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 |