UPDATE Weekly

There are a limited number of seats! Register today for Dementia Care for America’s Heroes: Understanding Dementia and Developing Skills for Positive Outcomes! This program will be held on March 24th, 2016 in Greensboro, NC and presented by Heather McKay, MS, OT/L, Dementia Care Specialist. Heather presented at our 2015 Annual Convention and Expo and is back by popular demand!

Heather will present a full day seminar that goes beyond the basics to address brain changes with dementia, communication challenges, the timeline of this disease and why people do what they do in every stage. Along with practical, ready-to-use communication techniques and hands-on skills that are safe for caregivers and those they support, participants will learn about the progression in 5 stages and strategies that work to support people at every stage. Participants will learn specific ways of grading their help to match a person’s changing needs and foster more positive interactions throughout the progression of dementia. Leaders will learn ways to engage and coach team members and support the whole team with objective competency measures that are helpful throughout the progression of dementia.

This program offers 5.5 contact hours for nursing home administrators. NCHCFA will issue a certificate of completion for 5.5 education contact hours for other attendees!

Click here to register now! Don’t miss out!

[Return to top]

The NC Division of Medical Assistance (DMA) and NCTracks are planning to reprocess claims affected by the Case Mix Index (CMI) Freeze placed in effect in June of 2015. Retroactive nursing home rate adjustments will be performed on claims with dates of service from January 1, 2015, to May 31, 2015. The reprocessing includes nursing home claims and Hospice claims that pay as a percentage of the nursing home rate. (Hospice revenue codes 658 and 659.)

Where possible, the claims that had a rate change will be processed as adjustments. Otherwise, the claims will be voided on March 20-21, 2016, and reprocessed as original claims. In both cases, the reprocessed claims will appear in the March 29, 2016, checkwrite. No action is required on the part of providers.

The reprocessed claims will appear in a separate section of the paper Remittance Advice (RA) with a unique Explanation of Benefits (EOB) code: EOB 06046 – CLAIM REPROCESSED FOR RATE ADJUSTMENT PAYMENT. The 835 electronic transactions will include the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835.)

Note that reprocessing does not guarantee payment for the claim. While some edits may be bypassed as part of the claim reprocessing, changes made to the system since the claims were originally adjudicated may apply to reprocessed claims. Therefore, the reprocessed claim could deny.

If the reprocessed claim denies and there are not sufficient funds to satisfy the full recoupment amount from claims paid in the current checkwrite, the recoupment process will continue on each checkwrite until the full amount due is recouped.

[Return to top]

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a press release titled CMS releases Skilled Nursing Facility utilization and payment data as part of its efforts to increase transparency in federal health programs. The Skilled Nursing Facility Utilization and Payment Public Use File (SNF PUF) contains information for 2013 on utilization, payments, and submitted charges organized by provider, state, and resource utilization group (RUG).

The data has a number of limitations. Most notably: 1) the data does not indicate the quality of care provided by individual skilled nursing facilities, 2) the data are not risk adjusted and thus do not account for differences in the underlying severity of disease of patient populations treated by providers, and 3) the data only reflects Medicare fee-for-service (FFS) and not Medicare Advantage utilization.

The Skilled Nursing Facility PUF contains five Microsoft EXCEL tables: 1) aggregated information by provider, 2) aggregated information by provider and RUG, 3) aggregated information by RUG, 4) aggregated information by RUG and state, and 5) aggregated information on therapy minutes by provider. CMS also provides a Frequently Asked Questions (FAQ) page related to the SNF PUF data.

In addition to information on payments and charges, the SNF PUF contains information on two categories of RUGs for patients who receive a significant amount of therapy: Ultra-High (RU) and Very High (RV) Rehabilitation RUGs. The fact sheet referenced above includes several tables and maps highlighting utilization patterns of concern to CMS, the agency describes that the results are consistent with prior CMS findings. Specifically, the SNF PUF shows that for these two RUGs, the amount of therapy provided is often very close to the minimum amount of minutes needed to qualify a patient for these categories.

Based on the 2013 information in the SNF PUF data, CMS found that:

• 51 percent of all RV assessments showed therapy provided between 500 and 510 minutes.
• 65 percent of all RU assessments showed therapy provided between 720 and 730 minutes.
• ore than one in five providers had more than 75 percent of both RU and RV assessments that showed therapy provided within 10 minutes of the minimum threshold.

In the Fact Sheet CMS also provided the following announcement:

“To help ensure that patient need rather than payment incentives are driving provision of therapy services, CMS is providing approval to the Medicare Fee-for-Service Recovery Auditor Contractors (RACs) to investigate this issue.”

American Health Care Association (AHCA) is recommending that SNF providers review the information in the SNF PUF tables for 2013, especially those data that are specific to their individual nursing centers. In particular, SNF providers should review table 5) aggregated information on therapy minutes by provider. This table provides specific detail for the percentage of RU assessments with reported therapy minutes between 720 and 730 minutes in column J, and the percentage of RV assessments with reported therapy minutes between 500 and 510 minutes in column H. There is a likelihood that the RACs may focus their initial attention in the investigation assigned to them by CMS to those nursing centers at or near the 100% rate of assessments falling exactly on or within 10 minutes of the RV and RU RUG thresholds.

AHCA will be reviewing the extensive SNF PUF data files in more detail and will be seeking more details regarding the scope of the Recovery Audit Program investigation. We will provide updates as details become available.

[Return to top]

On March 3, CMS announced the addition of new quality measures (QMs) to Nursing Home Compare (NHC) and the Five-Star Quality Rating System. The new measures are a part of the agency’s effort to track and encourage improvements in skilled nursing care centers for short-stay and long-stay patients and residents. These new additions also build on what CMS announced in February of 2015.

There are six new measures: four short-stay and two long-stay. The new short-stay measures are discharge back to the community, emergency room use, rehospitalizations, and improvement in function. Three of the four are aligned with the AHCA Quality Initiative. The new long-stay measures are decline in mobility and the use of hypnotics/anxiolytics.

What does this mean for American Health Care Association (AHCA) member centers? By the end of April, all six of the new measures will be added to NHC and accessible to the public. And in July, all but one measure – hypnotics/anxiolytics – will be added to Five-Star. CMS has not yet announced how the new QMs will impact the overall star rating.

AHCA hosted a Webinar for members on March 4 that walked through these new updates in greater detail. The recorded presentation, along with more specifics on the new measures, are available only to members on the Five-Star ahcancalED page here.

What can members do over the next few weeks to prepare for the addition of the new measures in April and in July?

1. Register for free to access members-only Five-Star resources on ahcancalED. Current resources include the March 4th AHCA Webinar, the questions and answers from that Webinar, and specifics on the new measurements. To access the resources on the site, you must 1) log in using your AHCA username and password and 2) register to download the Five-Star materials. Contact educate@ahca.org if you need any assistance.
2. Watch AHCA’s Webinar from March 4 if you have not already done so. Consider holding an all-staff meeting to watch the Webinar together.
3. Be sure your MDS coordinator is aware of the new updates. She/he will be able to access the QIES System one week before the new measures are added to NHC in April.
4. Start counting and tracking the number of residents and patients who are experiencing each of the QMs (e.g., discharge back to the community, emergency room use, rehospitalizations) by using Advancing Excellence’s free tracking tools.
5. Review and familiarize yourself with the specifics of the new measures. And don’t forget to include your staff in this process.
6. Go to AHCA’s LTC Trend Tracker(SM), a free, members-only online tool, to run your Discharge to Community and Hospitalization Rate reports. Once you have your report, look to see if you are above or below the national average to get a sense of how you are doing. Based on what you learn, set a goal to perform at least two-three points better than the average. Contact help@ltctrendtracker.com if you need any assistance.
7. Visit the AHCA Quality Initiative Website to access additional resources to improve your discharges back to the community and reduce hospital readmissions.
8. Stay tuned. AHCA will inform members of any new updates over the next few weeks.

[Return to top]

Palmetto GBA will host the JM Part A Ask the Contractor Teleconference (ACT) on April 21, 2016, from 2:00 PM to 3:00 PM ET. This call is intended for Part A providers billing for services rendered in Virginia, West Virginia, North Carolina and South Carolina. The topic will be Discussing Top Provider Inquiries. The ACT call is designed to open the communication channels between Palmetto GBA and the Jurisdiction M Part A provider community.

To participate on the call, dial (877) 789-3907 and use confirmation code 70010765.

You are encouraged to submit questions prior to the call. Just fill out the ACT Request for Inquiry Items form. This form may be sent via fax to (803) 935-0140 addressed to JM Part A Ask-the-Contractor Teleconference. All questions must be received at least five business days prior to the teleconference. To help ensure your access to this conference call we ask that you dial in five to 10 minutes prior to the scheduled start time.

An Encore digital recording of this conference will be available for replay two hours after the call’s completion and will be available until April 23, 2016, 11:59 PM. To access the recording, guests dial (855) 859-2056 and the Conference ID number shown above.

[Return to top]

Alliant Quality wants to encourage SNFs to keep signing up for the National Collaborative – or SPACE. Alliant recommends having as much time as possible to get started on Quality Assurance Performance Improvement (QAPI) improvement work and improving facility quality measures in a systems approach to improve their five star and composite scores.

Alliant Quality is the Medicare Quality Innovation Network (QIN)-Quality Improvement Organization (QIO) for North Carolina. Under contract with the Centers for Medicare & Medicaid Services (CMS), Alliant Quality invites your nursing home to participate in a collaborative designed to ensure that every nursing home resident receives the highest quality of care.

The Collaborative offers an exciting opportunity to learn from high performing nursing homes regarding their processes as they pertain to consistent/permanent staff assignment, teamwork and communications, leadership, regulatory compliance, clinical models, and quality of life indicators. The Collaborative aligns national nursing home quality initiatives and partnerships such as the Advancing Excellence in America’s Nursing Homes Campaign, The Partnership to Improve Dementia Care, and QAPI. Targeted focus areas will include increasing mobility, decreasing unnecessary use of antipsychotics in residents with dementia, decreasing potentially avoidable hospitalizations and decreasing healthcare acquired infections and conditions.

When ready to register, click here for the Participation Agreement and fax or e-mail it back to Lisa Klemis. For more details, e-mail Jennifer Brock at Jennifer.Brock@area-F.hcqis.org or call (678) 527-3417.

[Return to top]

National Nursing Home Week® is May 8-14, 2016! AHCA’s 2016 National Nursing Home Week® (NNHW) specialty products are now available for purchase. This year’s theme with logo, It’s a Small World with a Big Heart, is featured on many of the available items. To purchase National Nursing Home week specialty products including posters, balloons, t-shirts, buttons, and more, shop on-line or call 800-321-0343.

Members are encouraged to place orders early for best product selection (color, size, and available quantities). NNHW items are very popular and will sell out. Ask about our t-shirt discounts when ordering. Again, please do wait until the last minute, you don’t want to be disappointed!

[Return to top]

Join Alliant Quality for their 30 minute, Care Coordination Improvement Series. This month’s topic, Prescribing Quality: Safe and Effective Use of High Risk Medications

April 6th, 2016: 1:00 PM
To join this call: (800) 681-1617

Questions to consider:

• How do you identify patients at highest risk for medication-related problems?
• What processes do you have in place to facilitate the interdisciplinary team approach to medication management?
• How do you identify and resolve medication-related problems?

[Return to top]

In collaboration with its community partners, the NC Department of Health and Human Services proudly announces the 2nd Annual NC Community Transitions Institute. This initiative provides a hands-on, collaborative learning opportunity for professionals who assist individuals with long-term care needs to transition from facility settings to their homes and communities. Please find the call for applications at http://nursinghnc.webfactional.com/files/2016/03/FINAL_2016_TransitionsInstituteCallForApplications.docx. The application deadline is April 1st.

[Return to top]

Restorative nursing is an essential part of reimbursement, compliance, and the quality of life of your residents. Improper care planning or unclear documentation can negatively impact resident care and your bottom line. The Long-Term Care Restorative Nursing Desk Reference is a new all-inclusive desk reference that describes the clinical aspects of restorative nursing in detail and provides a much-needed guide for nurses in a long term care facility. This resource makes it easy to find instant answers to questions you may have about maintaining or developing your restorative program. The Long-Term Care Restorative Nursing Desk Reference offers the help you need to create or sustain an effective restorative care program that puts your resident’s needs first. This text also comes with a CD-ROM.

To order, visit http://www.AHCApublications.org or call (800) 321-0343. Fax orders may also be placed at (800) 869-5605.

Product #8241
AHCA MEMBERS $149.00

[Return to top]

If you missed Upcoming Hospice Regulations seminar, the notebook/presentation is now available for purchase. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org. The cost is $25 plus tax and shipping.

[Return to top]

The ROI of Employee Engagement In Hospitals

http://www.forbes.com/sites/kevinkruse/2015/02/26/the-roi-of-employee-engagement-in-hospitals/#32440d313c89

[Return to top]

Before 2012, the largest buyer of kale in the US was Pizza Hut, and they only used it as a garnish around their salad bar.

[Return to top]