November/December

Vol. 49 No. 11

Nov/Dec

Cover Story

https://www.providermagazine.com/Issues/2022/NovDec/Pages/Facilitating-Smoother-Care-Transitions.aspx

Facilitating Smoother Care Transitions

<p>Transitioning patients between settings has always been a bit of a roller coaster: improving, then facing challenges, then put on the back burner. The COVID pandemic brought the issue front and center, and many hope this is the start of a smooth ride. The need for clear, real-time communication between settings became a priority, and many organizations developed new systems and processes. However, while we’ve made strides, there are still gaps that need to be filled and opportunities for improvement. <br></p><p>“We’ve made progress in understanding this is a collaborative effort between settings. We are talking to each other more and using electronic health records (EHRs) to our advantage,” said Manisha Parulekar, MD, FACP, AGSF, CMD, director of the division of geriatrics at Hackensack University Medical Center and associate professor at the Hackensack Meridian School of Medicine. During the pandemic, she added, “we created different models where hospitals extended teleservices to nursing homes for videoconferences and consultations.” However, she stressed that we still need to look at ways to make transitions more efficient.<br></p><p><img src="/Issues/2022/SeptOct/PublishingImages/ArifNazir.jpg" alt="Arif Nazir" class="ms-rtePosition-1" style="margin:5px;width:108px;height:135px;" />Arif Nazir, MD, CMD, chief medical officer at BrightSpring Health Services, noted, “one issue has been that discharge planning usually doesn’t get addressed until a few days before the patient is due to leave the facility. This is the wrong approach. Discharge planning needs to start on admission. Then we need to continue to gain information about the patient/family and where they are going when they are discharged.” He added, “we need to be proactive. If you don’t start addressing these issues early on, you’re already missing the boat.”</p><h3>Dispelling Fear and Falsehoods</h3><p>Communication with residents and families is key to smooth transitions, so it is important to include them in conversations and listen to them. “A common issue is that their expectations are different from that of the health care team’s. Information needs to be communicated in a way they understand. We need to create multiple opportunities for advance care planning and conversations about their goals and expectations. Then we need to address these in the care plan,” said Nazir. “We need to emphasize and re-emphasize things, such as the need for some home health care services.” At the same time, when they express goals that are impractical or unrealistic, the team needs to work with them to arrive at an acceptable compromise. <br></p><p>“People are often intimidated by difficult terms and messages, an abundance of paperwork, and lots of information coming at one time. They may not understand things but hesitate to ask questions, or they are so overwhelmed, they don’t know what to ask. They also may have a fear of the unknown—such as there is a diagnosis on the chart that no one has discussed with them. Or they don’t know who to trust,” said Nazir. “We can address a lot of this by opening conversations sooner rather than later. We need to take the time to explain their illnesses and issues. Then we need to work as a team to manage their care and build trust.”</p><p>It’s a simple formula of person-centered care. “We need to make sure we ask patients and their families for their preferences. Quality is in the eye of the beholder. The patient, along with their family, can tell us about what is essential to quality of life for them,” said Nazir. He added the need to engage family. “We really need to think of families as a part, if not the leader, of the team. We need to put our assessments on the table and talk openly. If family members seem difficult or intrusive, it’s often because we aren’t committing the time to talk with them. We need to be humble and collaborative.” </p><h3>The Hospital Connection</h3><p>Communication between the hospital and nursing home has always been challenging and a source of gaps and missed information. During the pandemic, Parulekar said, “hospitals acknowledged the importance of partnerships and the need to work with nursing homes and subacute care facilities and look at ways to improve transitions. We started working closer together, sharing resources and protocols with each other.” This was especially useful in places where hospitals had more resources and could help share personal protective equipment, daily care rounds, and consultations. <br></p><p>While long term care facilities had greater access to hospital EHRs, Parulekar said, “interoperability is still a bucket where we need to make progress. It is time-consuming to go from one platform to another, and it requires extra steps. We need to make it easy to move between platforms without sacrificing security.”<br></p><p>While hospital partnerships improved during the pandemic, Parulekar suggested, so did the appropriate use of hospitalizations. “There has been an increased understanding and utilization of palliative care and when a patient can be treated in the nursing home. We need more focus on having a palliative care team, addressing care planning, and making sure we are transferring only those patients who need to be hospitalized.” She added, “I’m hopeful that the focus on advance care planning will remain, and we will continue to build on the momentum we’ve gained. We can use the example of the pandemic to emphasize why it’s important.”</p><h3>T is for Trust and Team</h3><p>Nazir said, “the pandemic showed that many things could be done differently and better. We were able to show that we can come together and use our knowledge as a team to improve transitions and outcomes, as we did for many patients with COVID-19.” We realized, he observed, that “we have more power than we thought, just by being more communicative. It gave me hope that we can improve outcomes if we put our minds to it.” Long term care facilities have realized that they need to assign people to ensure transitions, establish processes, and communicate with the hospital to secure information. Often, nurse practitioners and other clinical team members are taking on this role. </p><h3>Targeting Medication Management</h3><p>“Medication management on discharge from the nursing home is the number one issue, in my opinion,” said Nazir. “That is an area where we need to continue to make an impact.” Facilities can work with their pharmacy partners to take the lead on this, helping to make sure people know what medications to take when and to discard those they were taking before they went into the hospital. <br></p><p><img src="/Issues/Special-Features/PublishingImages/2022/JeremyColvin.jpg" alt="Jeremy Colvin" class="ms-rtePosition-1" style="margin:5px;width:108px;height:135px;" />“A partnership between the pharmacy and the facility care team can focus on polypharmacy,” said Jeremy Colvin, senior vice president of growth and market development at BrightSpring Health Services. “We can work together to ensure an integrated workflow that augments the team and provides needed educational pieces. </p><p>Then there need to be milestones identified along the way to bring clarity to the system.” Virtual case management is another element that enables an opportunity to triage, ask questions, and make sure gaps are addressed promptly.</p><p>Even when we’re not in the midst of a pandemic, facility teams are overburdened and turnover presents additional challenges, Colvin said. “A case manager can provide consistency and gets to know the patient and their families. Having that layer enables easy integration with the prescriber and pharmacist to promptly identify and address medication-related problems, such as duplicate prescriptions, missed dosages, and prescriptions that go unfilled.”</p><p>Beyond medications, a case manager can work with a social worker and community resources to provide needed help with things like cleaning, cooking, and transportation. “This creates continuity and consistency, so if unforeseen roadblocks arise, there will be a safety net,” said Colvin. </p><h3>Out of the Box, Into Their Homes</h3><p>Looking ahead, Nazir suggested, “we have some out-of-the-box thinking to do. There are some great models out there, such as value-based environments where practitioners have more ownership of the patient, and there is a value of connections through transitions.”</p><p>Parulekar said, “it is all our responsibility not to go back to the status quo. We have learned how critical communication is, and we need to keep the dialogue going.” This should include events such as quarterly meetings or breakfasts with hospital leaders and practitioners. Establishing relationships and getting to know each other can make a significant difference when someone has a question or needs information. This can mean the difference between a smooth transition home and a trip back to the hospital or emergency room. <br></p>

Care transitions can be a roller coaster. More communication and coordination are needed to smooth out the highs and lows.

2022-11-01T04:00:00Z

Caregiving

Bridging the Gap: Addressing the Need for Affordable Assisted Living	https://www.providermagazine.com/Articles/Pages/Bridging-the-Gap-Addressing-the-Need-for-Affordable-Assisted-Living-.aspx	Bridging the Gap: Addressing the Need for Affordable Assisted Living	<p>There will always be a market for high-end assisted living (AL) facilities. However, demographics are shifting, and a growing population of older adults need AL care but can’t afford the price tag. As a result, more builders, owners, and operators are creating facilities that are affordable for middle- and low-income people. <br></p><p>“There are a few factors playing a role in the need to address affordable AL. For one, there is a growing number of older individuals who don’t have children to care for them.” LaShuan Bethea, executive director of NCAL, explained, “the number of older adults needing assistance will grow, but the number of unpaid family caregivers will decline.” <br></p><p>Another factor involves home ownership, a key social determinant of health. “We are seeing more people who don’t own a home that they can use as an asset if they need AL. There also is a significant population that relies solely on Social Security and will require some kind of financial assistance to support their care. Finally,” Bethea said, “people are growing more medically complex and have a growing need for medical assistance as they age.”</p><p>The numbers are alarming. Currently, over 15 million adults aged 65 and older are economically insecure, with women as the majority of these. Millions of older adults are struggling to meet their monthly expenses but aren’t considered “poor” because they live above the poverty line. Social Security represents half or more of the income for 37 percent of men and 42 percent of women.</p><h3>Affordable Models of Care</h3><p>Many states are prioritizing affordable care for older adults via Medicaid waiver programs. “We need to get proactive and advocate for smarter Medicaid, or we will have large volumes of low-income seniors ending up in hospitals, emergency rooms, and nursing homes,” said Rod Burkett, chief executive officer of Gardant Management Solutions. “We need to ensure policymakers understand that Medicaid waivers won’t impact state budgets but will contribute to better quality of care and dignity of life.” <br></p><p>The reimbursement level has to be adequate, he added. “It’s important to have reputable operators, investors, and lenders who are willing to take on the risk of the Medicaid program, but reimbursement has to be robust enough. This needs to be a priority,” Burkett stressed. When a family in crisis is looking for affordable, appropriate care and they are put on a waiting list, this puts a burden on them and potentially puts the patient at risk for issues that can lead to an emergency room visit or hospitalization. “There can be unintended consequences of someone not being able to get into an AL facility they can afford, so we need capacity,” he said.</p><p>Bethea noted that there are options such as low-income tax credits and low-interest loans that can help eliminate some of the costs for residents and facilities. “To start, we need to have conversations with state Medicaid offices and find out what options are available for middle- and low-income older adults in your state,” she said. </p><h3>Design and Affordability</h3><p>In considering how to design affordable AL, Burkett suggested, “if you take the hospitality model as an example, we’re more Holiday Inn Express than Hilton. You won’t get fancy meals, huge rooms, or extravagantly elegant surroundings, but you’ll get basic amenities that focus on comfort, safety, and quality of care. We can take that attitude to operate and develop an affordable AL model,” said Burkett. </p><p>“We don’t need the biggest or ‘sexiest’ piece of land. We want the building to look nice inside and out, but we don’t need things like fresh flowers in the dining hall every day or four menu choices for every meal.”<br>Darren Azdell, AIA, NCARB, LEED PA, an architect and consultant, noted, “square footage is a distinguishing feature between high-end and middle-market buildings. However, we can use connections to exterior spaces to make the indoors look more spacious.” He added, “there also are things like finishes and types of flooring that are less costly but still look good.”<br></p><p>Staffing is a high cost for any facility. While cutting back on staff isn’t an option to reduce costs, there are ways to make staff more efficient and reduce the number of workers necessary to handle certain tasks, added Azdell. For instance, the kitchen can be designed efficiently so the chef can run a snack shop or bistro during down time. <br></p><p>Building an affordable AL building takes planning from day one and should involve the entire team—including contractors, architects, and others. “These individuals can help balance cost with aesthetics and functionality. They also can help prevent owners from going down a path that may seem cost-effective at first but ultimately may be more expensive,” said Azdell.</p><h3 class="ms-rteElement-H3B"><a href="/Articles/Pages/One-State-Report-Outlines-Strategies-to-Increase-AL-Affordability,-Accessibility.aspx">One State Report Outlines Strategies to Increase AL Affordability, Accessibility</a><br></h3><h3>Partnerships for Programming</h3><p>“Efforts such as exercise and wellness programs can be provided through local community groups, such as churches or local colleges,” said Azdell. Community connections and partnerships with nonprofit organizations can help cut costs for programming and even supplies. At the same time, volunteers can fill in for some staff to organize and oversee these events. Burkett observed, “we have a full-time resident services coordinator to oversee things like activities, social services, and transportation. Then we extend what they are able to do with volunteers from church groups, Girl Scouts, local entertainers, and community organizations.” </p><h3>Marketing Without Judgment</h3><p>When marketing middle-market and low-income AL, it is essential not to make potential residents feel blame or shame because they can’t afford a high-end community. Most older adults can’t afford high-end care through no shortcoming on their part. Instead, they’ve had to support parents and/or adult children, they have significant medical debt, or they’ve worked hard but are living paycheck to paycheck.<br></p><p>“Our marketing doesn’t lead with affordability, and we include the need for financial assistance as just another asset the resident needs—not unlike help with medication management or housekeeping,” Burkett said. Such a marketing approach is significant, Bethea said, noting, “there are stigmas that exist regarding money. Imagine working your entire life and needing assistance when you get older. We need to make sure people don’t hesitate to ask for the assistance they need because they are embarrassed or ashamed.”</p><h3>Taking Charge of a Growing Trend</h3><p>Burkett said, “There is no question that there is a growing need for affordable AL. It’s a huge market.” However, he added that it’s a state-by-state decision about how aggressively each locality wants to support this market. He concluded, “we have astute investors who are putting funds into this market and want to be part of affordable AL. We can all work together to help federal and state policymakers see the value of and need for these types of facilities and the urgent need to support them.”<br></p><p>NCAL sees affordable AL as an important issue. Bethea said, “we have a responsibility to accommodate these older adults. As an industry, we should see this growing middle- and lower-income market, identify barriers to overcome, and help provide solutions.” <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.</em></p>	Demographic changes are creating a demand for affordable assisted living. Here’s how facilities can get started.	2022-11-01T04:00:00Z	<img alt="" src="/Issues/2022/NovDec/PublishingImages/CF_AL.jpg" style="BORDER:0px solid;" />	Assisted Living	Cover Feature	Joanne Kaldy	49	11
Shine a Light on Employee Mental Health	https://www.providermagazine.com/Articles/Pages/Shine-a-Light-on-Employee-Mental-Health.aspx	Shine a Light on Employee Mental Health	<p>Mental health issues haven’t disappeared as the pandemic has waned. In fact, team members at all levels continue to be plagued by depression, anxiety, stress, and post-traumatic stress disorder (PTSD), with a corresponding impact on productivity and staffing. Yet, many staff members are hesitant to seek help because they fear they will be judged or penalized, and others want help but don’t know where to get it. With the holidays here and a new year on the horizon, now is the time to identify and implement best practices and ensure person-centered mental health care and support for your teams.</p><h3>Numbers Paint a Startling Picture</h3><p>Today’s workers don’t see mental health care as just another benefit. According to an American Psychological Association (APA) survey, eight in 10 workers say an employer’s efforts to support mental health is a key factor in whether or not they’d be interested in taking a job with that organization.<sup>1</sup> Specifically, they want benefits they see as conducive to mental health and wellbeing, such as more flexible work hours (41 percent), a workplace culture that respects time off (34 percent), and a four-day work week. While workers consistently express a desire for better wages, only 24 percent of workers in the APA survey said they don’t feel like they receive adequate compensation. Over two-thirds (71 percent) are worried about what inflation will do to their financial situation.<br></p><p>While your teams may want and need mental health support, they may hesitate to request or use these services. In one recent survey, 70 percent of employees said they thought their employers could improve their efforts to reduce mental health stigmas, and about a third said their employer doesn’t do a good job of promoting mental health resources or benefits.<sup>2</sup> </p><h3><img src="/PublishingImages/Headshots/PamTruscott.jpg" alt="Pamela Truscott" class="ms-rtePosition-2" style="margin:5px;width:108px;height:135px;" />Erasing the Stigmas</h3><p>“There is still a stigma about mental illness. We’ve made advances in the past 10-20 years, but people still feel hesitant to bring it up. This is true even though we are seeing a lot of depression and mental fatigue,” said Pamela Truscott, DNP/HSL, MSN/Ed, RN, QCP, DNS-CT, RAC-CT, CDP, director of quality improvement with NCAL. She stressed that destigmatizing mental health isn’t a one-and-done effort but also can’t be regulated or mandated through policy. <br></p><p>“Policies tend to be seen as related to regulations. It is likely to be more effective to encourage open discussions about mental health,” she said, adding, “be open about resources. Have a great employee assistance program (EAP), and make sure everyone knows what is available to them.” By frequently discussing mental health, this becomes the norm, and people will feel more comfortable talking about their feelings and seeking resources.<br></p><p>When employees come to a manager with a concern or problem, it is important to be empathetic and not judgmental. Understanding trauma-informed care can help. As Truscott observed, “each person has their own trauma, and we need to respect that.” For instance, someone who came from an abusive family situation might be traumatized by a resident having a loud argument with her daughter. If this person comes to you for help, it’s important to be empathetic even if you don’t understand why they’re upset. <br></p><p><span><img src="/Issues/2022/JuneJuly/PublishingImages/TinaSandri2.jpg" class="ms-rtePosition-1" alt="Tina Sandri" style="margin:5px;width:120px;height:134px;" /></span>This means that instead of saying, “It’s not that bad. Just ignore it,” offer some support: “I understand how this is upsetting to you. Why don’t you take a break, or would you like to go somewhere and talk about it?” <br></p><p>Tina Sandri, chief executive officer of Forest Hills of D.C., stressed, “we are living through a trauma that will affect us for years to come. We are still in a sustained battle. We need to be prioritizing ways to heal the body from trauma, and this calls for trauma-informed care for employees,” said Sandri. This needs to take into account that people have different coping mechanisms, and they think and digest information differently.<br></p><p>It is important to understand what will help you and others deal with trauma and short-circuit emotional responses. For instance, Sandri said, “our social worker came to me the other day and hugged me because she heard I might be upset. She knew that would be comforting for me because I’m a ‘hugger.’” <br></p><p>Sandri stressed, “we have to get a bit more emotionally intelligent about working with people through leadership training and listening skills.” Then, she suggested, instead of telling someone who is upset or agitated, “That’s not professional. Tone it down,” consider getting the person to a quiet space and asking, “What is concerning you right now?”</p><p>The things you do for residents to protect their mental health and wellbeing, you need to do for staff, said Truscott. “This has to be an ongoing priority and always on the table.”</p><h3>Better Mental Health, Better Workspace</h3><p>“Caring for the mental health of employees is an important workforce retention strategy,” said Truscott. Not every organization offers the same level of support for employees. However, there are numerous resources out there, so you don’t have to reinvent the wheel. For instance, AHCA is promoting mindfulness training. “We are offering tools and resources to people to handle any situation you find yourself in. We are all dealing with so much,” she said. “However, when workers have a variety of resources to use, they can find the ones that work for them, rebuild resilience, and gain perspective,” said Truscott.<br></p><p><img src="/Issues/2022/NovDec/PublishingImages/CF_mentalhealth-1.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />Some very helpful mental health supports are fairly simple. Truscott said, “deep breathing, taking a short walk outside or even just down the hall and back, or spending a few minutes in a quiet space can help.” It also can be useful for workers to have a colleague they can vent to. She added, “we need to help people use the resources they have to better manage stressful situations, to let go of the things they can’t control, and not to take on everyone’s problems.” When people own their situations and use tools and resources to move past them, they can be more optimistic and see the glass as half full.<br></p><p>Mental health care for employees can’t just mean a binder that gets put on the shelf and collects dust. <br></p><p>“Your resources always have to be out there. Posters staff will see, in-service programs, articles in newsletters, eblasts, and more give you multiple and ongoing opportunities to remind staff what is available to them and to normalize mental health care.”</p><h3>Short Circuit the Fight-Flight-Freeze Response</h3><p>Sandri was thinking about how to short circuit the fight-flight-freeze response people have to a trauma or stressful situation. This was a particularly urgent concern during the pandemic. “I saw one staffer crying on the floor in a fetal position. Another person was hyperventilating and had to go to the hospital. The psychosocial burden health care workers picked up going into the fire of the pandemic to serve was significant,” she said.<br></p><p><img src="/Issues/2022/NovDec/PublishingImages/CF_mentalhealth-2.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;" />“We need person-centered care for our employees that looks at them as individuals. In doing this, we build a sense of community,” Sandri said. A certified yoga instructor, she decided that this needed to be a feature of a program for her staff. Elsewhere, she took her team out and did some ax throwing with a yoga-trained professional. Additionally, she said, “we have introduced an EAP and revamped our employee benefit handbook to include clear information about how to access the EAP and mental health benefits.”<br></p><p>Sandri also uses a validated tool to help staff assess resilience. If they are feeling less resilient, they can then look at ways to support themselves, she noted, adding, “I am also offering eight weeks of mindfulness as online and in-person options to accommodate everyone who wants to participate.” <br></p><p>The efforts Sandri has put together for her team are her “own recipe” designed with her staff’s specific needs in mind. “We need to see, think, and feel the way our staff does and meet people where they are. We need to give them the help and support they need but also give them the space to be who they are.” <br></p><p>Sangita Lewis, OTR, senior vice president of sales at TMC, added, “for some people, giving them a raise will meet their needs; others just want some genuine recognition and one-on-one time with their leaders. We focus on being present. If you’re a supervisor, you can go out in the field and look at things from others’ viewpoints. We have an obligation to meet our staff’s emotional, mental, and spiritual needs and not just what they need to do their jobs.”<br></p><p>Sandri advised, “conduct a resiliency survey with staff and find out how resilient they are; listen and find out what their needs are. Don’t assume you know.” For instance, Sandri’s team discovered that her nursing staff wanted 12-hour shifts. This was a fairly simple change that made nurses happier. She said, “find out whether they will enjoy yoga or would rather have a dance party. Then meet people where they are.” She also suggested, “you also can work with health insurance and other partners to develop things like wellness programs.” <br></p><p><img src="/Issues/2022/NovDec/PublishingImages/CF_mentalhealth-3.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />Lewis offered, “one thing we’re doing well is going back to more live meetings. We think it’s important to see each other and interact in person. It is essential to stay engaged. We also have a monthly education day where different departments can share information and a program where our HR leaders are available during set times to talk and answer questions about mental health and other benefits. We also encourage leaders to get to know people and sense when something is ‘off’ or they need assistance,” she said. Finally, they promote physical wellness and financial wellbeing as well as mental health. For instance, they have a free financial wellness course to help people get out of debt and live a financially stable life. </p><h3>It’s Okay Not to Be Perfect</h3><p>“First thing, we need to admit that we’re not doing everything right, even though we all want to do the right thing. A key part of being a good employer is acknowledging that we can always do better,” said Lewis. “Everyone is going through something. Employers have to do a better job of caring for staff.” This has to be an ongoing grassroots effort, she said, adding, “We have to talk about it constantly, and communicate in an honest, caring way. That is a foundational piece that is expected of all of us as leaders.” This needs to be part of the organization’s core values and DNA. <br><br><span class="ms-rteFontSize-1"><em>References</em></span><br class="ms-rteFontSize-1"><span class="ms-rteFontSize-1"><em>1 </em></span><a href="https://www.apa.org/news/press/releases/%202022/07/workplaces-mental-health-supports" target="_blank"><span class="ms-rteFontSize-1"><em>https://www.apa.org/news/press/releases/ 2022/07/workplaces-mental-health-supports</em></span></a><br class="ms-rteFontSize-1"><span class="ms-rteFontSize-1"><em>2 </em></span><a target="_blank"><span class="ms-rteFontSize-1"><em>https://www.hrdive.com/news/employers-could-do-more-to-reduce-mental-health-stigma-year-round-workers/626848/</em></span></a></p>	The stigma around discussing mental health is going away, yet increased support, flexible policies, and empathy are still needed.	2022-11-01T04:00:00Z	<img alt="" src="/Issues/2022/NovDec/PublishingImages/CF_mentalhealth.jpg" style="BORDER:0px solid;" />	Caregiving	Cover Feature	Joanne Kaldy	49	11

2022 Assisted Living State Regulatory Review	https://www.providermagazine.com/Issues/2022/NovDec/Pages/2022-Assisted-Living-State-Regulatory-Review.aspx	2022 Assisted Living State Regulatory Review	<p><img src="/Issues/2022/NovDec/PublishingImages/JillSchewe.jpg" alt="Jill Schewe" class="ms-rtePosition-2" style="margin:5px;width:200px;height:200px;" />Assisted living (AL) regulations, statutes, and policies in 33 states were updated between 2020 and 2022, according to the National Center for Assisted Living’s (NCAL) 2022 edition of the Assisted Living State Regulatory Review.</p><p>“States continue to demonstrate their ability to respond to the evolving assisted living environment, foster quality improvement, support transparency for consumers, and maintain resident safeguards,” said LaShuan Bethea, NCAL Executive Director. </p><h3>What is the Assisted Living State Regulatory Review?</h3><p>The 2022 NCAL State Regulatory Review is a state-by-state report of assisted living regulations, recent legislative activity, and an overview of key regulatory topics that our members and stakeholders find important. For every state and the District of Columbia, this report provides information on topics such as how state agencies license assisted living (including those units with Alzheimer’s or other dementias), recent legislative and regulatory updates affecting AL, and requirements for resident agreements, admission, and termination, staffing and training—among other topics.</p><p>Historically, NCAL has published this report annually, but because of the public health emergency with COVID-19, the report is now available again after a two-year hiatus.</p><h3>Why is this a valuable resource for AL providers?</h3><p>Since regulations for AL are established and enforced at the state level, there is not a great resource for people to access individual state AL regulations. NCAL has created such a document with this publication. It is exciting to not only have the information in one place but also to be able to use it in multiple ways, including cross-referencing information between states and following state regulation activity. </p><h3>What are some of the key themes/takeaways in this report?</h3><p>It was no surprise to see that 65 percent of the states reported regulatory or legislative changes in 2020, 2021, or 2022 that impact AL residents, staff, and facility structures. These legislative changes affected a variety of requirements, including licensure, staff training, infection control, and residents’ rights.<br>With such significant activity in state regulatory changes, now: <br></p><ul><li>Forty-six states and the District of Columbia (92 percent) require a consumer disclosure, agreement, and/or bill of rights for residents. </li><li>All 50 states and the District of Columbia require a form of resident assessment and, at minimum, provide activities of daily living (ADL) for residents. </li><li>Forty-nine states and the District of Columbia (98 percent) have provisions around, and allow, providing medication management to residents.</li><li>Forty-five states and the District of Columbia (90 percent) have minimum educational and/or training requirements for AL administrators/directors.<br></li></ul><p>It is clear from the trends we have seen over the years that state regulations continue to increase in AL. States are making changes as they determine how to best serve their specific resident populations in the years ahead, and we anticipate this trend will continue.</p><h3>Where can I access the report?</h3><p>The full report can be found on the NCAL website at <a href="http://www.ahcancal.org/Assisted-Living/Policy/Pages/state-regulations.aspx">www.ahcancal.org/Assisted-Living/Policy/Pages/state-regulations.aspx</a>. <br></p><h3>Who should I contact with questions?</h3><p>For further questions, email <a href="mailto:ncal@ncal.org">ncal@ncal.org</a>. <br><br><em>Jill Schewe, LALD, is the director of policy and regulatory affairs for the National Center for Assisted Living (NCAL). </em></p>	It is exciting to not only have the information in one place but also to be able to use it in multiple ways.	2022-11-01T04:00:00Z	<img alt="" src="/Issues/2022/NovDec/PublishingImages/JillSchewe.jpg" style="BORDER:0px solid;" />	Assisted Living	Spotlight on Assisted Living
Be Prepared for the Shift to Population Health	https://www.providermagazine.com/Issues/2022/NovDec/Pages/Be-Prepared-for-the-Shift-to-Population-Health.aspx	Be Prepared for the Shift to Population Health	<p><img src="/Issues/2022/NovDec/PublishingImages/MikeCheek.jpg" alt="Mike Cheek" class="ms-rtePosition-2" style="margin:5px;width:108px;height:135px;" />Under traditional care arrangements, health care providers are reimbursed for the services provided. It is a patient by patient, treatment-based, reactive approach. For example, skilled nursing facilities are responsible for single-benefit, skilled care under Medicare part A. This is a specific situation where care and therapies are all aimed at rehabilitating the patient to levels of function prior to surgery, an accident, etc. <br></p><p>On the other hand, population health management (PHM) is a data-driven, holistic approach to care delivery and patient outcomes of a group of individuals, whether that cohort be defined based on the setting (i.e., nursing facility or assisted living) or chronic condition (i.e., dementia, COPD, etc.) or other feature. This “managed” care model means that everything from doctor visits to medication to specialty services—and the interactions between them—is governed from a proactive, preventative, and coordinated standpoint. This type of value-based care model rewards operators that improve care and reduce costs. Residents in skilled nursing facilities and long term care facilities receive higher quality, more timely care and a better overall experience, and the government achieves its goal of reducing per capita cost.</p><h3>Moving from Fee-for-Service to PHM </h3><p>The Centers for Medicare & Medicaid Services (CMS) and states are heavily focused on moving from fee-for-service and payment by volume to value-based care and PHM models, thereby also driving health plans, health systems, and physicians groups down this path. Being able to understand and adopt population health approaches is critical if long term care providers want to move upstream in the health care reimbursement food chain. For example, Medicare Advantage in 33 states grew by double digits, and there are states where Medicare fee-for-service is irrelevant. Over the last 20 years, the over-65 population has gradually migrated to managed care.<br></p><p>Adopting a PHM model benefits facilities by capturing more dollars for care, being efficient with those dollars to achieve high-quality outcomes, and allowing a range of risks for costs. There providers can have their own plan or partner on shared savings or other value-based reimbursement arrangements. </p><h3>AHCA/NCAL’s Population Health Summit</h3><p>A key step is understanding the PHM options and potential paths to engagement. AHCA/NCAL’s Population Health Summit will be held on December 7-8, 2022, at the Gaylord National Harbor in Maryland and offers long term care providers further exploration, solutions, and opportunities in PHM. This summit will equip providers with the first steps to move away from the fee-for-service environment and into managing the whole person. <br></p><p>The summit features sessions for providers just entering the space, those well into the space, and those looking to create local and regional relationships. Networking is vital because the regional nature of PHM models relies upon a variety of plan owners, provider networks, and even part owners. Additionally, it is an opportunity for providers to share best practices of managed care to improve quality care and the overall experience for residents. There will be sessions specifically for independent owners and assisted living operators as well.<br></p><p>There will be education on all levels of risk, from launching an institutional special needs plan, being involved in sub-capitation payment plans, or joining a preferred provider contract with an accountable care organization. This will allow attendees to find the right path at the right time for them to take on risk bearing and PHM approaches.<br></p><p>Dr. Mark McClellan, a former CMS administrator, will deliver the opening keynote. His research at Duke University’s Margolis School for Public Health about PHM models has been forward thinking and innovative. The closing keynote will be the deputy director for the Centers for Medicare & Medicaid Innovation, Ellen Lukens, talking about the innovation center’s vision for acute and long term care providers in their approaches to moving away from fee-for-service and to paying for value of care. </p><h3>Don’t Be Left Behind </h3><p>Traditional fee-for-service is largely going to be gone by 2030, replaced by a system that holds providers accountable through partial and total cost of care models for quality and outcomes. If you’ve not started to think through how you will function either as a meaningfully engaged partner in a value-based reimbursement environment or a risk-bearing entity, you’re going to be at a very serious disadvantage. <br><br><em>Mike Cheek is senior vice president for reimbursement and market strategy at AHCA/NCAL. Cheek and the reimbursement team work on traditional Medicare and Medicaid issues as well as with members to move into new, innovative PHM approaches.</em></p>	PHM is a data-driven, holistic approach to care delivery and patient outcomes of a group of individuals.	2022-11-01T04:00:00Z	<img alt="" src="/Issues/2022/NovDec/PublishingImages/PHM.jpg" style="BORDER:0px solid;" />	Population Health Management	Population Health Management
Maximize the DNS’s Role to Succeed in Value-Based Care	https://www.providermagazine.com/Issues/2022/NovDec/Pages/Maximize-the-DNSs-Role-to-Succeed-in-Value-Based-Care-.aspx	Maximize the DNS’s Role to Succeed in Value-Based Care	<p><img src="/Issues/2021/July/PublishingImages/AlexisRoam.jpg" alt="Alexis Roam" class="ms-rtePosition-1" style="margin:5px;width:108px;height:135px;" />The director of nursing services (DNS) plays a pivotal role in the success of a skilled nursing facility (SNF). As the leader of clinical care and services, the DNS drives the public ratings and overall performance of the quality of nursing care of a SNF, which impact census. Referral sources, including hospitals, form partnerships with SNFs based on this performance. Moreover, people base their selection of which SNF they will patronize based upon public ratings and the partnerships with hospitals. In addition, most of the regulatory and legal risks assumed by the SNF are related to nursing care. With so much at stake already, and with health care shifting to a value-based care system, the quality of nursing care and the significance of the DNS’s role in leading it are more important than ever. </p><h3>Expectation of a DNS</h3><p>The DNS is often chosen because they possess in-depth knowledge of the normal changes of aging and can care for elders as they navigate the relationship between wellness and aging, proving they excel as a gerontological registered nurse (RN). This is demonstrated by their ability to promote the elder’s strengths to foster wellness while simultaneously addressing the elder’s needs as age advances and/or disease and illness are experienced. The expectation is the DNS will replicate the same level of excellence they provided individually throughout the nursing department by leading the development and implementation of systems of nursing care that consistently produce desired outcomes. However, fulfillment of this expectation is not achieved when the DNS is underutilized in their main role.</p><h3><img src="/Issues/2022/NovDec/PublishingImages/caregiving1.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />Underutilization of a DNS</h3><p>A DNS is underutilized when they are expected to assume responsibility for a job that does not require their expertise and can be completed by someone else. For example, the staffing coordinator position is vital to the operations of the SNF, but it does not require the skills of a DNS. Underutilization also occurs when the DNS is included in the staffing float pool and consistently fills open shifts as a certified nurse aide (CNA) or charge nurse. Although each of these roles is essential, they do not require the skills of the DNS and take away from the DNS’s time to effectively provide clinical leadership. <br></p><p>Despite the DNS’s best attempts to juggle the expectations as the leader of clinical care and services as well as the other responsibilities outside the scope of the DNS, the workload overwhelms them. At this point, the DNS makes a choice—they quit because success as the leader of clinical care and services can’t be achieved or stay but prioritize the non-DNS responsibilities over the DNS responsibilities. <br></p><p>A SNF will go to great lengths to secure an RN with the talents and skills to be the DNS, including offering an appealing benefits and compensation package; however, the contradiction of hiring a DNS, but then not fully utilizing them in that capacity becomes apparent when considering the return on investment. The table, to the right, shows two examples of the breakdown in salary of a SNF paying a DNS to spend between 40 and 50 percent of their time engaged in non-DNS tasks. The decision to underutilize a DNS in their main role greatly diminishes the productivity of the one person hired to complete DNS tasks; thus, the investment in the DNS has a poor return.</p><h3>Maximize the DNS Role </h3><p>The health care system is transforming to value-based care, and this means SNFs must be innovative in the methods used to consistently produce quality of care and life outcomes as efficiently as possible. While the staffing crisis and other challenges resulting from the pandemic have exacerbated the underutilization of DNSs, it is not a new trend. Nonetheless, this approach does not position a SNF to thrive in value-based care, because the DNS needs to be at the heart of managing clinical care and services so that the facility can produce the best outcomes in nursing care. Therefore, a paradigm shift is necessary to change perceptions and practices that maximize the DNS’s role, and also attract and retain RNs who can navigate the current turbulence and are capable of leading a nursing department that can thrive in value-based care. </p><h3>Recognize the DNS as a Leader</h3><p>Although it sounds simplistic, the first action management can take is to redefine what a DNS means to the SNF in a way that recognizes the significance of the role as the leader of clinical care and services, rather than just an RN who fulfills a regulatory requirement with a title. Areas the DNS should lead that enable success in value-based care include the implementation of evidence-based practice, development of other gerontological nurses and CNAs, collaboration with hospitals and other health care settings, fiscal and budgetary input and management, and the design of efficient systems that can consistently produce quality and maintain regulatory compliance. </p><p style="text-align:center;"><img src="/Issues/2022/NovDec/PublishingImages/caregiving_table1.jpg" alt="" style="margin:5px;width:604px;height:408px;" /><br></p><h3>Establish Expectations and Goals</h3><p>Expectations provide clarity as to what the DNS role entails and the operating guidelines to execute functions of the position. Expectations also hold management accountable to commit to the expectations they set forth for a DNS. Management will need to formulate a strategy that includes measurable goals and concrete action steps to transition from the old expectations to the new expectations. For example, if the DNS is covering shifts, a plan to stabilize staff is imperative. Goals encourage the DNS to be part of the strategy and communicate what the priorities are. This empowers the DNS to overcome the current tumult but also inspires the pursuit of high performance in the nursing department, including the critical need to recruit and retain staff. </p><p>Underutilization of the DNS is not new, but SNFs that want to thrive in value-based care must change this practice. Maximize the DNS role by valuing the significance of clinical leadership and the potential the DNS has to impact the success of the SNF. <br><br><em>Alexis Roam, MSN, RN-BC, DNS-CT, QCP, is a curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN). Roam can be reached at </em><a href="mailto:aroam@aapacn.org" target="_blank"><em>aroam@aapacn.org</em></a><em>.<br></em></p><p><em><br></em></p><p style="text-align:center;"><em><img src="/SiteCollectionImages/logos/AAPACN.jpg" alt="" style="margin:5px;width:200px;height:56px;" /><br></em></p><p style="text-align:center;"><em><br></em></p><p style="text-align:left;"><span><span class="ms-rteForeColor-2">Learn more:</span></span></p><table class="ms-rteTable-default" width="100%" cellspacing="0" style="text-align:center;"><tbody><tr><td class="ms-rteTable-default" style="width:33.3333%;"><a href="https://ahcapublications.org/products/the-long-term-care-director-of-nursing-field-guide-fourth-edition?_pos=1&_sid=d309a2a42&_ss=r" target="_blank"><img src="/Issues/2022/NovDec/PublishingImages/DNGuide.jpg" alt="The Long-Term Care Director of Nursing Field Guide, Fourth Edition" style="margin:5px;" /></a></td><td class="ms-rteTable-default" style="width:33.3333%;"><a href="https://ahcapublications.org/products/nursing-and-therapy-a-collaborative-approach-to-documentation-quality-and-payment-reform?_pos=4&_sid=d309a2a42&_ss=r" target="_blank"><img src="/Issues/2022/NovDec/PublishingImages/NursingTherapy.jpg" alt="Nursing and Therapy: A Collaborative Approach to Documentation, Quality, and Payment Reform" style="margin:5px;" /></a></td><td class="ms-rteTable-default" style="width:33.3333%;"><a href="https://ahcapublications.org/products/nurse-managers-guide-to-retention-and-recruitment?_pos=5&_sid=d309a2a42&_ss=r" target="_blank"><img src="/Issues/2022/NovDec/PublishingImages/Retention.jpg" alt="Nurse Manager's Guide to Retention and Recruitment" style="margin:5px;" /></a></td></tr></tbody></table><p></p>	The expectation is the DNS will replicate the same level of excellence they provided individually throughout the nursing department by leading the development and implementation of systems of nursing care that consistently produce desired outcomes.	2022-11-01T04:00:00Z	<img alt="" src="/Issues/2022/NovDec/PublishingImages/caregiving2.jpg" style="BORDER:0px solid;" />	Caregiving	Focus on Caregiving
New PDPM LTC Trend Tracker Module Can Help with Medicare Compliance	https://www.providermagazine.com/Issues/2022/NovDec/Pages/New-PDPM-LTC-Trend-Tracker-Module-Can-Help-with-Medicare-Compliance.aspx	New PDPM LTC Trend Tracker Module Can Help with Medicare Compliance	<p>In October 2022, AHCA launched a new Patient Driven Payment Model (PDPM) module on the Long Term Care (LTC) TrendTracker (TT) platform that providers can use to monitor their Medicare Part A compliance risk. In this article, we will discuss why skilled nursing facility (SNF) Medicare compliance programs are important, where AHCA members can access the PDPM TT reports, what data are in the reports, and how the reports can be used for facility- or company-wide Medicare compliance programs.</p><h3>Why Are SNF PPS PDPM Compliance Programs Important?</h3><p>In October 2019, the Centers for Medicare and Medicaid Services (CMS) switched the SNF prospective payment system (PPS) model from the resource-use-based RUG-IV model to the PDPM, which is primarily based on unique resident characteristics as coded on the Minimum Data Set (MDS) resident assessment instrument.<sup>1</sup> In that rule, and in subsequent rulemaking,<sup>2,3,4,5</sup> CMS has emphasized that it is closely monitoring SNF payments and any associated changes in MDS coding that could suggest that providers are stinting on therapy services or reducing length of stays, inappropriately using concurrent and group therapies, or upcoding certain MDS items to achieve higher payments. The U.S. Department of Health and Human Services Office of Inspector General is also conducting a study to determine whether Medicare payments to SNFs under PDPM comply with Medicare requirements.<sup>6</sup><br></p><p>Per CMS, Medicare contractors conduct medical review to prevent improper payments and protect the Medicare Trust Fund.<sup>7</sup> Medical reviews involve the collection and clinical review of medical records and related information to ensure that payment is made only for services that meet all Medicare coverage, coding, billing, and medical necessity requirements. Medicare Fee-for-Service (FFS) reviews are conducted by Medicare Administrative Contractors (MACs), the Supplemental Medical Review Contractor (SMRC), Recovery Audit Contractors (RACs), and others. <br></p><p>These activities are based on data analysis and other findings indicative of a potential vulnerability, and programs, such as Targeted Probe and Educate, focus on providers with outlier data patterns that could suggest improper billing.<sup>8</sup> Providers that have timely access to data that indicate their risk for audit can use this information in compliance programs to identify any potential issues and implement corrective measures to either reduce the risk of audit or to be best prepared to respond to an audit. </p><h3>What Specific PDPM Information Is Now Available in TT?</h3><p>The AHCA PDPM TT reports contain facility-specific trends for 37 key metrics being evaluated by CMS and medical review contractors to target for potential payment errors. The reports, derived from MDS data, allow providers to compare and benchmark metrics on a quarterly basis against peers within their organization, state, or nationwide. The data go back to the onset of PDPM in October 2019, and reports can be generated in both table and trend chart formats. <span><span><img src="/Issues/2022/NovDec/PublishingImages/PDPM_Fig2.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;" /></span></span></p><p>The PDPM TT Report Summary contains 10 high-level aggregate trends: Average Medicare Rate PPD (per patient day); the average CMI (case-mix index) value for each of the five PDPM case-mix adjusted components (physical therapy = PT, occupational therapy = OT, speech-language pathology = SLP, nursing, and non-therapy ancillary = NTA); the average Medicare length of stay; and the average PT, OT, and SLP minutes per stay. Figure 1 provides an excerpt of the PDPM Case-Mix Index Components portion of an example facility for the most currently available four quarters of MDS data as compared to the selected peer group. Footnotes are included as appropriate to provide additional detail about the data and/or provider audit risk. <br></p><p><span></span>If the facility’s results are higher or lower than their peers for these factors, and if the footnotes indicate a potential audit risk, then exploration of the additional 27 trends listed in the Report Detail may be useful in tracking down the MDS data elements that are driving the differences. Figure 2 summarizes the additional types of trend data available in the Report Detail. <br></p><p>The Report Detail screen also allows providers to obtain graphic drill-down of the measures with a longer look-back period. As demonstrated in Figure 3, the SLP CMI trends listed in Figure 1 are displayed in a bar chart comparing the facility’s quarterly average SLP CMI trends to the peer group for the most recent three years of available data. </p><h3>Using PDPM TT Reports for Compliance Efforts</h3><p>Having different average payment or MDS coding patterns from other providers doesn’t necessarily mean a provider is doing anything wrong, especially if the provider is treating a different patient population and is getting good quality outcomes. However, as discussed above, having different rates than peers for certain metrics being evaluated by claim auditors may increase a provider’s risk for audit and payment denial if the MDS coding is not supported by the clinical documentation. <br></p><p style="text-align:center;"><img src="/Issues/2022/NovDec/PublishingImages/PDPM_Fig3.jpg" alt="" style="margin:5px;" /><br></p><p>For example, as shown in Figure 1, the facility had a higher SLP component average CMI than its peers, so looking at the PDPM TT Report Detail for the trends for various MDS items that impact the SLP component rates, such as cognition, SLP complexity, swallowing disorders, and mechanically altered diet, may be helpful in identifying the clinical characteristics driving the higher CMI value. Additionally, the TT drill-down report shown in Figure 3 can show if the difference from peers is a recent event or longstanding trend. <br></p><p style="text-align:center;"><img src="/Issues/2022/NovDec/PublishingImages/PDPM_Fig1.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" /></p><p style="text-align:center;"><br></p><p style="text-align:center;"><br></p><p style="text-align:center;"><br></p><p style="text-align:center;"><br></p><p style="text-align:center;"><br></p><p style="text-align:center;"><br></p><p style="text-align:center;"><br></p><p style="text-align:center;"><br></p><p style="text-align:center;"><br></p><p>Once a provider has identified the specific underlying MDS data items driving the differences, it will make it easier to focus internal chart audits to validate the accuracy of the coding and/or the completeness of the documentation supporting the coding. The results could then confirm whether the MDS coding is supported and defensible upon any future audit, or whether staff education efforts are necessary to assure the documentation and coding are appropriate.<em><br></em></p><p><em><span class="ms-rteFontSize-1">References</span><br class="ms-rteFontSize-1"></em></p><ul><li><em><span class="ms-rteFontSize-1">1 FY 2019 SNF PPS Final Rule 83 FR 39162, August 8, 2018 (<a href="https://www.federalregister.gov/documents/2018/08/08/2018-16570/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities" target="_blank">https://www.federalregister.gov/documents/2018/08/08/2018-16570/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities</a>)</span></em></li><li><em><span class="ms-rteFontSize-1">2 FY 2020 SNF PPS Final Rule 84 FR 38728, August 7, 2019 (<a href="https://www.federalregister.gov/documents/2019/08/07/2019-16485/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities" target="_blank">https://www.federalregister.gov/documents/2019/08/07/2019-16485/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities</a>)</span></em></li><li><em><span class="ms-rteFontSize-1">3 FY 2021 SNF PPS Final Rule 85 FR 47594, August 5, 2020 (<a href="https://www.federalregister.gov/documents/2020/08/05/2020-16900/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities" target="_blank">https://www.federalregister.gov/documents/2020/08/05/2020-16900/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities</a>)</span></em></li><li><em><span class="ms-rteFontSize-1">4 FY 2022 SNF PPS Final Rule 86 FR 42424, August 4, 2021 (<a href="https://www.federalregister.gov/documents/2021/08/04/2021-16309/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities" target="_blank">https://www.federalregister.gov/documents/2021/08/04/2021-16309/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities</a>)</span></em></li><li><em><span class="ms-rteFontSize-1">5 FY 2023 SNF PPS Final Rule 87 FR 47502, August 3, 2022 (<a href="https://www.federalregister.gov/documents/2022/08/03/2022-16457/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities" target="_blank">https://www.federalregister.gov/documents/2022/08/03/2022-16457/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities</a>)</span></em></li><li><em><span class="ms-rteFontSize-1">6 OIG Work Plan: Skilled Nursing Facility Reimbursement webpage (<a href="https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000575.asp" target="_blank">https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000575.asp</a>)</span></em></li><li><em><span class="ms-rteFontSize-1">7 CMS Medical Review and Education webpage (<a href="https://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/medical-review" target="_blank">https://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/medical-review</a>)</span></em></li><li><em><span class="ms-rteFontSize-1">8 CMS Targeted Probe and Educate webpage (<a href="https://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/medical-review/targeted-probe-and-educatetpe" target="_blank">https://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/medical-review/targeted-probe-and-educatetpe</a>) </span></em></li></ul><p><em>Daniel Ciolek is associate vice president, therapy advocacy, for the American Health Care Association.</em></p>	The reports, derived from MDS data, allow providers to compare and benchmark metrics on a quarterly basis against peers within their organization, state, or nationwide.	2022-11-01T04:00:00Z	<img alt="" src="/Issues/2022/NovDec/PublishingImages/PDPM.jpg" style="BORDER:0px solid;" />	CMS	PDPM Update

CEO of AHCA/NCAL Mark Parkinson on Changing Long Term Care for the Better	https://www.providermagazine.com/Articles/Pages/CEO-of-AHCA-NCAL-Mark-Parkinson-on-Changing-Long-Term-Care-for-the-Better.aspx	CEO of AHCA/NCAL Mark Parkinson on Changing Long Term Care for the Better	<p> Mark Parkinson, the president and CEO of the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL), recently joined the <a href="https://ltcheroes.com/" target="_blank">LTC Heroes</a> podcast to discuss the work that he and his team are doing to improve the lives of seniors. </p><p>“We want to create great experiences and a great setting for our residents while they're alive,” he said. He shared with <a href="https://experience.care/" target="_blank">Experience Care</a>’s Peter Murphy Lewis the innovative measures AHCA has taken to help make care more accessible. Parkinson also told how AHCA is advocating for fairer wages for long term care employees. You can watch the entire interview below:<br><br> </p><center><iframe src="https://www.youtube.com/embed/4RGLVZNvJSw?enablejsapi=1&origin=https://www.providermagazine.com" title=""Advocacy for LTC" Mark Parkinson - President & CEO at AHCA" allowfullscreen="" data-gtm-yt-inspected-32388671_20="true" id="772703113" width="560" height="315" frameborder="0"></iframe></center> <br><br>One important step to fulfilling those goals is pushing for reasonable regulations. “We're advocating against negative regulatory proposals, like the idea of requiring 4.1 hours of direct care per resident, whether the money is provided or not,” he said. “At the same time, we're trying to help states so they can continue to receive Medicaid increases by maximizing provider recovery at the state level.”<p></p><p>Still, there is much to be done in terms of filling out long term care teams. That is why Parkinson embraced an innovative idea that came from AHCA’s director of clinical and regulatory services, Pamela Truscott. She proposed developing a temporary nursing aide program in which individuals could be trained in eight to twelve hours. “We put the program together under Pam's leadership, took it to CMS, they approved it, and put the training up on our website for free, even for non-members,” he said. “Over 300,000 people have taken the training and over 200,000 are working in buildings.”</p><p>Lastly, AHCA works hard to ensure that caregivers are compensated fairly. So when the CMS proposed a 2 percent payment cut, Parkinson and his team got to work. “We went to our members and told them that we need to pull together to fight this,” he said. “We submitted 6,920 unique comments and changed their minds.” The result? “They went from a 2 percent cut to starting this October with a 2.7 percent increase. And it’s just a beautiful example of what can happen when we all pull together and get our message out.” It is that sort of collaborative spirit that drives AHCA forward everyday as part of a mission to improve the lives of America’s older adults and those who care for them.<em><br></em></p><p> <em>Cameron Zargar, Ph.D., is the director of content and editor-in-chief of the Experience Care website.</em><br></p>	Parkinson recently joined the LTC Heroes podcast to discuss the work that he and his team are doing to improve the lives of seniors.	2022-11-16T05:00:00Z	<img alt="Mark Parkinson" src="/PublishingImages/Headshots/MarkParkinson.jpg" style="BORDER:0px solid;" />	Quality
CMS Releases Managed Care Prior Authorization Proposed Regulation	https://www.providermagazine.com/Articles/Pages/CMS-Releases-Managed-Care-Prior-Authorization-Proposed-Regulation.aspx	CMS Releases Managed Care Prior Authorization Proposed Regulation	<p></p><p>The Centers for Medicare & Medicaid Services (CMS) has issued a <a href="https://cl.exct.net/?qs=af6c182f5155d10c8d146e1cc70f2c02f73d4f71606f43a02bd53dbc057b32d5a404cce926554b3d407dc0c1b8763e48293584871665d833" target="_blank">proposed rule</a> that would streamline processes related to prior authorizations (PA) for medical items and services. The proposed rule would also make information on plan PA performance – such as timeliness, as well as plan reasons for and methods of denials – public to providers and beneficiaries.<br><br>The proposed rule would apply to Medicare Advantage (MA) Plans, State Medicaid and Children's Health Insurance Program (CHIP) agencies, Medicaid Managed Care Plans, CHIP Managed Care Plans, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs). CMS estimates that efficiencies introduced through these policies would save physician practices and hospitals, alone, over $15 billion over a 10-year period.<br> <br>Key proposed provisions include: </p><ul style="list-style-type:disc;"><li><strong>Address challenges with the PA process faced by providers and patients, including requirements for certain types of plans to include a specific reason when denying requests, as well as publicly report certain prior authorization metrics</strong>. Additionally, the proposed rule would require plans to send decisions within 72 hours for expedited (i.e., urgent) PA requests and seven calendar days for standard (i.e., non-urgent) requests, which is twice as fast as the existing Medicare Advantage response time limit. CMS also suggests shorter timeframes may be more appropriate such as 48 hours for urgent PA requests and five days for non-urgent PA requests.</li><li><strong>Provide improved access to health data contained in patient records to providers and beneficiaries to reduce fewer disruptions in care.</strong> These policies include expanding the current source of information about prior authorization decisions, allowing providers to access patients' data by requiring plans to build and maintain more expansive patient databases accessible to providers, as well as to enable data exchange among plans to in-network providers.</li></ul><p>These provisions would likely offer providers and beneficiaries helpful new information to understand plan PA processes and patterns of behavior. <br><br>AHCA/NCAL will release a more thorough summary in the coming days and work with membership to comment. The deadline to submit comments is March 13, 2023.<br> <br>The <a href="https://cl.exct.net/?qs=af6c182f5155d10cd000d114494067610cb9bf7b7ddc09649b825bf8337c39f5891980991e04af8c7393ca6c9a21b4efe060cfbb992001fc" target="_blank">CMS Fact Sheet</a> and <a href="https://cl.exct.net/?qs=af6c182f5155d10c78dee041ab65e87e1738c3ec3c0cd52e44314cb3d27d16ebac3519c04bd748470bc1ac69008da4831b75f83ba1889c85" target="_blank">full text</a> of the proposed rule are both available. Please contact <a href="mailto:mcheek@ahca.org?subject=" target="_blank">Mike Cheek</a> with questions. <br><br></p>	These provisions would likely offer providers and beneficiaries helpful new information to understand plan PA processes and patterns of behavior.	2022-12-12T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/0120_News1.jpg" style="BORDER:0px solid;" />	CMS
Population Health Management Summit Offers Assisted Living Education Opportunities	https://www.providermagazine.com/Articles/Pages/Population-Health-Management-Summit-Offers-Assisted-Living-Education-Opportunities.aspx	Population Health Management Summit Offers Assisted Living Education Opportunities	<p><img src="/Issues/2022/SeptOct/PublishingImages/LaShuanBethea.jpg" alt="LaShuan Bethea" class="ms-rtePosition-2" style="margin:5px;width:169px;height:212px;" />The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) will host its 2022 <a href="https://www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx" target="_blank">Population Health Management Summit</a> December 7-8 at the Gaylord National Harbor in Maryland. This event has grown each year, as value based care and risk-based models move into the forefront of how long term care communities—including assisted living (AL)—continue to deliver quality care and improve the lives of residents.</p><p>You may <a href="/Issues/2022/SeptOct/Pages/Celebrating-Joyful-Moments-%26-the-Future-of-Assisted-Living.aspx" target="_blank">recall</a> that population health management (PHM) is the process of improving the health and quality of life for groups of residents. It focuses on wellness, prevention, and proactive care coordination/management. PHM models help achieve the triple aim—the right care, at the right time, in the right place. Although still a fairly new concept within AL, PHM is something that you not only need to understand but also be able to evaluate employing within your communities in order to improve quality outcomes for your residents, position yourself well in the market, and manage risk within communities.</p><p><strong>That is why it is so important for AL providers to </strong><a href="https://www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx" target="_blank"><strong>attend</strong></a><strong> this year's PHM Summit. </strong>This event features an AL-specific track with sessions that will cover the why, what, and how to help you stay ahead of the curve.</p><p>Highlights include:</p><p><strong>Wednesday, Dec. 7</strong><br></p><ul><li><em>Opening keynote speaker Mark McClellan, M.D., Ph.D., Director at the Margolis Center for Health Policy at Duke University</em>: McClellan is a physician-economist who focuses on quality and value in health care, including payment reform, real-world evidence, and more effective drug and device innovation. He is former administrator of the Centers for Medicare and Medicaid Services (CMS) and former commissioner of the U.S. Food and Drug Administration where he developed and implemented major reforms in health policy.</li><li><em>Healthcare Transformation: Why Should Assisted Living Providers Care?</em> Value based care, population health, I-SNPs, the alphabet soup continues; what does this mean for AL providers and why should they pay attention? Whether you know it or not, payors and referral sources are tracking your outcomes. What are the implications and what can you do?</li><li><em>Considerations for Assisted Living in Value Based </em><em>Care: </em>Join your peers for an interactive discussion on AL, value based care, and PHM, as well as get a better understanding of the sessions focused on assisted living for the next day.</li></ul><p></p><p><strong>Thursday, Dec. 8</strong><br></p><ul><li><em>Market Strategies for Assisted Living</em>—<em>Experience from the Field</em>: Consumers have always expressed their strong preference to receive care in their homes. The COVID-19 pandemic has accelerated the actualization of care-at-home services with growth in virtual care, emerging technologies, and value based care. Presenters will share models and market strategies to succeed in this changing landscape.</li><li><em>Sorting Through the ACO Maze</em>: Learn about one of the primary trends driving all of health care towards more value based, alternative payment arrangements, accountable care organizations (ACOs). Take a deeper dive into the two main ACO models and gain insight into what you must consider when thinking about ACO partnerships.</li><li><em>Primary Care: Do you Own, Contract, or Partner?</em> Primary care is the building block of PHM models. Given its primacy, how do LTC providers approach engagement with physicians and advance practice professionals? What do you need to consider as you evaluate your options?</li><li><em>Closing keynote speaker Ellen Lukens, Deputy Director of the CMS Innovation Center: </em>Lukens has deep experience both within and outside the government tackling complex health policy issues. Prior to this role, she served as the Group Director of the Policy and Programs Group within the CMS Innovation Center, where she led the team that provides cross-cutting support for Center-wide policy and portfolio management.</li></ul><p></p><p>The time to plan for the future of AL is now—and that includes population health management. This Summit offers an invaluable opportunity to learn more about how to be successful utilizing PHM strategies and models in your communities.</p><p>I look forward to seeing you there!</p><p>Online registration for the Population Health Management Summit is open through November 30.<em> </em><a href="https://www.ahcancal.org/Education-Events/Population-Health-Management-Summit/Pages/default.aspx" target="_blank"><em>Register today!</em></a></p><p><em>LaShuan Bethea is the executive director of the National Center for Assisted Living (NCAL).</em></p>	This event has grown each year, as value based care and risk-based models move into the forefront of how long term care communities—including assisted living (AL)—continue to deliver quality care and improve the lives of residents.	2022-11-07T05:00:00Z	<img alt="" src="/Articles/PublishingImages/2022/PHM_2022.jpg" style="BORDER:0px solid;" />	Population Health Management

At Many Seniors Homes, Every Day Celebrates Veterans	https://www.providermagazine.com/Articles/Pages/At-Many-Seniors-Homes,-Every-Day-Celebrates-Veterans.aspx	At Many Seniors Homes, Every Day Celebrates Veterans	<p>Every day is Veterans Day in our world,” said Kelly Odegaard, vice president of Operations and Veterans Services, Westcare Healthcare Management, Salem, Ore., who operates two senior care centers in his state.</p><p>“Veterans Day is a holiday vacation day off in a lot of places, but not here,” he joked.<br></p><p><img src="/Issues/2022/NovDec/PublishingImages/veterans2.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:133px;" />His team and residents are excitedly preparing for upcoming events, including a parade nearby in Albany, Ore., that is known to be the largest held west of the Mississippi River. This year’s celebration is the 25th annual and will be the first held in-person since the pandemic.<br></p><p>Odegaard brings his community’s 14-passenger van and a string of classic collectible cars to ride in the parade, including a Harley-Davidson honor bike that is decorated fully in support of Veterans.<br></p><p>The parade route is typically lined five- to 10-people deep along the road, said Odegaard, who live-streams the event back to his communities (one in Lebanon, Ore., and one in The Dalles, Ore.) so that those who can’t attend can still enjoy it.<br></p><p>At the Lebanon center, there’s a hefty lineup of activities. Gnomenuts Hot Donuts will be providing free donuts and coffee for Veterans. The decorated Harley-Davidson motorcycle will take a few more laps in a post-parade “drive by.” The Oregon State University ROTC joins the center for a special medals ceremony and then stays for an ROTC Happy Hour by the fire pit with live music.<br></p><p>At The Dalles location, there’s a Klickitat Veterans Celebration, with a luncheon and festivities focused on Vets from that tribe, which is based in Washington state. It features live music, special refreshments, games, and prizes.<br></p><p>Local schools provide handmade thank-you cards that are presented to all the Veterans. Veterans’ banners are displayed downtown that highlight the Oregon Veterans Homes.<br></p><p>Additionally, a special meal from the food and nutrition department will be served—this year it will provide steaks.<br></p><p>Odegaard’s Veterans Homes are larger than the average U.S. Veterans homes that house about 80 Veterans. The capacity at The Dalles center is 151 with 96 occupants. The capacity at the Albany center is 154 with 134 occupants.</p><h3>Maine Veterans’ Homes to Print 40th Annual Resident Calendar</h3><p>Maine Veterans’ Homes (MVH) has its eyes on Vets year-round, culminating in its production of an annual calendar that highlights its great residents.<br></p><p>MVH is a gold quality award level provider with roughly 625 residents in its six homes located throughout Maine, in Augusta, Bangor, Caribou, Machias, Scarborough, and South Paris.<br></p><p><img src="/Issues/2022/NovDec/PublishingImages/veterans1.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:300px;" />Each year, in time for the Veterans Day holiday, it produces a full-color, full-year calendar that features the life stories of 12 of its residents (two Veterans are chosen from each center).<br></p><p>This year represents the 40th anniversary of the calendar, and it again plans a print run of 10,000. Copies are provided to all residents and their families as well as Veterans services groups and the public.<br></p><p>“It’s so popular that we start getting requests for it in September,” said Christine M. Henson, Communications Manager, MVH. MVH also produces a digital copy available on its website at <a href="https://mainevets.org/calendar/" target="_blank">https://mainevets.org/calendar/</a>.<br></p><p>On Veterans Day, MVH hosts a service where prayers are recited, and Vets and their families gather for a celebration with music and a local color guard. Many also participate in civic parades as the home is located along the parade route. Residents also enjoy gift cards and baked goods, decorated in a Veterans Day motif.<br></p><p>“The entire day is very heartwarming,” Henson said. “The residents really look forward to it.”</p><h3>Massachusetts’ Elder Services</h3><p>Frank Romano is a Vietnam Veteran and owner of Massachusetts-based Elder Services.<br>He served in 1968-69 and knows first-hand how important Veterans Day is to anyone who served in the military. <br></p><p>“These are the people we have to respect, but it’s easier said than done,” Romano said. “Veterans Day, in my opinion, has too much become another retail holiday; but it means so much to the Vets.”<br></p><p>Romano said his centers “go all out” to honor them, including inviting members of Congress to his facilities. To ensure the guests can attend, Romano typically schedules his celebrations the Tuesday before Veterans Day to better fit into the Congress members’ busy schedules. Romano sets up tents outside and invites a variety of other speakers to address his enthusiastic crowds. <br><br><em>Paul Bergeron is a freelance writer based in Herndon, Va. </em></p>	The national holiday shines a brighter spotlight on those who served.	2022-11-01T04:00:00Z	<img alt="" src="/Issues/2022/NovDec/PublishingImages/veterans.jpg" style="BORDER:0px solid;" />	Caregiving	Special Feature	Paul Bergeron	49	11
Insurance Corner	https://www.providermagazine.com/Articles/Pages/Insurance-Corner-Cianci.aspx	Insurance Corner	<p><img src="/Issues/2022/NovDec/PublishingImages/Compass_Cianci.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:108px;height:135px;" />There are many misconceptions surrounding the Employee Retention Credit (ERC) because of the iterations and legislative changes during the pandemic. Here are several of the most common misconceptions we hear. </p><p><strong>We are considered an essential business and do not qualify.</strong> <span class="ms-rteForeColor-2">False.</span> An essential business can qualify for the ERC because gross receipts declined by 20 percent year-over-year in comparable quarters or because its operations are fully or partially suspended because of a government order.</p><p><strong>We used the Paycheck Protection Program and do not qualify.</strong> <span><span class="ms-rteForeColor-2">False.</span></span> The stimulus package passed in December 2020 amended the original legislation and now allows for companies who received PPP funds to also take the ERC.</p><p><strong>We didn't experience a year-over-year decline in sales by 20 percent </strong><span><strong>and do not qualify</strong></span><strong>. </strong><span><span class="ms-rteForeColor-2">False.</span></span> Your company had to see either a 20 percent decline in gross receipts OR suspension in operations, not both. Almost every facility has been impacted in some way by a governmental order.<br></p><p><strong>We have been profitable thrrough the pandemic </strong><span><strong>and do not qualify</strong></span><strong>.</strong> <span><span class="ms-rteForeColor-2">False.</span></span> We have seen many companies that were profitable receive hundreds of thousands to millions of dollars in credits. </p><p><strong>We do not pay taxes because we are a nonprofit and do not qualify.</strong> <span><span class="ms-rteForeColor-2">False.</span></span> This tax credit applies to tax-exempt organizations if the business operations have been fully or partially suspended due to governmental orders related to COVID-19. </p><p><strong>Our business stayed open the whole time and does not qualify.</strong> <span><span class="ms-rteForeColor-2">False.</span></span> If your business had to change in any way due to governmental orders OR if gross receipts declined by 20 percent when you compare to the same quarter in 2019, you can still qualify.</p><p>To discuss your company’s specific situation, contact Nick Cianci, owner of Compass Total Benefit Solutions, at <a href="mailto:nick@compasstbs.com">nick@compasstbs.com</a>.<br></p>	There are many misconceptions surrounding the ERC because of the iterations and legislative changes during the pandemic.	2022-11-01T04:00:00Z	<img alt="" src="/SiteCollectionImages/logos/CompassTB.jpg" style="BORDER:0px solid;" />	Caregiving	Special Feature		49	11
Where Innovation Meets Data	https://www.providermagazine.com/Articles/Pages/Where-Innovation-Meets-Data.aspx	Where Innovation Meets Data	<p>“The core advantage of data is that it tells you something about the world that you didn’t know before,” said Hilary Mason, a data scientist. <br><br>The American Health Care Association (AHCA)/National Center for Assisted Living (NCAL) is changing the way the long term and post-acute world gathers, analyzes, and shares data through the Long Term Care Data Cooperative. <br></p><p><img src="/Issues/2022/NovDec/PublishingImages/LTC%20DataCoop.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:121px;" />The Cooperative is the first of its kind in the world. Formed in partnership by AHCA/NCAL and Brown University and funded by the National Institute on Aging, the Cooperative is an effort to improve the quality of care within skilled nursing care centers through a new—and collaborative—approach to gathering and sharing patient data. Both the scale and the methods for aggregating data give the Cooperative its innovative edge. This large-scale effort involves any long term or post-acute care center across the nation that chooses to enroll, and the data are being gathered from multiple electronic medical record (EMR) software vendors into a single repository of information.<br></p><p>“This project was born out of a real need for better data during the pandemic,” said Dr. David Gifford, MD, MPH, chief medical officer and director of the Center for Health Policy Evaluation in Long Term Care at AHCA/NCAL. “It started with an idea of gathering data to truly understand how infection prevention methods were working within centers across the country and to gain better insights into the effectiveness of the vaccines. It grew from there into a look at the effectiveness of practices and the research required to make critical decisions about patient care.”</p><h3>Determining Effectiveness of Treatments</h3><p>In the long term care sector, the vast majority of treatments, medications, and practices that are adopted for use within nursing homes are often developed outside of the nursing home environment, explained Gifford. Their effectiveness for this population is unknown. Gaining access to long term care patients and data is complex, and researchers often use settings or younger populations more conducive to testing and data gathering.<br></p><p><img src="/Issues/2022/NovDec/PublishingImages/DavidGifford.jpg" alt="David Gifford" class="ms-rtePosition-1" style="margin:5px;width:108px;height:135px;" />“The challenge then is determining what is truly effective and—equally as important—what is not effective specifically in a long term care environment,” said Gifford. “The Cooperative is helping to change this by providing access to real patient data for verified research opportunities.”<br></p><p>Through the Cooperative, vetted federally funded researchers would have access to data in a way that’s never been available before. Nearly 1,000 centers have signed up to participate in the Cooperative completely free of charge. As enrolled providers, these centers will feed real-time data from their EMRs to the Cooperative, where it will be translated into a shared data platform. As more centers participate, more data become available, offering better and more realistic insights into the effectiveness of treatments than have ever before been provided. </p><h3>Providers Led the Effort</h3><p>The benefits to researchers are numerous, but all research will be guided by the decisions of providers. Researchers will need to move through an extensive approval process to gain access to the Long Term Care Data Cooperative, which will include input from participating providers, who will have the opportunity to review each application and decide on appropriate uses of data. <br></p><p><img src="/Issues/2022/NovDec/PublishingImages/LonnitaMyles.jpg" alt="Lonnita Myles" class="ms-rtePosition-2" style="margin:5px;width:108px;height:135px;" />“This is, above all, a provider-led effort,” said Lonnita Myles, project director of the Long Term Care Data Cooperative. “We are involving providers every step of the way through town halls, one-to-one interaction, and large-scale feedback reports.” <br></p><p>All participating centers in the Cooperative receive feedback reports, which can greatly influence patient outcomes, explained Myles. The comprehensive collection of data is an ongoing process that will continue for years to come, enabling centers to gain more insights with every new report.<br></p><p>“These feedback reports are a repository of all collected data, and it is an extremely effective roadmap to help providers decide what to do next. They will have the information they need to make important decisions within their own care centers,” said Myles. “The real impact of the Cooperative is the ability to see the effect of decisions as measured through data, thus allowing providers to take informed and educated next-steps in initiatives, procedures, and more.”</p><h3>Connecting EMR Data to CMS Claims</h3><p>In addition to feedback reports, centers are able to view linkage of available EMR data to Medicare claims. The Cooperative’s data-streaming process, which has been pioneered by data science expert Exponent Inc., will merge EMR data with CMS claims data to give centers rapid access to information about critical measures of quality care, such as rehospitalization rates. <br></p><p>Finally, participating centers have direct access to AHCA/NCAL leadership involved in the Cooperative as well as to experts in the industry who are connected to the Cooperative. The barrier to entry is low for centers who are interested in enrolling. In less than 30 minutes, most centers can complete the registration process. Additional introductory calls and information gathering will be coordinated by AHCA/NCAL. The process is completely free for all centers, and centers do not need to be active AHCA/NCAL members to participate. <br></p><p>“The existence of this program means it’s already a success,” said Gifford. “More than a thousand centers have enrolled, we’re receiving applications for research, and word is spreading. This is something that’s never been done before—and we’re proud to be behind it.”<br></p><p>For more information on the Long Term Care Data Cooperative or to enroll, visit <a href="https://www.ahcancal.org/Data-and-Research/Pages/LTC-Data-Cooperative.aspx" target="_blank">https://www.ahcancal.org/Data-and-Research/Pages/LTC-Data-Cooperative.aspx</a> or contact <a href="mailto:LTCDataCooperative@AHCA.org" target="_blank">LTCDataCooperative@AHCA.org</a>. <br><br><em>Claire Krawsczyn is a freelance writer and creative consultant serving industries such as long term and post-acute care. She can be reached at <a href="mailto:claire@goverano.com" target="_blank">claire@goverano.com</a>. </em></p>	AHCA/NCAL is changing the way the long term and post-acute world gathers, analyzes, and shares data through the Long Term Care Data Cooperative.	2022-11-01T04:00:00Z	<img alt="" src="/Issues/2022/NovDec/PublishingImages/LTC-DC.jpg" style="BORDER:0px solid;" />	Management	Special Feature	Claire Krawsczyn	49	11

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