Spring 2023

Vol. 50 No. 1

Spring 2023

Cover Story

The Ripple Effect of Benefits, Opportunities That Come from Quality Awards

https://www.providermagazine.com/Issues/2023/Spring/Pages/The-Ripple-Effect-of-Benefits-Opportunities-That-Come-from-Quality-Awards.aspx

The Ripple Effect of Benefits, Opportunities That Come from Quality Awards

The pursuit of quality is a constant in long term care, and little is more representative of that than the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) National Quality Awards Program. As of 2021, nearly 2,000 providers have received the Bronze award, nearly 700 have received the Silver, and 49 have received the Gold. Award recipients consistently perform better than the national average in several areas, including hospital readmissions and off-label use of antipsychotics. They also have higher ratings regarding surveys, staffing, and quality metrics. But the awards are about more than numbers. Pursuing the awards opens doors to new and innovative opportunities, and it equips organizations and teams to more adeptly manage crises and change, thrive, and be resilient.<img src="/Issues/2023/Spring/PublishingImages/TammyKelly.jpg" alt="Tammy Kelly" class="ms-rtePosition-1" style="margin:5px;width:180px;height:225px;" />“The awards program represents a journey. It’s a framework for a better resident experience and quality of life. It enables staff to work better, smarter. You can set deployment goals and introduce team-building activities such as contests between departments,” said Tammy Kelly, PT, LNHA, RAC-CT, director of resident assessment instrument and clinical reimbursement at Commonwealth Care of Roanoke. “And you gain employee enthusiasm and engagement.” She noted that it also can be used as a metric in the value-based payment system for incentive payments. “There are so many things you can weave into this.”Mike Hensley, managing partner and owner at Burgess Square Healthcare and Rehab Centre in Westmont, Ill., observed, “We were always striving for quality before the awards journey, but this is a systematic way for facilities to achieve quality goals that give AHCA a foothold in Washington, so they can show policymakers and others that their members are committed to excellence in patient care and achieving quality outcomes.”<h3>The Ripple Effect … or a Wave? </h3>As teams sharpen their skills, taking a hard look at the systems and processes and making changes and improvements in pursuit of the Quality Awards, their accomplishments flow into other areas. For instance, Hensley said, “We were named the number one skilled nursing facility provider in Illinois by Newsweek, and we were in the top 60 in Illinois as identified by U.S. News & World Report. Our quality improvement efforts as we pursued the awards set us up for these accomplishments.” On a local level, Hensley said, “we received positive media recognition, and this was invaluable.” Of course, such acknowledgement takes some effort, he noted, saying, “When we received the Gold award, it was a major accomplishment and a heavy lift, and we did it during the pandemic. We promoted the prestigious value of this achievement. Then we were named number one by Newsweek, and that really caught fire with physicians, hospitals, and potential residents.”<h3>From Stick to Carrot </h3>Particularly during the pandemic, long term care providers came under scrutiny and were often unfairly portrayed in the media. The focus was often negative and critical. Genuine opportunities to celebrate are empowering and essential. <img src="/Issues/2023/Spring/PublishingImages/MikeHensley.jpg" alt="Mike Hensley" class="ms-rtePosition-2" style="margin:5px;width:180px;height:225px;" />Hensley said, “When you look at the operations of nursing centers and organizations, we are measured in an infinite number of ways on everything from staff retention and turnover to outcomes. But almost 100 percent of these measurements involve a negative outcome associated with the grade or rating. For instance, if you are cited too many times, your star ratings go down. We have so many sticks coming at us but few carrots.” The Quality Award process is something providers can strive for, he said, that has a positive outcome “beyond what we do every day.” He noted, “When we went through the awards, it was the pursuit that was the important part. We are always improving our quality, and we had concrete results to celebrate and many carrots in a world where there are so many sticks.” <h3>From Assessment to Action and Teamwork </h3>Going through the process helps connect the dots. Kelly said, “As I was writing for the Bronze award, I started connecting things. Then we wrote for the Silver, and it opened a whole world to us—with new and better processes and systems. It created a ripple effect.”At a time when it is more essential than ever to have cohesive, committed teams, Kelly observed that writing for the awards “brings disciplines together.” She explained, “Your teams begin to understand and appreciate the whole picture. You establish sustainable processes and systems and concentrate on things beyond the daily minutia. You step back, let it run, and focus on other opportunities for quality improvement. As the teams and processes become more efficient, the energy you previously put into putting out fires you can now direct toward broadening your perspective and moving your organization forward.” Using the <a href="/Issues/2023/Spring/Pages/The-Partnership-of-Baldrige-Criteria-and-Quality-Awards.aspx" target="_blank">Baldrige criteria</a> employed in the Quality Awards program for ongoing process improvement, she suggested, enables you to look at opportunities to continue building on your processes and systems and for other resources such as grants and research partnerships. “This process makes us more comfortable opening doors and inviting people in,” Kelly said.Opening doors also enables providers to strengthen relationships. Kelly said, “As part of the Baldrige criteria, you take a deep dive into who your stakeholders are, and you identify who you work well with, as well as those who have a strong need for your services but you’re not well-connected with—such as a hospital system.” She said that her organization has been able to make closer connections with area hospital systems so they can move patients more effectively through the continuum, and communicate and share information effectively. “If we can break through the blame game via such efforts and share information more transparently, we become allies instead of just a referral source and receivers.”<h3>Weathering Whatever Comes </h3>While data is still being collected, it seems clear that Silver and Gold Quality Award recipients weathered the pandemic more efficiently and effectively. “A word we use a lot in the program is sustainability, and going through the awards process helps organizations build that,” said Kelly. This means that when a crisis takes focus away from other efforts, facilities can go on autopilot for a time and don’t fall apart. She explained, “Going through the application as a team and setting up interdisciplinary processes build confidence, teamwork, and oneness of thought so when things get difficult, there is more stability and agility. The team is able to pull together when things feel like they’re burning down around us. We have solid ground to stand on.”During the pandemic, organizations learned that transparency builds trust. Kelly observed that Quality Award participants already knew this. These organizations have already assessed and addressed how and with whom they share information, and what information various audiences need access to. They realize, she said, that “if people don’t have good information, they make it up; and when this happens, things go sideways.” Going through the awards process and sharing information, she said, builds confidence in your ability to communicate both “when things are great and when they’re not so good.”<img src="/Issues/2023/Spring/PublishingImages/LisaPearson.jpg" alt="Lisa Pearson" class="ms-rtePosition-1" style="margin:5px;width:180px;height:225px;" />Lisa Pearson, MSN, RN, CIC, director of infection prevention and quality improvement at South Davis Community Hospital in Bountiful, Utah, said, “At the beginning of the pandemic, we recognized that staff wanted information. There was a lot of fear that could be felt everywhere. Having information was essential, so we created a newsletter—The COVID Connection—containing the information staff needed.” At the same time, she said, “we already had key people in place who knew what they needed to do. We formed a task force with key leaders, and we created a systematic process to respond to new guidance and information with daily team meetings.” As a result, she said, they reacted less with fear, and they made decisions that were data-informed instead of based on emotion.Hensley noted, “We were much better equipped to handle the pandemic, and we were able to respond to the almost daily changing guidance. We could rely on our processes and provide our staff with great stability in uncertain times.” Pearson agreed, “Going through the awards program teaches you not to have a reactive approach where you’re putting out fires all the time. Instead, you become proactive and are able to mitigate many small problems before they become big ones.” She added, “Since you have streamlined and efficient processes in place, it saves time, and you have happier staff and better outcomes.”<h3>Star Staffing </h3>While the Quality Awards aren’t a panacea, Hensley noted their value for improving—or at least stabilizing—staffing. He said, “If you are a quality nurse, wouldn’t you rather work for a five-star Gold award facility? It’s easier to retain and recruit good staff when you demonstrate your commitment to quality and make it clear that you engage and value staff in these efforts. It also may be a deterrent to those who just want a job and don’t have any real interest or passion for long term care.”Even with a strong staff, it can be challenging to ask people to do the work of writing for Quality Awards. However, Hensley stressed, “pursuing this milestone is worth it. It engages our staff and gives them purpose beyond what they are doing every day. It makes a weak team strong and a great team exceptional.” He suggested that it can be easier to pursue the awards if “you take it in small steps and celebrate milestones.”For those organizations that feel like they’re just staying above water, Pearson suggested, “You are the perfect candidate for this. It will teach you to develop processes; identify blind spots; and better support staff, residents, families, and other stakeholders. The awards aren’t just a vanity project. They will help you not only survive but thrive.”

Putting quality improvement processes in place can win awards, but also helps build teamwork, motivation, and communication.

2023-03-01T05:00:00Z

Quality Awards

The Ongoing War on Infections	https://www.providermagazine.com/Issues/2023/Spring/Pages/The-Ongoing-War-on-Infections.aspx	The Ongoing War on Infections	<p>Infectious diseases will continue to present challenges for long term care. While vaccines and treatments for COVID-19 have had a positive impact, antibiotic-resistant bacteria and other infections are creating concerns and demanding attention. The good news is that we know more than ever about infection prevention and control, and there are a plethora of tools, resources, and best practices to rely on.</p><h3>Antimicrobial Resistance</h3><p>Antimicrobial, or antibiotic, resistance happens when bacteria become immune to the medications designed to kill them. In the U.S. alone, more than 2.8 million antimicrobial-resistant infections happen each year, and these result in more than 35,000 deaths, according to the Centers for Disease Control and Prevention (CDC). The main cause of antibiotic resistance is antibiotic use, specifically the overuse of these medications. The more antibiotics people take, the greater their chances of becoming resistant to them. </p><p>Over the years, antibiotics have been a popular treatment for a variety of illness, and many consumers have come to view these as miracle drugs. However, antibiotics are needed only for treating certain infections caused by bacteria, and increasingly, these drugs are reserved for use in treating serious, life-threatening conditions such as sepsis.</p><p>Unfortunately, some clinicians, patients, and family members continue to rely on antibiotics—often inappropriately—for a wide array of conditions. For instance, asymptomatic bacteriuria and pyuria are common among long term care residents, and older adults have a high rate of bacterial colonization in urine. These can lead to an erroneous diagnosis of a urinary tract infection (UTI), and this is a major driver for the overuse of antibiotics. </p><p>“If I were to test everyone in my nursing home with a urinalysis, most would test positive for a UTI,” said Leslie Eber, MD, CMD, a Colorado-based physician and AMDA—The Society for Post-Acute and Long-Term Care Medicine’s 2021 Medical Director of the Year. That is why one of the items in AMDA’s Choosing Wisely list of interventions that clinicians should heed is “don’t obtain urine tests until clinical criteria are met.” </p><p>“Antibiotics can do more harm than good. Every year we have residents who die from <em>C. difficile</em> because of an antibiotic. These drugs can lead to severe outcomes,” said Eber.</p><p>There is a need for more education about the dangers of antibiotic overuse and antimicrobial-resistant bacteria. Part of this, suggested Eber, involves changing the conversation. “When a family member wants an antibiotic and thinks we aren’t doing enough for their loved one if we won’t prescribe it, we need to make it clear that we actually are trying to protect mom or dad by denying them this medication,” Eber suggested.</p><p><img src="/Issues/2023/Spring/PublishingImages/Buslovich.jpg" alt="Steven Buslovich, MD" class="ms-rtePosition-1" style="margin:5px;width:180px;height:226px;" />Steven Buslovich, MD, CMD, MSHCPM, a New York-based geriatrician and co-founder and chief executive officer of Patient Pattern, suggested that one challenge stems from nurses being inadequately trained about antibiotic appropriateness. This is an issue particularly when there are lots of agency staff or nurses who have little experience in long term care, he said. “We need to train them to go back to the basics instead of going right to medication.” </p><p>For instance, dehydration is a common cause of foul-smelling urine and confusion, which can lead to a prescription for antibiotics to treat a UTI. “Creating hydration protocols where you have dedicated times on each shift to make sure patients get fluids can help reduce infections in general, as well as issues such as delirium,” Buslovich observed.</p><p>Eber suggested a multi-pronged approach to address antibiotic resistance: “First, you need an antibiotic stewardship program that leadership is invested in. This should also be a topic at quality-assurance and performance-improvement meetings. And everyone on the team—from the infection preventionist and CNAs [certified nursing assistants] to housekeeping and hospitality staff—should be informed about it and understand their role.” </p><p>Second, she suggested, discuss stewardship on admission. There are numerous patient education materials available, so you don’t have to reinvent the wheel. For instance, Mass General has a fact sheet on antibiotic stewardship (<a href="https://www.mass.gov/service-details/antibiotic-stewardship" target="_blank">https://www.mass.gov/service-details/antibiotic-stewardship</a>). “This lets patients and families know from the start that antibiotic stewardship is a priority for us and that it’s in their best interest,” she said. </p><img src="/Issues/2023/Spring/PublishingImages/LisaPearson.jpg" alt="Lisa Pearson, MSN, RN" class="ms-rtePosition-2" style="margin:5px;width:180px;height:225px;" /><p>Lisa Pearson, MSN, RN, CIC, director of infection prevention and quality improvement at South Davis Community Hospital in Bountiful, Utah, said, “I do a monthly report of health-care-acquired infections and include a stewardship summary. I categorize antibiotics as appropriate or not, and if not, why not. Then I send this report to the nurse managers and nurse practitioners seeing our patients.” She also creates a breakdown of areas of concern and sends that information quarterly to physicians. </p><p>Additionally, Pearson and her team include education about antibiotic-resistant bacteria in annual competencies for nursing staff. “We have access to ready-made education, and we created our own competencies about resistance.” The facility just completed materials to hand out to families to help them understand why antibiotics may not be appropriate. Pearson concluded, “If I have a specific concern, I will bring it to the prescriber and talk about what we need to do, and we’re always looking for opportunities to improve education and policies.”</p><p>The CDC recommends several core elements of antibiotic stewardship that can help curtail inappropriate antibiotic use: </p><ul><li>Leadership support. </li><li>Accountability. </li><li>Drug expertise. </li><li>Actions to improve use.</li><li>Tracking (monitoring antibiotic prescribing, use, and resistance).</li><li>Reporting information to staff on improving antibiotic use and resistance. </li><li>Education. </li></ul><p>“This is a great guide for what we need to include in our stewardship efforts,” said Eber. </p><p>However, Eber noted that it is also important to have a strategy for changing provider behaviors. “We found that one way to do is to monitor how many urinalyses are ordered in a month and if these met the designated criteria. We report this back to prescribers so they can see if their tests were ordered appropriately and how their numbers compare with those of others,” she noted. This is motivating because practitioners want to provide the best care they can and be comparable to their peers.</p><p>Stephen Creasy, director of clinical services for PharMerica, stressed that antibiotic stewardship must continue to be a priority. He noted, “If you look at new drug approvals, there are not a lot of new antibiotics coming out. That is concerning as we see more instances of resistance.” He also referred to a recent study showing that approximately half of Streptococcus cases in adults are resistant to at least one antibiotic. <br></p><h3>Triple Threat</h3><p>One infection-related challenge providers are seeing is what some are calling a “tridemic”—COVID-19, the flu, and respiratory syncytial virus (RSV). While COVID-19 and flu are familiar to this setting, RSV has required a new focus. Traditionally, RSV has been thought of as more of a pediatric illness. However, each year between 60,000 and 120,000 older adults are hospitalized with this illness, and up to 10,000 die.</p><p><img src="/Issues/2023/Spring/PublishingImages/Creasy.jpg" alt="Stephen Creasy" class="ms-rtePosition-1" style="margin:5px;width:180px;height:225px;" />RSV usually causes mild symptoms like those caused by the common cold, and most people recover within a week or two. However, it can have serious consequences if not managed promptly; and like many illnesses, it can be more serious in older adults, especially those with underlying respiratory conditions such as chronic obstructive pulmonary disease or asthma. </p><p>Many respiratory illnesses have similar symptoms, such as fever, cough, congestion, and sneezing or other nasopharyngeal issues. However, wheezing, which sounds like a whistle or rattle when a person breathes, is a unique symptom of RSV and can distinguish this condition from other respiratory illnesses. </p><p>While these and other infections continue to challenge providers and their teams, they are better equipped than ever to prevent and manage them. Eber said, “We now know what to do about isolation, personal protective equipment (PPE), and how respiratory viruses spread.” However, while there are vaccinations for COVID and the flu, and one is in the development for RSV, “people are tired of talking about vaccines. We still need to put significant work into our messaging that includes the latest knowledge. And we need to figure out how to get staff and resident buy-in to move forward,” Eber said.</p><h3>Lessons Learned<br></h3><p>One of the few positives that came out of the pandemic is that facilities now have more tools, resources, and knowledge to prevent and manage infections. Pearson said, “Generally speaking, our staff is more aware of the impact of respiratory illnesses on patients, and they are more conscientious about reporting illness and using preventive measures such as PPE. We use N95 masks more liberally, and our teams know when and how to use them.”</p><p>Pearson and her team have prioritized ways to prevent the spread of infections. “We’re using fogging machines—hand-held devices to disinfect high-touch surfaces such as door handles. We also have designated times during shifts when everyone stops what they are doing and wipes down surfaces,” she said. There also is more of a focus in many facilities on air filtration. </p><p>Another effective infection-prevention process used at South Davis Community Hospital, Pearson said, involves screening as part of the employee sign-in system, where employees scan a code when they clock in and answer questions about their infection exposure. The facility also has a task force of six clinicians who rotate being on call. They text employees to follow up on testing recommendations and results. “This has been very effective in catching people who are sick with COVID before they get to the floor and those who came to work sick even though they tested negative. We started this early in the summer of 2020 and continue to use it,” Pearson said.</p><p>Buslovich said, “The number one lesson we learned from the pandemic is the need for more early screening and detection, as well as more frequent vital-sign monitoring for those at risk for infections. This is the best strategy to avoid hospitalizations, complications, and long courses of treatment.”<br></p><p><br></p><p><span class="ms-rteForeColor-2"><strong>Learn More</strong></span> <br></p><p><img src="/Issues/2023/Spring/PublishingImages/AHCANCALed_600x337_IPCO.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:210px;height:119px;" />Now more than ever, an infection prevention control officer is critical to have in your organization. AHCA/NCAL offers an updated Infection Preventionist Specialized Training for health care professionals who want to serve as infection preventionists as established in the Centers for Medicare & Medicaid Services Reform of Requirements of Participation for Long Term Care Facilities.</p><p>For more information, visit <a href="https://educate.ahcancal.org/p/ipcov2" target="_blank">https://educate.ahcancal.org/p/ipcov2</a>.<br><br></p>	Reducing antibiotic prescriptions, applying infection-prevention processes, and increasing education are key weapons in the fight against antibiotic resistance.	2023-03-01T05:00:00Z	<img alt="" src="/Issues/2023/Spring/PublishingImages/Infection.jpg" style="BORDER:0px solid;" />	Infection Control	Cover Feature	Joanne Kaldy	50	1
The Three Ps: Offering Benefits that Attract, Engage Staff	https://www.providermagazine.com/Issues/2023/Spring/Pages/The-Three-Ps.aspx	The Three Ps: Offering Benefits that Attract, Engage Staff	<p>Attracting and retaining good staff is about more than wages and traditional benefits. Increasingly, the key to engaged teams involves three Ps—partnerships, personalized perks, and personal or professional development. “Employees want to know that they are appreciated as individuals, and they want organizations that are willing to invest in them and help them grow and thrive,” said Jim Janicki, APR, chief administrative officer of Nebraska-based Hillcrest Health Services. </p><h3>Partnerships<br></h3><p>These can be local or national, but they enable team members to get services, products, discounts, and more. “We are able to offer discounts through certain businesses we have relationships with, such as shipping companies, hotels, and mobile phone services,” said Janicki. A key to the success of such partnerships, he suggested, is letting team members know they are available and what they entail. “They won’t use these benefits if they don’t know about them,” he explained. </p><p><img src="/Issues/2023/Spring/PublishingImages/JimJanicki.jpg" alt="Jim Janicki" class="ms-rtePosition-2" style="margin:5px;width:159px;height:200px;" />Genesis HealthCare has a unique partner of sorts in its Michael R. Walker Foundation, a nonprofit charitable organization funded by contributions made by employees for employees whose financial situations have been severely impacted by medical emergencies, natural disasters, fire, domestic abuse, and funeral expenses. Genesis also has community partnerships with over 450 schools for student clinical placements and career advancement. Brandon D. Poole, Genesis chief human resource officer, said, “This provides a meaningful way for people to start their careers or further their education and career pathways with one of our affiliated locations.”</p><p>Rivka Heisler, regional director of employee experience at Autumn Lake Healthcare in Baltimore, Md., said, “We are so excited to have partnered with the Baltimore Ravens this season, and we’ve seen a huge uptick in our staff morale. We do things like raffle sweepstakes to our suite at Ravens Stadium, based on attendance. At the same time, Ravens players, cheerleaders, and team mascots come to special events, and our scrubs are even Ravens branded. This is a wonderful partnership that really makes staff feel special and connected to their community.”</p><h3>Personalized Perks</h3><p>“We find that people respond best to things that are personalized and recognize that we know and appreciate their efforts,” said Janicki. For instance, they use an online gifting platform that enables employees to redeem gift vouchers for prizes they want—things like snack boxes, air purifiers, coffee makers, electronics, and subscriptions. The amount is based on achieving awards for creating amazing customer experiences. </p><p>Another popular perk at several Hillcrest locations is the “Rock the Box” program. This involves workers getting to choose a prize from a box when a supervisor wants to recognize someone for doing something great. These are small gifts, said Janicki, but they are given in the moment, and the person is recognized in front of others, which makes them feel recognized and validated for their hard work. </p><p>Large events and celebrations may seem impersonal, but they can help people feel appreciated and give them a chance to share fun and create happy memories with colleagues away from the stress of the office. For instance, Hillcrest has an annual employee appreciation event—a huge celebration with games, food, an Elvis impersonator, 20-second grabs in a cash cube, and more. At the end of the night, there is a raffle with over 80 prizes such as electronics or tech devices.</p><p>Autumn Lake recently held a family fun day at the Maryland State Fair. Employees and their families had exclusive access to the fairgrounds. All the rides were open, and there were food stands, live music, and street performers. There also was a space where employees with side hustles could set up booths to sell their products, such as jewelry. In the past, Autumn Lake rented out a Six Flags amusement park for staff and had a holiday party at Ravens Stadium in Baltimore. </p><p>Having special events that celebrate teams brings everyone together and helps eliminate the “us versus them” feelings staff may have about management. Swati Gaur, MD, MBA, CMD, AGSF, a Georgia-based medical director, said, “It sends the message that this is our team and every member is important. We are all in this together.”</p><p>While large events can be fun and team building, Heisler stressed the value of smaller events to recognize the uniqueness of individual buildings. She said, “Every building is different, so we create lots of varied initiatives. We have fun competitions, team-building activities, and, of course, snacks. We celebrate and show gratitude at every chance possible. We also have inter-facility competitions like pumpkin-carving competitions at Halloween, gingerbread-decorating contests for the holidays, and so much more.” She added, “We gear our programs specifically to our employees. We want them to know and feel we truly support them.” </p><p>Recognizing workers who are willing to sacrifice holidays to work, Hillcrest offers a $50 bonus for individuals who cover a shift over Christmas. Sherry Perry, a long-term certified nursing assistant and chair of the National Association of Health Care Assistants, stressed the value of a thoughtful gift for the holidays, as well. “A turkey or ham, gift cards, or bonuses based on profits or longevity are very much appreciated by everyone, especially those who have to work and won’t be able to be with their loved ones for Thanksgiving or Christmas,” she said. </p><p>Perry also stressed the value of acknowledging the varying needs of workers at different stages of life. She said, “Right now we have several generations in the workplace. We need different benefit packages based on where people are in life.” </p><p>For instance, younger workers might want things like cash bonuses, low-interest loans to buy a car, and tuition reimbursement. When they start to have families, they may want child care support and parental leave. Older workers may want more time off and retirement benefits. <br></p><p style="text-align:center;"><img src="/Issues/2023/Spring/PublishingImages/Strategies%20for%20Staffing.png" alt="Strategies for Staffing" style="margin:5px;width:511px;height:333px;" /><br></p><h3>Personal and Professional Development<br></h3><p>“We have a professional development program that includes tuition assistance and paying for various certifications or licensures. We pay for these things to help our people grow,” said Janicki. His organization also offers a program that pays $1 toward student loan debt for every hour a nurse works. </p><p>Janicki said, “I want to start a life coach type of program for our employees. This would provide them with things like financial counseling, goal-setting, career guidance, and problem-solving. One of our strategic missions is to be an employer of choice. This program would reach out to our teams and let them know they’re part of our family.”</p><p>When Tana Gall, president of Merrill Gardens, finds people in her organization who take initiative, show great passion for long term care, and go above and beyond, she brings them in for “dream job conversations,” where they talk one-on-one about what they like about their job, where their interests lie, and how they think they can contribute to the organization and the community around them. “We talk about the possibility of crafting a job around their interests and abilities. If we can’t do that, I look for ways we can involve them in projects or activities that bring them joy and satisfaction,” Gall said. “We need to recognize people who go above and beyond and reward them with things that are meaningful for them. This keeps them motivated and on a career path that will bring them satisfaction and benefit the organization.”</p><h3>Presentation Is Important<br></h3><p>It is important to see various benefits or perks from the employees’ viewpoint. For instance, Janicki said, “Things like food pantries may be seen by staff as a handout instead of a benefit.” </p><p>Perry agreed, noting, “Workers don’t want food pantries. They want to go to the store and buy their food. As for oil changes or other transportation benefits, the message may be seen as you just care about them coming to work.” A better approach may be to offer gift cards to a local grocery store. Instead of free oil changes for front-line or low-income workers, have a day when everyone in the organization can partake of this benefit. </p><p>Janicki said, “You need to be careful about the perks or benefits you offer. Sometimes, things seem like a good idea in theory but aren’t practical in reality.” For instance, Hillcrest tried to have a shuttle service from more populous areas but couldn’t make it work logistically. At the same time, they gave out gas cards but realized they had to declare the value on taxes, and that created issues.</p><p>Gaur noted, “When we just do things like pizza parties, people can feel shortchanged. They don’t want more pizza. They want to know they make a difference and are appreciated.” </p><p>For instance, Gaur said that when a local business brought in lunch for staff as gesture of appreciation, that “meant the world to them.” She noted, “But it wasn’t really about the food. It was about being visible and acknowledged for their hard work. That means more than anything else.” Elsewhere, she noted, “we have a local business who sells special cupcakes. We order these for certain events, and staff really love them. But again, it’s not as much about the food as the thought behind it.”</p><p>When employers prioritize the three Ps, talk to staff about what really matters to them, and find creative ways to support and recognize their teams, they can improve retention and engagement and have communities where people want to work. <br></p>	Companies must use partnerships, personalization, and professional development to craft benefits that employees want.	2023-03-01T05:00:00Z	<img alt="" src="/Issues/2023/Spring/PublishingImages/3Ps.jpg" style="BORDER:0px solid;" />	Workforce	Cover Feature	Joanne Kaldy	50	1

Apprenticeships Move into the Mainstream	https://www.providermagazine.com/Issues/2023/Spring/Pages/Apprenticeships-Move-into-the-Mainstream.aspx	Apprenticeships Move into the Mainstream	<p><img src="/Issues/2023/Spring/PublishingImages/AssistedLiving-2.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:219px;" />Apprenticeships aren’t a new concept, but they’ve recently become a part of long term care—in particular, assisted living—strategies to solve workforce shortages. Last year, American Health Care Association/National Center for Assisted Living (AHCA/NCAL) partnered with Equus Workforce Solutions to offer long term care apprenticeship programs, with the goal of getting more people engaged in skilled nursing and assisted living. As the program expands and more apprenticeships get up and running, it’s increasingly clear that apprenticeship programs are here to stay. </p><h3>Securing Structure, Finding Funding<br></h3><p>One benefit of working with a program like the Equus–AHCA/NCAL partnership is that organizations don’t have to start from scratch and chart unfamiliar territory. “It helps bring more structure to what we are doing. It fits our existing training program into a more structured apprenticeship,” said Mark F. Klyczek, president and chief executive officer of Virginia Health Services. This leads, he suggested, to opportunities for funding to help offset the costs of internal training. He said, “When you have an internal apprenticeship program, it may qualify you or the apprentices for additional funding or programs. For instance, for a military veteran, it might mean a housing stipend or other funding is reactivated through the GI Bill.” </p><p>He added, “It can grow quickly into more funding than you may think.”</p><p>R. Michelle Day, national workforce solutions director at Equus, said, “We start with sharing the benefits of apprenticeships, that is, the ‘whys.’ We also talk about support. We work hard to gather information to package the program according to the organization’s needs.” She added, “We want to simplify the process as much as we can. We realize companies are already overwhelmed. We became a national program sponsor so we could take some of that heavy lifting off employers.”</p><p>Of course, Day said, there is a learning curve involved, but Equus is trying to make that easier, too. “We provide technical assistance in bite-size pieces. We don’t want to overwhelm people with terminology, resources, etc. We work to meet employers where they are and provide information and support accordingly,” she said. </p><h3>The Advantages of Third-Party Partnerships<br></h3><p>Not only can partnering with an established entity like Equus help ensure your apprenticeship program starts and stays on the right track, but it also takes some burden off team leaders and others so the program doesn’t add more work for them. At the same time, it is essential to involve your teams in the program. </p><p>Klyczek said, “We all need to understand how we want to grow the program. When different areas of the organizations have training needs we may have handled internally, we want people to think about the potential for an apprenticeship.” He also noted that even when you work with partners, “there is a lot of reporting. Each grant has a unique reporting requirement. This is a necessary evil, and there is some time involved in this.”</p><p>Deborah Rowe, vice president of nursing workforce development at Genesis, noted, “There are specific requirements and reporting associated with each apprenticeship, and they may vary per state. This includes hours, eligibility requirements, clinical competencies, wage reports, mentor reports, etc. Keeping abreast of each specific requirement for the integrity of the apprenticeship is important. You need dedicated and committed staff to launch the apprenticeship program.” </p><p>However, she stressed, “while there is a dedicated effort for the success of the apprenticeship program, the success lies with the individuals themselves to participate and engage in the program.”<br></p><h3>The Marketing Advantage</h3><p>If you can offer job candidates paid training and a job, this is a definite marketing advantage, particularly in a tight hiring market. This means promoting the value of the program to prospects. Klyczek said, “Apprentices enjoy the program quite a bit. They get increases in wages throughout the process. We make it clear where those increases will come, and we even have nice graphics showing when pay increases happen. We also have an ‘earn as you learn’ component so they get paid when they’re in class.” </p><p>In addition, apprentices can access up to $600 or $700 to help pay for things like rent, car repairs, laptops or phones, and new glasses. This can be significant, said Klyczek, for entry-level workers “who don’t have a lot of extra cash to meet those needs. It also helps provide a cushion for some unexpected life issues.”<br></p><h3>The Road to Retention</h3><p>While the apprenticeship program can help attract new hires, said Klyczek, it also resonates with existing staff. “They see it as a pipeline, and they appreciate us bringing more people in and reducing the use of agency staff,” said Klyczek, adding, “we’ve come to rely on apprenticeships.” In the past year, Virginia Health Services has trained about 70 people in the program and is on track to train that many or more this year. </p><p>Klyczek concluded, “I think staff will see the end result, which is more adequately and consistently trained team members on the floor. The apprentices learn our values and culture and are part of the team from the start.”</p><h3>Accolades from Employers<br></h3><p>In general, employers are enthusiastic about apprenticeships. Day offered, “One has operated their program for over a year. They report that the retention rate went from 33 percent to 84 percent. Another organization in a rural county had pretty much exhausted applicants. When they offered apprenticeship opportunities, they received 14 applications in one day.”</p><p>Genesis launched an apprenticeship program in 2020, and Rowe said it was “a natural progression from our nurse aide training programs.” She said, “The benefits of the apprenticeship include working with community partners that offer recruitment, prescreening for nurse aide training and licensed practical nurse apprentice candidates, success coaches, grant funding for training, mentor education, and maintenance of apprenticeship reporting. This allowed further engagement with educational institutions on clinical affiliations, training and education, and promotion of career pathways. We worked collaboratively to recruit, train, and support a pipeline of certified and licensed care providers for patients and residents.”</p><h3>Positive But Not a Panacea<br></h3><p>While apprenticeships are showing great promise, Day and Klyczek both stress that they are not meant to be a panacea or a sole strategy for recruitment. Day said, “Before you do this, it is important to realize that the apprenticeship is just part of your efforts to address workforce shortages.” </p><p>She also observed that several ingredients are necessary for apprenticeships to be successful. For one, she said, “you definitely need a champion, someone who understands the ‘whys.’ Then you need someone to be the point of contact, and you need to be able to identify and support qualified mentors to train apprentices.” Day added, “You also need buy-in from a fiscal perspective to offer progressive pay as people complete instruction and obtain competencies. It also is important to have clear career lattices or pathways for employees. They need to know what they are expected to do to move to the next level.” <br></p><h3>Expansion Is on the Menu</h3><p>“We are thinking that any training should be an apprenticeship program moving forward. And we are looking to see if there is an avenue for certification to be part of such programs,” said Klyczek. “It sends a good message to new hires. They see that you’re committed to internal movement, growth, and advancement.” His organization is preparing to roll out a process for environmental services and dietary staff. </p><p>Day agreed, stating, “I’m hearing good things, and there is much interest in learning more about how to use apprenticeships. In the health care industry in particular, many occupations with such programs are seeing the benefits, including high retention rates, and that’s exciting.” </p><h3>Way of the Future<br></h3><p>Even as the workforce crisis eases, apprenticeships are here to stay. “Those who don’t have apprenticeships will be in the minority soon, and they won’t be able to compete with those who do have such programs. The more people use apprenticeships, the more they will want them, and the more job seekers will come to expect them,” said Klyczek. </p><p><img src="/Issues/2023/Spring/PublishingImages/JoanneKaldy.jpg" alt="Joanne Kaldy" class="ms-rtePosition-2" style="margin:5px;width:134px;height:169px;" />Day offered, “I see apprenticeships being a topic of conversation for many years to come. We are seeing unprecedented funding to help solve staffing crises in many industries, and apprenticeships are part of this.” She added, “You will hear the term ‘modern apprenticeships.’ Many see this as a viable solution to help upskill workers, and many career seekers see it as another path to earn a credential.” <br></p><p><em>Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.</em><br></p><p><br></p>	Apprenticeships help ease workforce shortages and help engage more people in careers in skilled nursing and assisted living.	2023-03-01T05:00:00Z	<img alt="" src="/Issues/2023/Spring/PublishingImages/AssistedLiving.jpg" style="BORDER:0px solid;" />	Assisted Living	Spotlight on Assisted Living
Nursing Home Quality Measure Performance Recovery	https://www.providermagazine.com/Issues/2023/Spring/Pages/By-The-Numbers.aspx	Nursing Home Quality Measure Performance Recovery	<p>During the height fo the pandemic in 2020, nursing homes implemented processes to prevent the spread of COVID-19 such as no communal dining, restricting visitors, and limiting in-person social interactions.</p><p>Click to view <a href="/Issues/2023/Spring/Documents/Spring23_BTN.pdf" target="_blank">Top 5 Most Improved Quality Measures</a>.<br><br></p>	During the height fo the pandemic in 2020, nursing homes implemented processes to prevent the spread of COVID-19 such as no communal dining, restricting visitors, and limiting in-person social interactions.	2023-03-01T05:00:00Z	<img alt="" src="/Issues/2023/Spring/PublishingImages/Spr_BTN.jpg" style="BORDER:0px solid;" />	By the Numbers	By the Numbers
Effects of the Payment Reduction for Therapy Assistant Services	https://www.providermagazine.com/Issues/2023/Spring/Pages/Effects-of-the-Payment-Reduction-for-Therapy-Assistant-Services.aspx	Effects of the Payment Reduction for Therapy Assistant Services	<p><img src="/Issues/2023/Spring/PublishingImages/MedicareFig1.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:444px;height:374px;" />When the Bipartisan Budget Act of 2018<sup>1</sup> was enacted, eliminating annual benefit limitations for Medicare Part B (Part B) physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services, Congress also added new provisions to implement a 15 percent payment reduction for services furnished wholly or in part by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). The PTA/OTA adjustment policy became effective in 2022.<sup>2</sup> </p><p>This was implemented without any knowledge about how PTAs and OTAs are utilized in rural or medically underserved areas, as the Centers for Medicare & Medicaid Services (CMS) did not begin collecting claims data on services furnished under the supervision of the PT or OT billing the services until 2020. This article will summarize key findings about the utilization of PTA/OTA services by skilled nursing facility (SNF) providers in 2021 in an analysis<sup>3</sup> performed by Dobson DaVanzo & Associates and commissioned by a coalition of advocacy groups, including American Health Care Association/National Center for Assisted Living (AHCA/NCAL).<sup>4</sup> </p><h3>Percentage of Medicare Beneficiaries Residing in Rural and/or Medically Underserved Areas<br></h3><p>In 2021 there were nearly 67 million Medicare beneficiaries. As Figure 1 depicts, of these, 37 percent resided in either rural or medically underserved areas. Twenty states or United States territories had over 50 percent of beneficiaries in these locations. Montana and Puerto Rico have the highest portion at 93 percent, while only 13 percent of New Jersey residents live in such disadvantaged locations. </p><h3>Medicare Part B Therapy Utilization in 2021—All Geographic Areas<br></h3><p style="text-align:center;"></p><p>As depicted in Table 1, total Medicare Part B payments for all Part B PT, OT, and SLP services in 2021 for 228 million services totaled $7.8 billion. Of this, SNF providers furnished 68 million services totaling $2.5 billion, or 32.5 percent of all therapy services. Specifically of all Part B therapy services, SNFs represented 70.9 percent of SLP,20.6 percent of PT, and 61.1 percent of OT payments.</p><p></p><p style="text-align:left;"></p><p style="text-align:center;"><img src="/Issues/2023/Spring/PublishingImages/MedicareTable1.jpg" alt="" style="margin:5px;" /> </p><p style="text-align:left;">With regard to PTA and OTA services:<br></p><ul><li>SNF services furnished by PTAs represented 54.4 percent of PT payments within SNFs settings, and 46.3 percent of PTA payments across all settings. </li><li>SNF OTA services represented 52.5 percent of OT payments within SNF settings, and 85.2 percent of OTA payments across all settings. </li><li>Medicare does not recognize SLP assistants; therefore, 100 percent of such services furnished in all settings are provided by a speech-language pathologist. </li></ul><p>What is clear from these national utilization numbers is that PT and OT services are furnished, entirely or in part, by a PTA or an OTA in SNF providers at a disproportionately higher percentage than in other settings. As a result, the impacts of the 15 percent PTA/OTA Part B payment reductions have a disproportionate impact on SNF providers nationwide.<br></p><h3> Medicare Part B Therapy Assistant Utilization in 2021—Rural or Medically Underserved Areas</h3><p>Looking more closely at the differences in PTA/OTA utilization between SNF and other Part B therapy provider settings, we compared SNF and non-SNF payments in 2021 for services furnished entirely or in part by a PTA or OTA. We also paid particular attention to differences between therapy assistant use in rural or medically underserved communities and urban communities with adequate health care access. </p><p>In the left side of Figure 2, a relatively small percentage of PT Part B services in non-SNF settings are furnished by PTAs, with a nominal difference between urban and rural/underserved areas (21 percent and 21.8 percent, respectively). Non-SNF OTA use in urban areas (33.6 percent), although in the minority of all OT services furnished, was nearly double that of rural/underserved (17.1 percent).</p><p><img src="/Issues/2023/Spring/PublishingImages/MedicareFig2.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:444px;height:374px;" />In contrast, more than half of Part B PT and OT services in SNF are furnished by PTAs or OTAs, and the relative amount is higher in rural/underserved areas. Specifically, while PTA use in urban areas was 51.5 percent of SNF PT payments, this increased to 58.8 percent in rural/underserved locations. Similarly, OTA represented 50.1 percent of SNF OT payments in urban locations and increased to 56 percent of total OT payments in rural/underserved locations. </p><h3>Implications on Beneficiary Care<br></h3><p>The Medicare Part B therapy utilization data presented by Dobson DaVanzo and highlighted in this article reveal three important findings of significance that potentially impact beneficiary access to care from SNF providers. </p><p>First, a significant portion of Medicare beneficiaries (37 percent) live in rural or medically underserved areas where access to care has been historically limited. </p><p>Second, because SNF PTA services represents 46.3 percent of Part B PTA payments, and SNF OTA represents 85.2 percent of OTA payments across all settings, SNF providers bear a disproportionate negative impact of the recently imposed 15 percent PTA/OTA payment adjustment. </p><p>Third, because SNF providers in rural/underserved locations need to use PTA/OTA services approximately 6 percent more often than urban SNFs, these providers also bear a disproportionately larger negative impact of the recently imposed 15 percent PTA/OTA payment adjustment than non-SNF providers. <br></p><h3>Outlook</h3><img src="/PublishingImages/Headshots/DanCiolek.jpg" alt="Daniel Ciolek" class="ms-rtePosition-2" style="margin:5px;width:180px;height:217px;" /><p>Given the current therapy workforce shortages and difficulty in recruiting therapy personnel into rural and medically underserved locations, the recently imposed payment reductions that target PTA and OTA services could significantly reduce beneficiary access to care where access is already limited. AHCA anticipates that, when the 2022 claims data is available, it will reveal the harmful impacts of the recently implemented Part B PTA/OTA payment reductions, particularly in those rural/underserved locations at most risk. In the last Congress, the Stabilizing Medicare Access to Rehabilitation and Therapy Act (H.R. 5536) was aimed at mitigating the impact of the 15 percent PTA/OTA payment reduction, including an option for providing an exemption for rural and medically underserved areas.8 Efforts by AHCA/NCAL and our therapy coalition partners are already underway to reintroduce similar legislation in the upcoming year. <br></p><p><em>Daniel Ciolek is associate vice president, therapy advocacy, for the American Health Care Association.</em><br></p><p><br></p><p></p><p><span class="ms-rteFontSize-1"><strong>References</strong></span></p><p><span class="ms-rteFontSize-1">1. Pub. L. 115–123, February 9, 2018. </span><span style="font-size:9pt;"><a href="https://www.congress.gov/115/plaws/publ123/PLAW-115publ123.pdf" target="_blank">https://www.congress.gov/115/plaws/publ123/PLAW-115publ123.pdf</a></span></p><p><span class="ms-rteFontSize-1">2. CMS Therapy Services webpage at <a href="https://www.cms.gov/medicare/billing/therapyservices" target="_blank">https://www.cms.gov/medicare/billing/therapyservices</a>.</span></p><p><span class="ms-rteFontSize-1">3. Final Report: Impact on Medicare Spending of the Stabilizing Medicare Access to Rehabilitation and Therapy Act – Appendix – Detailed Data. August 18, 2022. Dobson DaVanzo & Associates, LLC.</span></p><p><span class="ms-rteFontSize-1">4. Coalition members: American Physical Therapy Association (APTA), American Health Care Association (AHCA), American Occupational Therapy Association (AOTA), Alliance for Physical Therapy Quality and Innovation (APTQI), National Association of Rehabilitation Providers and Agencies (NARA), National Association for the Support of Long Term Care (NASL), and Private Practice Section of the American Physical Therapy Association (PPS)</span></p><p><span class="ms-rteFontSize-1">5. Derived from Exhibit 1 in Final Report: Impact on Medicare Spending of the Stabilizing Medicare Access to Rehabilitation Act – Appendix – Detailed Data. August 18, 2022. Dobson DaVanzo & Associates, LLC.</span></p><p><span class="ms-rteFontSize-1">6. Derived from Exhibit A-4 in Final Report: Impact on Medicare Spending of the Stabilizing Medicare Access to Rehabilitation Act – Appendix – Detailed Data. August 18, 2022. Dobson DaVanzo & Associates, LLC.</span></p><p><span class="ms-rteFontSize-1">7. Derived from Exhibit A-7 in Final Report: Impact on Medicare Spending of the Stabilizing Medicare Access to Rehabilitation Act – Appendix – Detailed Data. August 18, 2022. Dobson DaVanzo & Associates, LLC.</span></p><p><span class="ms-rteFontSize-1">8. Stabilizing Medicare Access to Rehabilitation and Therapy Act (H.R. 5536) <a href="https://www.congress.gov/bill/117th-congress/house-bill/5536/all-info" target="_blank">https://www.congress.gov/bill/117th-congress/house-bill/5536/all-info</a></span><br></p><p><br></p>	Does the Medicare Part B Therapy Assistant Adjustment Policy increase inequities for beneficiaries in rural and medically underserved areas?	2023-03-01T05:00:00Z	<img alt="" src="/Articles/PublishingImages/740%20x%20740/healthcare_finance.jpg" style="BORDER:0px solid;" />	Medicare	Medicare
Leadership Must Be Engaged in MDS Changes to Succeed	https://www.providermagazine.com/Issues/2023/Spring/Pages/Leadership-Must-Be-Engaged-in-MDS-Changes-to-Succeed.aspx	Leadership Must Be Engaged in MDS Changes to Succeed	<p></p><p><img src="/Issues/2023/Spring/PublishingImages/caregiving2.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:274px;height:185px;" />When major changes to the minimum data set (MDS) take effect October 1, 2023, they will affect many roles in addition to nurse assessment coordinators (NACs). The expected changes will require clinical leadership to update policies and review clinical and documentation practices to ensure the MDS accurately reflects the services provided. Also, the interdisciplinary team (IDT) must consider these changes when developing care plans and providing patient care. Clinical leadership, the NAC, and IDT members should apply the following tips to start preparing for coming MDS changes. <br></p><h3>1. Provide training on ethnicity, race, and culturally competent care planning.</h3><p>Several data elements that focus on social determinants of health are now in the MDS, including expanded options for ethnicity and race on the upcoming MDS 3.0 Nursing Home Comprehensive Item Set, version 1.18.11. While this may initially seem like a minor change to the MDS, the IDT must consider how these items affect health, functioning, quality of life, and risks and consider these factors when developing the care plan. Appendix PP in the State Operations Manual provides the following guidance with F-tag 656: “The services provided or arranged by the facility, as outlined by the comprehensive care plan, must be culturally competent and trauma-informed.” <br></p><p>Race and ethnicity will also become Standardized Patient Assessment Data Elements (SPADEs) for the Skilled Nursing Facility Quality Reporting Program (SNF QRP) starting October 1, 2023. The SNF QRP requires SNFs to report all MDS items used to calculate the SNF QRP measures and SPADEs. Required MDS items that are coded with a dash, indicating the item was not assessed, count against compliance with the SNF QRP annual payment update (APU) threshold, which mandates that at least 80 percent of MDS assessments report 100 percent of the required data elements. Noncompliance results in a 2 percent reduction to the Medicare APU for the facility for that program year.</p><h3>2. Develop the process for documenting the communication of the reconciled medication list. <br></h3><p>Two SNF QRP process measures will also begin collecting data on discharge assessments starting October 1, 2023—the Transfer of Health (TOH) Information to the Provider and the TOH Information to the Patient. These measures rely on documentation from the discharging nurse to support that a current reconciled medication list has been provided to either the patient or caregiver or the subsequent provider as appropriate. Additionally, the documentation must demonstrate how this information was provided, whether verbally, on paper, through an electronic health record or health information exchange, or by other methods. If this process lacks supporting documentation in the medical record, the MDS will be dashed, showing there is no information or the item was not assessed. Coding these items with a dash will also count against compliance with the SNF QRP APU threshold. <br></p><h3>3. Provide training to the IDT to identify and address social isolation.</h3><p>A new MDS item asks the resident, “How often do you feel lonely or isolated from those around you?” It is coded with a frequency from never to always and includes options to code if the resident declines to respond or is unable to respond. However, when the IDT identifies symptoms of social isolation, it is responsible for identifying the root cause and potential risks, as well as implementing interventions to mitigate these risks. This MDS item is included in the SPADEs, but a dash is not an allowable response option for this item.</p><p>Appendix PP emphasizes the significant impact that social isolation may have and addresses it in several sections of guidance. F604, Respect and Dignity, instructs surveyors to observe for social isolation, withdrawal, and loss of self-esteem, among other indicators. Appendix PP also addresses social isolation as a potential consequence of a fall, a complication related to fecal incontinence or having a feeding tube, an adverse effect of medications, and as a manifestation related to trauma or post-traumatic stress disorder. <br></p><h3>4. Train nurses to query physicians for appropriate indication for medications. </h3><p>Several changes will likely affect Section N, Medications, with the MDS v1.18.11 this fall. Among them is the addition of anti-platelet and hypoglycemic medications to the list of high-risk drug classes coded on the MDS when received in the seven-day look-back period. However, starting October 2023, the MDS will also identify whether there is an indication of use for all medications the resident received within that drug class. All the high-risk drug classes and indication-of-use items are also considered SPADEs and, if dashed, would count against compliance with the SNF QRP APU threshold. Additionally, if the MDS indicates a medication does not have an indication for use, surveyors may use this information to identify unnecessary drugs. Appendix PP provides guidance with F-tag 757 that defines unnecessary drugs and includes “medications without adequate indication for use” as part of this definition under §483.45(d). </p><p>Even before implementation of the new requirements, clinical leadership can strengthen processes around medications and train nurses to query physicians for an appropriate indication of use when one is not provided for a medication. However, it is important for nurses to recognize that it is outside their scope of practice to assign a diagnosis. For example, the physician orders an antibiotic after receiving the results of the a urine analysis. The nurse cannot create a new diagnosis of a urinary tract infection without having physician documentation that supports this new diagnosis. Nurses must be trained on how to follow up with the physician to gather the appropriate documentation to support the indication of use of this new medication.</p><p><span style="color:#130c0b;font-family:"pt serif", serif;font-size:1.71429rem;font-weight:700;">5. Review all MDS changes and </span><span style="color:#130c0b;font-family:"pt serif", serif;font-size:1.71429rem;font-weight:700;">develop a plan.</span><br></p><p>Clinical leadership, the NAC, and the IDT must begin preparing for 59.5 new items being added to the MDS 3.0 Item Sets, v1.18.11. However, the updated Resident Assessment Instrument User’s Manual, which will provide coding instructions for these new items, has not yet been released. Until then, facility staff will need to use the draft MDS item set to identify changes, recognize facility policies they may impact, and review procedures that may not fulfill the documentation requirements necessary to support MDS coding. </p><img src="/PublishingImages/Headshots/JessieMcGill.jpg" alt="Jessie McGill, RN" class="ms-rtePosition-2" style="margin:5px;width:165px;height:165px;" /><p>With this information, develop a plan for training staff and updating policies and procedures. Facility staff can use the Centers for Medicare & Medicaid Services’ document Overview of Data Elements Used for Reporting Assessment-Based Quality Measures and Standardized Patient Assessment Data Elements Affecting FY 2025 Annual Payment Update (APU) Determination to identify the specific MDS items. The document can be found at <a href="https://www.cms.gov/files/document/fy-2025-snf-qrp-apu-table-reporting-assessment-based-measures-and-standardized-patient-assessment.pdf" target="_blank">https://www.cms.gov/files/document/fy-2025-snf-qrp-apu-table-reporting-assessment-based-measures-and-standardized-patient-assessment.pdf</a>. The FY 2025 program year uses calendar year 2023 data and will start including the new SPADEs and measure data starting October 1, 2023.<br></p><p><em>Jessie McGill, RN, RAC-MT, RAC-MTA, is curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN).</em><br></p>	Major changes to the MDS in 2023 will affect several roles and leadership will need to prepare for the impact.	2023-03-01T05:00:00Z	<img alt="" src="/Issues/2023/Spring/PublishingImages/Caregiving.jpg" style="BORDER:0px solid;" />	Caregiving	Focus on Caregiving
National Quality Award Program Lays the Groundwork for QAPI	https://www.providermagazine.com/Issues/2023/Spring/Pages/National-Quality-Award-Program-Lays-the-Groundwork-for-QAPI.aspx	National Quality Award Program Lays the Groundwork for QAPI	<p><img src="/Issues/2023/Spring/PublishingImages/Quality.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />The AHCA/NCAL National Quality Award program is a rigorous three-level process that evaluates a long term care organization’s capabilities against the Baldrige Excellence Framework, a systems, data-driven approach to performance excellence. <br></p><p>Each progressive award level—Bronze, Silver, and Gold—requires a more detailed demonstration of superior performance. As teams work toward achieving each level, providers learn and develop over time successful habits that make it easier to comply with federal Quality Assurance and Performance Improvement (QAPI) requirements.</p><p>The program lays the groundwork for the successful implementation of QAPI in five key ways.<br></p><h3>1. A focus on resident excellence. </h3><p>The Quality Award program’s Baldrige framework emphasizes the importance of going beyond customer satisfaction to engage residents and exceed their expectations. This emphasis on the resident allows for the provision of person-centered care. </p><h3>2. A focus on valuing people. </h3><p>The program’s framework recognizes that an organization’s success relies on an engaged workforce, and that engagement is dependent on meaningful work, clear organizational direction, and the ability to learn and grow. This enables providers to connect staff engagement, competencies, and training directly to the work of the organization to provide person-centered care. <br></p><h3>3. A focus on visionary leadership.</h3><p>The Baldrige framework requires senior leaders of any organization to lead by example, set high expectations for their workforce, and create a customer-focused organization. <br></p><h3>4. A focus on fact-based management.</h3><p>The Baldrige framework requires organizations to make fact-based decisions through systematic analysis of performance measures to support and inform the operations of the organization. <br></p><h3>5. A focus on continuous quality improvement.</h3><p>Fundamental to the Baldrige criteria is the concept of continuous quality improvement of an organization’s approaches to work, which leads to improvements and innovations that move organizations toward providing the highest level of care to their residents/patients. <br></p><h3>Gold Examples</h3><p>The linkages between QAPI and the Baldrige-based National Quality Award are best explained by two award-winning providers: </p><ul><li>South Davis Specialty Care in Bountiful, Utah, recipients of the 2009 and 2019 Bronze awards, 2012 and 2020 Silver awards, and 2014 and 2022 Gold awards</li><li>Burgess Square Healthcare and Rehab Centre, in Westmont, Ill., recipients of the 2017 Bronze, 2018 Silver, and 2020 Gold awards<br></li></ul><p>In “Business Success Through Continuous Quality Improvement,” Lisa Pearson, MSN, RN, CIC, director of infection prevention and quality improvement at South Davis Specialty Care, and Kristin Thrun, administrator and director of operations at Burgess Square Healthcare and Rehab Centre, share their centers’ experiences, examples, tips, and best practices on leveraging Baldrige to successfully operationalize QAPI. You can find the session at <a href="https://educate.ahcancal.org/products/business-success-through-continuous-quality-improvement#tab-product_tab_meet_the_speakers" target="_blank">https://educate.ahcancal.org/products/business-success-through-continuous-quality-improvement#tab-product_tab_meet_the_speakers</a>.</p><p>To learn more about the Baldrige-based National Quality Award program, visit ahcancal.org/QualityAward. </p><p>Register for the AHCA/NCAL Quality Summit, May 22-24, 2023, in Grapevine, Texas, for sessions focused on the Quality Awards, the Baldrige criteria, QAPI, and more! Go to <a href="https://www.ahcancal.org/Education-Events/Quality-Summit/Pages/default.aspx" target="_blank">https://www.ahcancal.org/Education-Events/Quality-Summit/Pages/default.aspx</a> to register. <br></p><h3>› About QAPI<br></h3><p>The QAPI program was introduced by Centers for Medicare & Medicaid Services for nursing homes to adopt a systems, data-driven approach to improvement. The program merges two complementary approaches to quality management: Quality Assurance (QA) and Performance Improvement (PI). Together, QA and PI combine to form QAPI, a comprehensive approach to ensuring high-quality care. Learn more at <a href="https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/QAPIAtaGlance.pdf" target="_blank">https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/<br>QAPIAtaGlance.pdf</a>.<br></p>	Five ways the AHCA/NCAL Award Program aligns with the Baldrige Excellence Framework and leads to QAPI success.	2023-03-01T05:00:00Z	<img alt="" src="/Issues/2023/Spring/PublishingImages/Quality.jpg" style="BORDER:0px solid;" />	Quality Awards	Quality Awards
Providers Embrace Population Health Model	https://www.providermagazine.com/Issues/2023/Spring/Pages/Providers-Embrace-Population-Health-Model.aspx	Providers Embrace Population Health Model	<p>By 2030, all Medicare beneficiaries will be in some type of accountable care relationship—Medicare Advantage (MA), accountable care organizations (ACOs), or other model. While these models are traditionally driven by health plans, hospitals, and physicians, more and more long term care providers are taking advantage of population health, which puts them in the driver’s seat as the provider and entity best suited to care and be accountable for the health and outcomes of their residents. <br></p><p><img src="/Issues/2023/Spring/PublishingImages/PHM-2.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:414px;height:277px;" />Providers are steadily moving to population health models of care that address individuals’ whole-person needs at all points along the continuum of care, including in the community setting, through participation, engagement, and targeted interventions for a defined population. There are different paths to participation in population health; one is through launching a special needs plan (SNP), a type of MA plan. </p><p>By becoming their own MA organizations, providers have greater flexibility in the Medicare program, which ensures the right care is delivered at the right time in the right setting and helps reduce potentially avoidable hospitalizations.<br></p><h3>Step 1: Consider What Risk You Are Willing to Take</h3><p>Shelby Barnes, MSN, ARNP, FNP-BC, nurse consultant at HealthCARE of Iowa, guided her organization’s implementation of an institutional special needs plan (I-SNP), which launched January 1, 2023. </p><p>HealthCARE of Iowa began by considering what risk it was willing to take on as a provider, i.e., independent owner, or whether it made more sense to have an experienced SNP partner that would have more overall involvement.</p><p>“We didn’t have the numbers to do it ourselves, so we worked with a partner organization and determined they would have more of a role in assuming the risk,” Barnes said.</p><p>Meanwhile, she asked as many questions of as many people in the field as she could. Among those questions:</p><ul><li>What amount of risk will we shoulder?</li><li>What amount of responsibility do we take on as an organization?</li><li>What level of responsibility do the individual facilities have?</li><li>What support do you provide?</li><li>How long does this process take to implement from conception to initiation of the plan?<br></li></ul><p>Ted LeNeave, chief executive officer of Accura HealthCare, said obtaining an education, such as attending AHCA’s Population Health Management Summit or reading whatever you can about I-SNPs, is a great way to start. “Talking to other I-SNP owners about their experiences helps one understand what to expect at all levels of the implementation and ongoing process,” he said.</p><p>Barnes said, “There is a lot that goes into starting your own I-SNP, and we realized that, for us, the best option was to work with a reputable organization. This partner organization made sense, as they are not only insurance providers, but they have their own nursing homes and understand our unique needs and challenges.” <br></p><h3>Step 2: Educate Stakeholders and Staff</h3><p>Barnes then spoke to executives, senior leaders, and directors of nursing to explain where the population health and accountable care movements were going and what options they had to help them get there.</p><p>“Our partner did a lot of the heavy lifting for us,” Barnes said. “They did all the work to gain network adequacy in the targeted counties for 2023. They are continuing to work toward expanding into more counties in Iowa to gain the network adequacy needed for 2024. They contacted all the outside hospitals, clinics, and provider groups, which lifted a huge burden off the provider owners.”</p><p>The partner organization also does the back-office operations management for the I-SNP plan, including hiring all the needed staff to operate the plan successfully in Iowa. HealthCARE of Iowa provides consulting to about 1,000 skilled nursing facility beds and 1,000 assisted living and independent living beds.<br></p><h3>Step 3: Get Buy-In</h3><p>To get buy-in into the program, it is crucial to explain it at a high level and to emphasize all the benefits for residents.</p><p>“Focus on the quality of care they will receive, not only from our staff but also from the health plan,” Barnes said. “Explain how the health plan provides added staff to help drive quality outcomes. These new staff members become a part of our team, working together toward a common goal.” </p><p>Any stakeholders in the resident care arena—including the billing department, clinical staff, primary care providers, operations, residents, and families—must be kept abreast of the program’s progress.</p><p>“It’s important to explain that not all I-SNPs are created the same, and they don’t all function the same way.” Barnes held meetings to discuss the different population health models emerging into the space and the differences between them, and how this approach isn’t a one-size-fits-all solution. </p><p>LeNeave said the proof of increased quality of care and life is the recipe for buy-in from everyone who will be impacted by transitioning to an I-SNP.</p><p>“We simply shared outcomes, both clinical and financial, to our operators and community care providers,” he said. “The messaging was simple: better quality for residents, created by better communication and services because of a broader integrated care market where all providers have to work together and are not in their own silos.”</p><h3>Step 4: Promote the Program’s Positives</h3><p>Having an increased or added burden was also a concern for both primary care providers and other staff, Barnes said.</p><p>“This was alleviated by open communication and by explaining that the I-SNP provides extra staff, on top of the care already provided, and the roles that the I-SNP can assist with as far as coordination or family notification in change in condition or order changes.</p><p>“This is an easy sell to the families because it doesn’t change or stop any of their existing care; it only adds more people focused on their loved one,” Barnes said.</p><p>Barnes said the I-SNP model of care allows her organization to provide a higher level of care in areas that previously had barriers, such as rural areas with limited access to advanced practice providers, or where care is being provided but isn’t well supported financially.</p><p>“This pulls both of those areas together. It helps break down the walls in the requirements for payment of service. It feels more like the payer and health care providers are working toward a common goal that is focused on the residents.”<br></p><h3>Note: Not All Residents Will Participate</h3><img src="/Issues/2023/Spring/PublishingImages/PaulBergeron.jpg" alt="Paul Bergeron" class="ms-rtePosition-2" style="margin:5px;width:146px;height:183px;" /><p>Not all residents would choose to enroll in the I-SNP, Barnes said, so she had to look at options through traditional Medicare to ensure all residents could participate in a value-based care arrangement. Under Medicare fee-for-service, there are ACO options for both short term and long term care residents. </p><p>“It’s important to understand that residents’ needs vary, and which accountable care options will work best for them depend on their length of stay, what care needs they have, and which payer they have,” Barnes said. </p><p>“This is why is it crucial to know who the payers are for your residents that can help determine which accountable care options would work best for your facility demographics.” <br></p><p><em>Paul Bergeron is a freelance writer based in Herndon, Va.</em><br></p>	HealthCARE of Iowa moved to a population health model using four important steps during the transition.	2023-03-01T05:00:00Z	<img alt="" src="/Issues/2023/Spring/PublishingImages/PHM.jpg" style="BORDER:0px solid;" />	Management	Population Health Management

AHCA/NCAL Launches New Campaign to Recruit Long Term Caregivers	https://www.providermagazine.com/Articles/Pages/AHCA-NCAL-Launches-New-Campaign-to-Recruit-Long-Term-Caregivers.aspx	AHCA/NCAL Launches New Campaign to Recruit Long Term Caregivers	<p>Our nation’s long term care providers are in the midst of a historic workforce crisis brought on by the pandemic—the entire sector has lost more than 300,000 jobs since the pandemic began in 2020.<sup><a href="https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/BLS%20JULY%202022%20JOBS%20REPORT.pdf" target="_blank">1</a></sup> On top of this, more and more Americans are in need of long term care services as the Baby Boomer population ages. Providers are constantly seeking dedicated caregivers to fill these important roles. That is why the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) recently launched Careers in Caring—a national campaign that provides resources to providers to assist them in their hiring efforts and improve the public perception of long term care careers. </p><p>Careers in Caring offers customizable tools for facilities and state associations to help create hiring campaigns in their communities and encourage more caregivers to enter the long term care profession. All of the Careers in Caring material, including sample job posts, social media toolkits, and talking points, incorporates research-tested messaging and proven practices to recruit individuals into these rewarding careers.<sup><a target="_blank">2</a></sup> </p><p>Working in a long term care facility provides endless opportunities, including the chance to serve one of our nation’s most vulnerable, special populations. The focus in these roles is on treating the whole person, not just a medical condition, and there is potential for career advancement. Along with these benefits and more, Careers in Caring is showing individuals how working in the long term care community truly improves the lives of millions in positive and supportive work environments. The campaign promotes core messaging that showcases the familial aspect of long term care, the sense of purpose it brings, and the stepping stone that can kick-start a successful career in health care. </p><p>Careers in Caring is designed as a one-stop shop for nursing homes, assisted living communities, and other long term care providers to spread the word that they can offer rewarding careers with tremendous opportunities to make an enormous impact on the lives of others. The number of job opportunities in our nation’s long term care profession is continually growing, and many more individuals are needed to care for millions of seniors and individuals with disabilities. Careers in Caring provides our facilities with the support they need to build a strong long term care workforce. <br></p><p><br></p><p style="text-align:center;"><a href="http://www.careersincare.org/" target="_blank"><img src="/Issues/2023/Spring/PublishingImages/CareersInCaring.jpg" alt="" style="margin:5px;width:483px;height:160px;" /></a><br></p><p><br></p><p><span class="ms-rteFontSize-1"><strong>References</strong></span></p><p><span class="ms-rteFontSize-1">1. <a href="https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/BLS%20JULY%202022%20JOBS%20REPORT.pdf">https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/BLS%20JULY%202022%20JOBS%20REPORT.pdf</a></span></p><p><span class="ms-rteFontSize-1">2. <a target="_blank">https://careersincare.org/resources/research-based-approach-to-hiring/</a></span></p>	Careers in Caring offers customizable tools for facilities and state associations to help create hiring campaigns in their communities and encourage more caregivers to enter the long term care profession.	2023-03-01T05:00:00Z	<img alt="" src="/Issues/2023/Spring/PublishingImages/CIC.jpg" style="BORDER:0px solid;" />	Workforce	Special Feature		50	1
Alleviating the Stress of Infection Prevention and Control Audits	https://www.providermagazine.com/Articles/Pages/Alleviating-the-Stress-of-Infection-Prevention-and-Control-Audits.aspx	Alleviating the Stress of Infection Prevention and Control Audits	<p><img src="/Issues/2023/Spring/PublishingImages/KellieDuvall.jpg" alt="Kellie Wilson" class="ms-rtePosition-1" style="margin:5px;width:180px;height:225px;" />Long-term and post-acute care providers know one thing to be true: audits can be stressful, time consuming, and costly. For most providers, state audits are an expected “surprise” that can impact workflow and operations for days at a time. They have to be ready at all times during their review window. Failures result in costly fees that, in most cases, could be avoided. For these reasons and more, PharMerica launched its Infection Prevention & Control Program Audit to help providers better prepare and maintain infection prevention (IP) practices within their centers.</p><p>“The Infection Prevention & Control Program Audit is designed to alleviate the time requirement, stress, and anxiety that comes with audits,” said Kellie Wilson, vice president of client support services for PharMerica. “We wanted to develop a program that would serve nurses, providers, and ultimately residents by offering a comprehensive review of potential IP shortfalls that could impact their center, cause deficiencies on an audit, and cost them a lot of money and time.”</p><p>The initial idea for the program came from a current PharMerica customer. The center was struggling to prioritize its plan to develop an IP program due to limited resources, staffing shortfalls, and a short time frame for preparation. </p><p>“We were already sending our nurse consultants to the centers for a variety of other tasks and skills,” said Wilson. “We simply asked ourselves: could our nurses help our centers better prepare for an audit?”</p><p>The answer was a resounding yes. In partnership with Joleann Beene, RN-BC, IP-BC, FACDONA, CDP, CADDCT, PharMerica’s director of nurse consulting services, a team of nurses began building the basic structure of what would come to be the Infection Prevention & Control Program Audit. Beene guided the content of the program based on her four decades of experience working as a clinical leader of multiple long-term care companies, laying out the fundamental pieces of the audit in a way that her team of nurses could replicate.</p><p><img src="/Issues/2023/Spring/PublishingImages/JBeene.jpg" alt="Joleann Beene, RN" class="ms-rtePosition-2" style="margin:5px;width:180px;height:225px;" />“We know centers everywhere are being hit hard by workforce shortages and are turning to agency teams to stay afloat,” Beene said. “This becomes an added challenge for centers, who are relying on teams with no strong affiliation to the facility and no deep knowledge of their specific infection prevention protocols. It becomes an area of vulnerability, and puts extra emphasis on full-time nurses, caregivers, and leadership to become the true stewards of an IP program—which is a lot to ask of a busy team of people.”</p><p>The core of the Infection Prevention & Control Program Audit is the mock audit during which nurse consultants move through an audit process in a way that resembles the state’s auditing procedures. Then, like in a real audit, the center is delivered a report with its deficiencies. The critical—and most valuable—difference of PharMerica’s audit is that it comes with the support of nurse consultants, who are able to review the results with the center, help them understand why they would have received a citation on a certain portion, and what they can do about it moving forward. </p><p>“Sometimes, the results are easy fixes, such as teaching staff not to carry linens in a way that they come in contact with their uniforms,” said Beene. “Other times, it’s more complex, like rebuilding some of the systems and protocols that got neglected during the pandemic. But what we know is that infection control remains the top tag cited for facilities, and our audit program can provide the feedback and clarity needed to avoid fines and begin the improvement process.”</p><p><img src="/Issues/2023/Spring/PublishingImages/Edwin.jpg" alt="Edwin Alvarez" class="ms-rtePosition-1" style="margin:5px;width:180px;height:225px;" />If the results of a center’s state audit are returned with deficiencies, they often result in fines—sometimes to the tune of thousands and thousands of dollars—as well as formal citations of the failures. The mock audit and subsequent conversations about the deficiencies can offer peace of mind and confidence to a workforce in advance of an audit.</p><p>“I wanted our center to have an edge on audit season,” said Edwin Alvarez, Country Oaks Care Center’s certified infection preventionist. “We were going through a transition of leadership, and everyone was moving offices. Things were out of place, still in boxes, and we were having difficulty prioritizing. The idea of an audit was well received. My team was comfortable with our nurse consultant, and they knew she would help guide us in the right direction.”</p><p>Alvarez noted that after the mock audit was complete, the center received a detailed breakdown of the checklist with the results. </p><p>“Infection prevention and control has become a dramatic responsibility for every facility, and the training of a team can be very difficult,” said Alvarez. “The mock audit gave us a clear range and scope of issues to focus on, and it helped us to determine our priorities moving forward.”</p><p>By offering deep expertise amid staffing challenges and focused guidance for improvement, PharMerica’s program can help centers improve their IP practices during their survey window and beyond, benefitting facility, staff, residents, and patients alike. For more information, visit <a href="http://www.pharmerica.com/IPCP" target="_blank">www.PharMerica.com/IPCP</a>. </p><p><strong class="ms-rteForeColor-6">Mock Survey Program Coming in 2023 </strong></p><p>The success of PharMerica’s Infection Prevention & Control Program Audit paved a path for a new service: mock surveys. Similar to the IP audit program, mock surveys will put centers through the survey process, helping to expose vulnerabilities, identify shortfalls, and make a plan for improvement. The mock survey program will launch in 2023. </p><p>To learn more about how PharMerica’s clinical consultants can provide expert advice to help your facility comply with evolving requirements and regulations, visit <a href="http://www.pharmerica.com/" target="_blank">www.PharMerica.com</a>.<br><br></p><p style="text-align:center;"><img src="/SiteCollectionImages/logos/PharMerica.jpg" alt="" style="margin:5px;width:220px;height:46px;" /><br></p>	We know centers everywhere are being hit hard by workforce shortages and are turning to agency teams to stay afloat.	2023-03-01T05:00:00Z	<img alt="" src="/SiteCollectionImages/logos/PharMerica%20740.jpg.jpg" style="BORDER:0px solid;" />	Infection Control	Special Feature		50	1
Minding the Knowledge Gap	https://www.providermagazine.com/Articles/Pages/Minding-the-Knowledge-Gap.aspx	Minding the Knowledge Gap	<p><img src="/Issues/2022/NovDec/PublishingImages/LTC%20DataCoop.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:200px;height:122px;" />The long term and post-acute care sector is on the precipice of a new era of research. The shift is being led, in part, by the Long Term Care Data Cooperative (“the Cooperative”)—a strategic, multi-partner alliance of providers, academia, government organizations, and the private sector with the goal of creating a comprehensive repository of patient data. </p><p>The Cooperative has been in development for several years. At first, it was primarily an ambitious idea from data enthusiasts at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and Brown University after the COVID-19 pandemic highlighted the vacuums of information and gaps in shared knowledge within the sector. Then, with the engagement of critical partners like the National Institute on Aging for funding and Exponent, Inc. for technical acumen, the Cooperative moved from idea to prototype. </p><img src="/Issues/2023/Spring/PublishingImages/DavidGifford.jpg" alt="David Gifford, MD" class="ms-rtePosition-2" style="margin:5px;width:180px;height:225px;" /><p>With nearly two years of logistics, planning, and technical development underway, the Cooperative is now poised to change the way the world collects and uses data from thousands of long term care providers across the United States. </p><p>“Before now, researchers and providers have been limited to CMS [Centers for Medicare & Medicaid Services] reports and vendor reports,” said David Gifford, MD, MPH, chief medical officer and director of the Center for Health Policy Evaluation in Long Term Care at AHCA/NCAL. “These reports have an important role, but there are so many reports that simply couldn’t be developed due to access to information. We want to enhance the pool of data in a more universal way—by gathering more information from more people to better understand what’s happening in long term care.” </p><h3>Streamline, Standardize, and Share<br></h3><p>The Cooperative is the first data aggregator of its kind in long term and post-acute care. Prior to the Cooperative’s development, each center had its own data set and reports to track a multitude of points. In many cases, data stopped at the facility level. Now, through the Cooperative, data from roughly 135 organizations representing 1,500 centers is accessible. </p><p>Any long term or post-acute care center in the country can opt to participate at no cost. By enrolling, the providers agree to have information that is already being collected by their electronic medical record (EMR) software sent to the Cooperative. Once received, the data is sorted and calibrated to match the universal language of the Cooperative’s reporting tools—a complicated task that requires the standardization of language and confirmation of data equivalence from three distinct EMR vendors: PointClickCare, MatrixCare, and American HealthTech. </p><p>The output of the Cooperative is a standardized set of data points from thousands of centers, representing hundreds of thousands of individuals, that is diverse, comprehensive, and large enough to provide meaningful data to researchers.</p><h3>A Provider-Led Initiative</h3><p>Maintaining a provider-centered approach is a core component of the Cooperative and a central tenet of its functionality. The Cooperative’s various committees are led by providers, and every proposed research project must be reviewed and approved by a research review committee. </p><p>“Providers get to decide what would be helpful to the sector and to their own operations,” Gifford said. “We are not commercializing the data or simply handing it over to anyone who asks for it. We want to make the data useful for providers to help them improve their own operations.”</p><p><img src="/Issues/2023/Spring/PublishingImages/LonnitaMyles.jpg" alt="Lonnita Myles" class="ms-rtePosition-2" style="margin:5px;width:180px;height:225px;" />Providers that are enrolled in the Cooperative are invited to attend quarterly town hall meetings to provide feedback on research proposals, receive updates about the Cooperative’s progress, and ask technical or data-related questions. These ongoing conversations are completely voluntarily and not required for participation. According to Lonnita Myles, project director of the Long Term Care Data Cooperative, providers have been rising to the occasion.</p><p>“We’ve seen so many [AHCA/NCAL] members enroll and volunteer to serve on various committees. They’re getting involved and want to know more about how this data can serve not just their own center but the long term care community at large.”</p><h3>The Future of Long Term Care Research<br></h3><p>Since the initial data collection began, researchers have been eager to access the Cooperative. According to Gifford, the focal point of approved research projects is effectiveness: What does the sector need to know to perform better? </p><p>“We’ve experienced tremendous interest from researchers on a variety of effectiveness topics,” Gifford said. He noted that a variety of research topics have been proposed, such as antibiotic stewardship, how to partner with nurses in rehabilitation centers to prevent falls, how to better understand the most effective way to prevent hypoglycemic episodes, and how to help with staffing competency training, among others. </p><p>“People are reaching out. Ideas that we never anticipated are coming forward and they’re great. We’re figuring out how to make it happen,” said Gifford.</p><p>Kaley Hayes, Pharm.D., Ph.D., is an assistant professor within Brown University’s Department of Health Services, Policy, and Practice and one of the Cooperative’s first approved researchers. Hayes is using the Cooperative’s data for observational studies that provide evidence on the safety and effectiveness of chronic medications for older adults, particularly those residing in long term care.</p><p><img src="/Issues/2023/Spring/PublishingImages/KaleyHayes.jpg" alt="Kaley Hayes, Ph.D." class="ms-rtePosition-1" style="margin:5px;width:180px;height:226px;" />“In my research specifically, the electronic health-record data the Cooperative provides contains much richer information than we typically have access to on such a large scale,” Hayes said. “For instance, my research is now able to leverage many new data elements to address drug effects, like exact timing of medication administration and information on a patient’s daily vital signs, like blood pressure, that have never been available for such a large and diverse group of people.”</p><p>Beyond leveraging the data itself, Hayes is using the Cooperative to gain access to providers who can provide critical insights and context to the data she is using.</p><p>“Not only does the LTC Data Cooperative allow for new research questions to be asked that answer long-standing knowledge gaps, it’s also incredibly helpful to connect with real-world providers to learn what parts of my research are most helpful for them and to communicate research results. The LTC Data Cooperative offers critical connections that allow for expeditious and impactful knowledge translation of my research.”</p><p>The Cooperative will remain an ongoing, growing initiative. Providers that are interested in learning more about enrolling can contact the Cooperative via email at <a href="mailto:ltcdatacooperative@ahca.org" target="_blank">ltcdatacooperative@ahca.org</a> or online at <a href="http://www.ahcancal.org/datacooperative" target="_blank">www.ahcancal.org/datacooperative</a>. </p><p><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 claire@goverano.com.</em><br></p>	The Long Term Care Data Cooperative is a strategic, multi-partner alliance of providers, academia, government organizations, and the private sector with the goal of creating a comprehensive repository of patient data.	2023-03-01T05:00:00Z	<img alt="" src="/Issues/2023/Spring/PublishingImages/Knowledge.jpg" style="BORDER:0px solid;" />	Caregiving	Special Feature	Claire Krawsczyn	50	1

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