. Guide to Marketing to Leading-Edge Seniors and Baby Boomers, co-written with America s #1 marketer Dan S. Kennedy, is now available at our nation s top booksellers such as Barnes and Noble, Books-a-Million and Amazon.com however you re invited to discover how you can get a free copy of this book (which features Chip s exclusive chapter on marketing nursing home and assisted living care and services) plus other free bonus gifts as part of his brand new Marketing Magic DVD seminar series an excellent resource to help your nursing facility or assisted living community attract more new residents in this time of added government interference. Discover more about Marketing Magic for Nursing Facilities at and get details about Marketing Magic for Assisted Living Facilities at plus again get your free book. HAT Advantage continued from page 4 STEP 12: Take Systemic Action Implement changes or corrective actions that will result in improvement or reduce the chance of an event recurring. This is often the most challenging step in the process. No doubt that developing the QAPI program will require changes to and creation of new infrastructures and policies and procedures. Expanded leadership and operations and comprehensive training will be necessary for implementation of QAPI. Increased scope of responsibilities and assurances of the governing body and potential waivers of privileges are some of the legal issues presented by the QAPI. We are advising our owners and operators on potential litigation risks and the strategizing to develop policies and procedures and leadership protocols that will preserve available privileges and protect individuals and governing bodies from possible liability. Developing best practices for risk reduction and quality of case at all levels will 5 promote the most effective QAPI. Beginning where your organization is now with QAA is the first step. Part 2 continues with recommendations for preparing for QAPI related to leadership, policies and procedures and privilege tips. Ms. Adelman is a Shareholder Of Hagwood Tipton Adelman, PC and practices in the Memphis, Tennessee office. She is a member of the Board of Directors and serves as the firm s President. For over 20 years, Rebecca has concentrated her practice in healthcare law, long-term care assisted living and medical malpractice defense litigation. Her expertise and her scope of practice involve all insurance defense litigation areas including premises and product liability as well as employment law. Please feel free to contact her at radelman@hatlawfirm.com.

6 NAL Professional Not Coming Addressed to You Personally? We want to make sure you are personally getting this newsletter each month, not just have it forwarded to you because you re now holding down the position of a predecessor! Let us know you now are on the job. your name, facility/company name and address to chip@ecpnews.net & we ll update our records. Just put NAL Professional on the subject line and we ll take care of the rest. NAL PROFESSIONAL P.O. Box 4852 Johnson City, TN PRSRT STD US POSTAGE PAID MWI Proactive Medicare Optimization! Did 2012 CMS Changes impact your financials? We are here to help! Dart Chart Systems offers Proactive Analytics Financial Analysis and Daily RUG Scores Optimize upstream analytics COT Dashboard Discharge Risk Dashboard (coming soon!) Integrated solutions: ADT, MDS & Therapy Benchmark Your Organization Call Dart Chart Systems at for your complimentary financial assessment. We believe you deserve credit for all the care you provide.