UPDATE Weekly

Register today to attend the fifth annual NCHCFA Summer Symposium August 9-11, 2016 at the Embassy Suites Resort at Kingston Plantation, Myrtle Beach, SC for the most up to date information affecting long term care. Administrators and registered nurses will be able to earn up to 11.5 hours of continuing education. The early registration fee has been extended until Friday, July 29, 2016!

NCHCFA has exceeded its block of rooms at the Embassy Suites Resort. NCHCFA is working with the hotel to secure a few additional rooms for our event. Please call the Association office at (919) 782-3827 as soon as possible if you need an overnight reservation. NCHCFA will do our best to accommodate all attendees for the event within the hotel properties!

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Earlier this week, the Centers for Medicare & Medicaid Services (CMS) issued a lengthy proposed rule aimed at expanding bundled payments in the Medicare program. The new rule, which is over 900 pages long, proposes to do the following:

• Implement a new, mandatory bundled payment model for heart attack and bypass surgery episodes that will be tested in 98 randomly-selected Metropolitan Statistical Areas (MSAs) across the country (yet to be selected);
• Expand the current Comprehensive Care for Joint Replacement (CJR) program by adding a hip and femur fracture episode in the 67 MSAs that already have begun testing the model (click here to review AHCA’s summary of the CJR final rule);
• Implement a new incentive payment model around cardiac rehabilitation to be tested in 90 MSAs (45 of which were also selected for the aforementioned cardiac episode model and 45 of which were not); and
• Establish a pathway for physicians with significant participation in bundled payment models to qualify for payment incentives under the recently proposed Quality Payment Program by adding a new voluntary bundled payment model to the Bundled Payments for Care Improvement (BPCI) initiative, which will be available in 2018.

These policies, if implemented as they are currently proposed, likely would have a significant impact on many of our members. In the coming days, AHCA staff will be reviewing and analyzing the proposed rule in depth, and we will release a more detailed summary and analysis of the various proposals. We will work with the appropriate member committees, workgroups, and constituencies to gather feedback and develop robust comments. Comments on the rule will be due near the end of September. Should you have any questions in the meantime, please do not hesitate to e-mail James Michel with AHCA.

Please find some additional resources below:

• Click here for the full proposed rule.
• Click here for the CMS press release on the rule.
• Click here for the CMS fact sheet on the rule.

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In April 2016, the Centers for Medicare & Medicaid Services (CMS) issued its proposed rule for the SNF prospective payment system (PPS) fiscal year (FY) 2017 update. CMS is proposing a net market basket increase of 2.1 percent. This increase represents an average for the country. Actual rate changes will vary state to state and county by county. Most counties in North Carolina actually have rate reductions in the proposed rule. Thirteen counties have increases in the proposed rule.

To help providers determine the actual impact of the proposed rule, the American Health Care Association has developed the SNF PPS Rate Calculator. This Excel spreadsheet tool will compare the proposed rates effective October 1, 2016 to those currently being paid and will calculate the total impact for a provider based on the facility specific Medicare RUG distribution.

For more information on the proposed rule and to access the rate calculator, click here.

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A new fact sheet is available for the Skilled Nursing Facilities (SNFs) Readmission Measure (SNFRM). The SNF Value-Based Purchasing (VBP) program ties portions of SNF payments to performance on this measure, which is calculated by assessing the risk-standardized rate of all-cause, unplanned hospital readmissions for Medicare Fee-For-Service SNF patients within 30 days of discharge from a prior proximal hospitalization. Visit the SNF VBP Webpage for more information on the program.

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The Palmetto GBA Medicare listserv is a convenient communication tool that offers its members the opportunity to stay informed about:

• Medicare incentive programs
• Fee Schedule changes
• New legislation concerning Medicare
• And additional information

To register to receive the Palmetto GBA Medicare Listserv, go to http://tinyurl.com/PalmettoGBAListserv and select “Register Now.” Complete and submit the online form. Be sure to select the specialties that interest you so information can be sent.

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The North Carolina Health Care Facilities Association would like to thank our 2016 Summer Symposium Corporate Sponsors for supporting the upcoming Fifth Annual Summer Symposium in Myrtle Beach, SC! We appreciate your support: Blue Ridge Pharmacy, Healthcare Services Group, Liberty Healthcare Group, Medipack Pharmacy, NH Med Services, QMX Mobile Health & Southern Pharmacy Services.

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On the July 14th Open Door Forum call, the Centers for Medicare & Medicaid Services (CMS) reported that starting on July 27 at 10:00AM ET the Quality Measure (QM) component of the Five-Star Rating System will reflect five of the six new QMs that are currently featured on Nursing Home Compare (NHC). You will recall, the agency announced in March that this change was going to happen in July. For a summary of that presentation and a list of the six new measures, click here.

CMS also announced that it has posted an updated Technical User’s Guide on its Web site here. On the second page of the guide, there is a short list of the overall changes you can expect. Below are the key changes outlined in the guide:

• The five new QMs will be phased in between July 2016 and January 2017.
• In July 2016, they will have 50 percent of the weight of the current measures.
• In January 2017, they will have the same weight as the current measures.
• The methodological changes that will be introduced in July include:

o Using four quarters of data rather than three for determining QM ratings.
o Reducing the minimum denominator for all measures (short-stay, long-stay, and claims-based) to 20 summed across four quarters.
o Revising the imputation methodology for QMs with low denominators meeting specific criteria. A facility’s own available data will be used and the state average will be used to reach the minimum denominator.
o Using national cut points for assigning points for the ADL QM rather than state-specific thresholds.

NCHCFA recommends members review the guide for more details.

In addition, the agency is making changes to the CASPER provider preview report. The revised report will incorporate the new measures, display updated star ratings, and include a new column that shows the points assigned to each QM for a better understanding of the quality rating. All skilled nursing care centers will have access to their preview reports through the QIES System by the end of this week.

On Thursday, July 28 at 3:00 PM ET, AHCA will host an all-member Webinar to walk through these changes and answer questions. Please register here.

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Palmetto GBA performed service-specific prepayment targeted medical review on Skilled Nursing Facility (SNF) claims for the 14 Lower Resource Utilization Group (RUG) Codes. This edit was set in North Carolina, South Carolina, Virginia and West Virginia. In North Carolina, the denial rate was 86.8%. The results and recommendations for the eleventh quarter of targeted medical review, for claims processed January 1, 2016 – March 31, 2016, can be found by clicking here.

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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, contact information is on the Participation Agreement. For more details, e-mail Jennifer Brock at Jennifer.Brock@area-F.hcqis.org or call (678) 527-3417.

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This is part of a series featuring one element of the Building Prevention Into Every Day Practice: Framework for Successful Clinical Outcomes.

Success in achieving positive resident/patient outcomes is even more critical now than ever before. The link between quality and payment in long term and post-acute care is growing stronger, as evidenced by the SNF Value Based Purchasing Program (VBP), Improving Post-Acute Care Transformation (IMPACT) Act, SNF Quality Reporting Program (QRP) and more. In addition, regulatory activity is intensifying through focused surveys on adverse events, dementia care and MDS. The Five-Star Rating system and Nursing Home Compare have been revised and will add items in the future as it broadens public reporting and transparency. Most importantly, consumers expect and deserve high quality care.

The entire framework outlines key elements that are critical to successful clinical and organizational outcomes. Positively, these elements reflect common denominators that cross multiple care situations. Therefore, instead of being yet another initiative or single focused project to achieve just one outcome, it is a way of acting, thinking and being that will benefit multiple areas across an organization. Each element is addressed in detail throughout the framework.

This week we will feature the element of Clinical Foundation: Individualized Care Approaches Reflected in Care Planning

Key Takeaways: Individualized Care Approaches Reflected in Care Planning

 The care plan is the principal guidance for structures and processes related to each individual’s outcomes.
 Individualized care plan approaches based upon a systematic process help the person reach their highest practicable level of function and well-being.
 Resources and processes that help familiarize staff more readily with each person’s care plan is essential.
 The care plan must be done in the proper context, without discipline-specific or topic-specific “silos”.

Probing Questions for Team Reflection and Discussion:

1. How do we breathe life into care plans?
2. What do we do well to know each person? What can we do better?
3. Do our care plans reflect an understanding of the “big picture” and are all goals pertinent and in the proper context?
4. Are we helping each person reach their highest practicable level of function and well-being? How do we know?

Visit the AHCA Clinical Practice Web site to learn more about the element of “Clinical Foundation: Individualized Care Approaches Reflected in Care Planning”.

What does this mean? Why is this important? What are some examples? What is my part (as an individual employee, manager or practitioner)? What can my organization do?

Start somewhere, pick one element and work through it with your team.

Enjoy the journey through the framework!

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Join the North Carolina Culture Change Coalition for a workshop challenging your understanding of diversity in the realm of caring for seniors. This event is open to all assisted living and nursing home staff, members of the Quality Improvement Organization (QIO), Ombudsmen, etc.

Through this workshop, participants will be able to:

• Recognize attitudinal barriers, stereotypes and fears that affect how we interact and feel about people with disabilities.
• Recognize attitudinal barriers, stereotypes and fears that affect how we interact and feel about people in the LGBTQ (Lesbian, Gay, Bi-Sexual and Transgender) community.
• Describe techniques for embracing a diverse cultural staff and resident-body as an asset to a LTC community.

Cost: $50 per person
Continuing Education Hours: 5.5
(Pre-approval submitted for NH & AL Administrators and Nurses)

Dates & Locations:

• October 6th – Nash Community College; 522 N Old Carriage Road, Rocky Mount, NC 27804
• October 12th – Trinity Village; 1265 21st Street NE, Hickory, NC 28601
• October 19th – Levine Senior Center; 1050 Devore Lane, Matthews, NC 28105
• October 26th – Coastline Convention Center; 503 Nutt Street, Wilmington, NC 28401

Time: 8:30 AM – 4:00 PM

Lunch & snacks will be provided

Speakers:

• Paige Averett, Ph.D., MSW – Associate Professor at East Carolina University’s School of Social Work and internationally recognized expert on LGBT aging, families, and children.
• Lyndall Hare, Ph.D. – Concierge Gerontologist coaching organizations and training professionals working in the field of aging.
• Cindy Deporter, MSSW – State Survey Agency Director for NC Division of Health Service Regulation (DHSR)
• Tammy Wade and Frances Robinson – Regional Employment Services Specialists for Vocational Rehabilitation with the NC Division of Vocational Rehabilitation.

To register, click here. Registration must be submitted by September 16, 2016.

Questions? Please contact: Carolyn Hill at chill371@nc.rr.com or Alice Carroll at alicecarroll@friendshomes.org.

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There is a powerful lineup of speakers for the AHCA/NCAL 67th Annual Convention & Expo! During the opening session, don’t miss author, expert, and futurist in the field of Demography and Generational Marketing, Kenneth W. Gronbach. Kenneth uses wit, humor, and common sense as he forecasts societal, cultural, and political phenomena with uncanny accuracy.

During the closing general session, don’t miss co-author of the New York Times best seller In an Instant, Lee Woodruff! Lee chronicles her family’s journey to recovery following her husband Bob’s roadside bomb injury in Iraq and helped put a face on the serious issue of traumatic brain injury among returning war veterans, as well as the millions who live with this often invisible, but life-changing affliction. She will also share her personal insights as a caregiver.

To hear them, and register for the AHCA/NCAL 67th Annual Convention & Expo visit http://www.AHCAconvention.org!

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This newly updated and revised book presents ready-to-use materials for planning, implementing, and evaluating cultural competence strategies and programs. Learn to identify the needs of diverse constituents, evaluate and assess cultural competence on a companion Web site.

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

Product #8173
AHCA MEMBERS $80.00

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This DVD, Mobility and Safe Movement of the Elderly, Improving Your Skills to Prevent Injuries and Reduce Falls, by Teepa Snow, MS, OTR/L., FOTA, Dementia Care & Training Specialist, was developed in conjunction with Wake Allied Health Education Center, Durham Technical Community College and the University of North Carolina School of Medicine, Office of Information Systems. The content is formatted in separate segments in order to customize the delivery of content to your learning objective. Handouts developed by Teepa accompany each video and may be reproduced. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org. The price is $35.00 (tax and shipping included).

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Unrealistic Expectations May Lead To Poor Choices At End Of Life: Study

http://www.providermagazine.com/news/Pages/2016/0716/Unrealistic-Expectations-May-Lead-To-Poor-Choices-At-End-Of-Life-Study.aspx

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Article II, Section 1, Clause 5 of the U.S. Constitution has only three requirements for a president. (1) Must be at least 35 years old, (2) have lived in the United States at least 14 years, and (3) be a natural-born citizen.

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