Customizing Screening for Accuracy and Convenience<p>​​<img src="/Topics/Special-Features/PublishingImages/2021/1121/NateSchema.jpg" alt="Nate Schema" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;210px;height&#58;210px;" />​​​​​​When the COVID-19 pandemic hit in early 2020, providers needed all hands on deck, all the time. When the Centers for Medicare and Medicaid Services (CMS) issued new requirements on visitor restrictions, The Evangelical Lutheran Good Samaritan Society—the largest not-for-profit provider of senior housing and services in the United States—was ready with a customized solution that has helped streamline visitor screenings and saved staff time.&#160;</p><p>Nate Schema, vice president of operations at Good Samaritan Society, oversees 300 locations across 22 states. “When the pandemic broke out, we realized quickly that we would have to hardwire a system for visitation,” he says. “So we custom-built a platform to integrate with our system.”</p><h2>​​Reasons For Change</h2><p>A key reason for the change was Schema and his team wanted to have automated information to share with CMS and with surveyors.&#160;</p><p>“We didn’t want to be reliant on bundles and reams of paper and have to go through that when checking information at all our sites,” he says. “We are able to flag any symptoms that people might be having and then integrate that into how we communicate our results to CMS. We wanted to broadly hardwire all we were doing.”&#160;</p><p>For example, if a surveyor were to come in and ask for a record of those who have checked into the facility, Schema and his team wanted to have information ready to share on demand. “We would have all kinds of automated background that we could run reports on and demonstrate all that we were doing to keep our residents safe,” he says.</p><h2>How The Program Developed<br></h2><p>To start, Schema and his team purchased a number of iPads, and then the company’s developers wrote a new program. “We incorporated all of the screening questions that we were required to ask of visitors and employees upon coming into our locations, and then we deployed that to all 300 sites,” he says. “So whether you were going to one of our senior living communities or to one of our skilled nursing facilities, we have that iPad technology in place when people come in our doors.”</p><p>The new screening process was launched in April 2020, at all 300 locations. “We wanted to make sure we had visibility of this process of all our locations,” says Schema.&#160;​</p><h2>​​How It Works&#160;<br></h2><p>Walking into the front entrance at a Good Samaritan facility, a visitor or employee will arrive to a kiosk that includes an iPad. The visitor selects their options on the touch screen and will have their temperature taken, most often by an automated temperature screening hung on the wall next to the iPad. If any symptoms are detected, the visitor is asked to leave. Repeat visitors have information on file. “We prepopulated our employee data, and the visitor information accumulates over time,” Schema says.&#160;</p><p>If anything is flagged or if people are having symptoms,&#160;an email notification is automatically sent to that facility’s site leader. That individual then communicates the issue to family members and staff as appropriate. “While we built some communication templates out, we encourage all of our leaders to put their personal touch and style on the message, because no one knows their family members like they do,” says Schema.​<br></p><h2>​​Adoption Among Staff</h2><p>Every week Schema and his team take two actions to help keep everyone aligned. The first is a weekly 500-person teleconference with all of Good Samaritan’s department leaders, location leaders, and executive team. The second is every Thursday the team sends out a leader link message that includes updates of the screening program and what the team has observed in terms of adoption. “Right now we have conducted over 3.5 million check-ins between family members and employees,” says Schema. “Those are screenings we’ve done through this automated process. So we know it’s working, and it continues to be a vital resource for our people so they can focus on what they do best, and that’s taking care of the residents.”</p><h2>​Regular Updates</h2><p>Updates occur periodically with questions that are asked on the kiosk. Early on during the pandemic, everything had to be actively screened. “So, regardless of the technology being right there, we [employees] actively had to ask people questions and take their temperature,” Schema says.</p><p>“Now where states allow, we are able to move toward a passive process. A family member or visitor comes in, they type in their own info, and in many locations their temperature is taken by the automated system.”</p><p>The technology, which has brought multiple benefits to Good Samaritan Society, is here to stay, says Schema. “This technology has allowed us to communicate with not only our employees at a different level but also with our family members,” he says.&#160;</p><p>As a result, Schema and his staff are proud to be more visible and more transparent in real time. “What we learned early on in the pandemic is that we wanted to make sure that all of​ our family members are reassured on a daily and a weekly basis that they knew what was happening in our buildings,” he says. “Whether we have one positive case or one person with symptoms, we wanted to be able to share that.”</p><h2>​​Future Plans&#160;<br></h2><p>A recent update includes a visitor check-in reservation process. While it has not received the same kind of adoption as the screening process, Schema sees potential. “I really envision that as we continue to move forward, we will see more people schedule times to come visit,” he says. “We can’t have 50 family members in our buildings like we once could. We need to know who’s coming to our building at all times because of the nature of this virus.”</p><p>Capacity tracking, which would be unique site to site, is something that the team will continue to monitor as a future enhancement.</p><p>The best advice from Schema to fellow providers is to leverage technology and not be afraid to dive in. “Whether you are a stand-alone operation or a member of a multifacility chain, we need to continue to leverage technology in new and creative ways if we are going to truly be able to meet the demand that’s out there,” he says.</p><p>“There’s no question that we are working through some unprecedented shortfalls with staff. So saving even a couple of minutes—whether it’s screening in or scheduling visitation—those all add up. I would encourage all providers to jump in feet first on this one.”&#160;<br></p><p>​</p>2021-11-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2021/1121/CF1.jpg" style="BORDER&#58;0px solid;" />Management;QualityAmy MendozaGood Samaritan keeps everyone in the loop with weekly updates to each of its 300 skilled nursing and senior living centers.
AHCA/NCAL National Quality Awards 2021 Recipients<p>The American Health Care Association/National Center for Assisted Living is pleased to present the companies that have earned AHCA/NCAL National Quality Awards in the Gold—Excellence in Quality, Silver—Achievement in Quality, and Bronze—Commitment to Quality categories. </p><p><strong style="color&#58;#cc9900;"><span style="color&#58;#cc9900;">GOLD</span></strong><br>Gold recipients demonstrate through their approach, deployment, and consistency of results that they are achieving high levels of performance in health care, customer satisfaction, market, workforce, process, and leadership outcomes. At the Gold level, applicants must address the Health Care Criteria of the Baldrige Performance Excellence Program in its entirety.</p><p><strong class="ms-rteThemeForeColor-2-3">SILVER</strong><br>Applicants that receive the Silver award provide an extensive assessment of their systematic approaches, performance measures, and sustainable organizational and process results that are linked to the key customer requirements, success factors, and challenges the applicants previously identified in earning the Bronze award. </p><p><strong style="color&#58;#996633;"><span style="color&#58;#996633;">BRONZE</span></strong><br>Applicants that receive the Bronze award are able to describe their vision and mission, outline plans to improve processes within their communities, identify key challenges, and recognize the relationship of these factors with their ability to achieve performance improvement.</p>Click to see <a href="/Monthly-Issue/2021/October/Documents/2021_QualityAward.pdf" target="_blank">complete list</a>.<p>​</p>2021-10-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2021/1021/1021_QA.jpg" style="BORDER&#58;0px solid;" />Quality AwardsCompanies that have earned AHCA/NCAL National Quality Awards in the Gold, Silver, and Bronze.
Creating Seamless Transitions in Challenging Tımes<p>“The best transition of care is when there is no transition at all.” James Lett, MD, coined this maxim many years ago, and it’s still the mantra of post-acute and long term care providers.<br></p><p><img src="/PublishingImages/Headshots/RajeevKumar.jpg" alt="Rajeev Kumar, MD" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;145px;height&#58;186px;" />“Of course, sometimes transitions are necessary, so we need to focus on doing this as seamlessly as possible,” says Rajeev Kumar, MD, CMD, FACP, chief medical officer of Symbria in Warrenville, Ill. “Even though we are well into the third decade of meaningful EHR [electronic health record] use, we still have discordant records, and what happens in the hospital doesn’t always filter back to the nursing home, and vice versa.”</p><h2>Working Toward the Ideal Transition</h2><p>The Centers for Medicare and Medicaid Services (CMS) defines transitions of care as the movement of a patient from one setting of care to another. This setting may include hospitals, ambulatory care practices, ambulatory specialty care practices, long term care facilities, home health, and rehabilitation facilities. It involves care coordination that ensures accurate clinical information is available to support medical decisions by both patients and providers.<br></p><p>“An ideal transition is grounded in knowing who the patient is—their goals, wishes, needs, and support systems,” says Kathleen McCauley, PhD, RN, FAAN, FAHA, professor of cardiovascular nursing at the University of Pennsylvania School of Nursing. “And there have to be partnerships that happen between the person and their network and where they’re going in the continuum.”<br></p><p>McCauley refers to a study she was part of—a qualitative analysis of what patients and families feel on discharge&#58; “One thing that stood out was they often felt like they were out in the wilderness,” she says. “Good transitions anticipate what will be needed and help the patient and family prepare. You can’t do this in a 30-minute interview at the bedside. Everyone needs to work together, starting with identifying what’s important to the person and knowing what their goals are.” </p><h2>From Miscommunication to Connection</h2><p>Transitions have always been a challenge, plagued by miscommunication, lack of communication, and delays in communication. Value-based care initiatives have helped, suggests Kumar, “because no one wants to be penalized for high readmission rates or wasteful utilization.” This has motivated better communication between settings, but gaps still exist, he says, and while it may seem obvious that better communication is the answer, it’s easier said than done. <br></p><p>While EHRs have evolved over the years to improve communication, Kumar says, “Even today, we are facing challenges getting hospitals to understand what is happening in nursing homes. The hospitals and hospitalists are looking after their facilities’ interests and want to move COVID patients out sooner, but we need to protect our vulnerable residents, so we want patients tested first before they can enter our facilities.”<br></p><p>Nonetheless, some good has come out of the pandemic. Robert Choi, chief executive officer of Caraday Healthcare in Austin, Texas, says, “The pandemic revealed that hospital and skilled nursing facility partnerships are strong, and that nursing homes are seen as an essential part of the health care continuum. It also exposed opportunities for greater innovation, integration, and <a href="/Topics/Special-Features/Pages/Interoperability-Where-Do-We-Stand.aspx" target="_blank">interoperability</a>.”<br></p><p>Having a care management company or dedicated team to follow up on and track patients throughout the continuum can help promote seamless movement. “We formed our own home health and home-based care program to navigate patients from the hospital to the skilled nursing facility to home,” Choi says. “We also have strong partnerships with physician groups through the continuum of care who are essential across these transitions.” <br></p><p>Choi says his company has focused its internal analysis, research, and development of systems and processes with the goal of facilitating a safe discharge home. “We are building integrations and working with our health care partners and physicians to ensure we aren’t beholden to 17-plus different communication platforms and software subscriptions,” he says.<br></p><p>Despite these kinds of advances, data exchange continues to be a challenge. “We always strive to keep open lines of communication and provide real-time information,” Kumar says. “And we continue to highlight the challenges related to EHRs and the importance of nursing homes having access to real-time data. In particular, real-time medication reconciliation is crucial.”</p><h2>Warm Handoffs Are Hot</h2><p>Warm handoffs have always been shown to be effective, Kumar notes. Communication is important, but sometimes a lack of time gets in the way. “However, a quick text or a two-minute phone call can be a tremendous help when a patient is being transferred,” he says. “In fact, it goes a long way to help the physician and care team understand what is happening with that patient. It’s important to put some time and effort into it.” <br></p><p>Kumar says that it is also essential to have a protocol for “mandatory warm handoffs.” One option is to have a dedicated liaison who can talk to families, patients, and providers when patients leave or come back to the facility. That can go a long way toward ensuring patient safety, he says.<br></p><p>“It would be helpful to have nurse practitioners onsite who are trained in transitions of care and who can be contacted if a patient experiences an acute change,” McCauley adds. “They can focus on putting the pieces together and keeping patients out of trouble and, whenever possible, out of the hospital.”<br></p><p>It helps to have a good rapport with hospitalists so that patient transfers aren’t the only time providers initiate communication. “Periodically I go to their meetings, and sometimes they ask me to do educational presentations,” Kumar says. “For instance, I’ve talked about the Beers list and medications that should be prescribed carefully, particularly in frail, older patients.”<br></p><p>It also can help, McCauley suggests, to have tip sheets or checklists to address problems the patient is likely to experience, such as constipation or ambulation challenges. This can help prevent surprises and issues that can fall through the cracks after a transition. <br></p><p>Telemedicine helped enable virtual communication during the pandemic. However, Choi notes, “As a veteran of telemedicine and virtual care, I am the largest supporter of digital health. However, a telemedicine visit doesn’t solve the need for more information sharing and care coordination. There is a lot of communication and interactions among multiple parties that need to happen. There also are processes that need to be designed and implemented between health care ecosystem partners.”</p><h2>Education Makes a Difference</h2><p>“The tool I’ve found to be most useful is education,” Kumar says. “People want to do the right thing, but there is a lot of misinformation, doubts, and questions. Having something like a one-on-one dialogue or a webinar to ensure everyone has consistent, up-to-date information helps.” <br></p><p>The need for education isn’t limited to providers and staff. “Sometimes families or patients misunderstand what they are told, and by the time they come to us, they can have a lot of misconceptions,” he says. “First we need to sit down and find out where they’re coming from and what happened. It’s all about transparency, honesty, and humility.”<br></p><p>Family communication and education also need to involve what the patient will need on returning home and what that involves, McCauley says. “We don’t have a system designed to meet the needs of elders when they go home. We expect family members to deliver care that would be challenging for a trained nurse, and the patient is stuck in the middle.”<br></p><p>Strong partnerships and consistent, ongoing communication between nursing homes and their primary care provider are key to ensuring no one feels that they’re in the wilderness or being asked to provide care that is beyond their skill and knowledge levels.<br></p><p>Most people are open to communication “if you take a blame-free approach and not point fingers,” Kumar says. “If there is a problem at the other end, we need to be able to talk about it, and we expect them to tell us if we could have done something better or different.” It is essential to espouse patient-safety culture with a focus on brainstorming for success instead of placing blame or making excuses. “We need to prioritize patient-safety culture to enable everyone to perform at their best,” he says. </p><h2>The Road Home</h2><p>“In our research, the most common goal patients have is to go home, live and function in their house, and not be a burden,” McCauley says. “That’s a phenomenal goal, but first you have to be safe, be able to make or get meals, take medications safely, and so on. You have to participate in physical therapy to get stronger and have the stamina to care for yourself and not deteriorate.<br></p><p>“Using goals as a driver is a way to get people motivated and help them appreciate small successes in physical therapy. “ <br></p><p>To identify these goals, it is essential to give patients and families, including family members who know the patients and their history, a place at the table and really listen to their goals and expectations. It’s important to realize they may have unrealistic expectations.<br></p><p>To help them focus on what they can do and to set realistic expectations, “We need to find out what gives them joy and what quality of life means to them,” McCauley says. “Start with what’s important to the patient, and then you can put a plan into place that includes good symptom management.”</p><h2>When Readmissions Happen</h2><p>It’s imperative to look at each readmission and understand what happened, Kumar says. “We do a root-cause analysis of every hospitalization—what happened, what caused it, and if/how it was avoidable.”<br>McCauley says that while it’s essential to prevent avoidable readmission, there are times when it’s appropriate to send a patient out.<br></p><p>“An urgent visit with the physician is better than an ER [emergency room] visit, and an ER visit is better than a hospitalization. But we need partnerships between nursing homes and the hospital to plan, communicate, and determine when a transfer is essential and what it will take to ensure a smooth transition.”<br></p><p>Putting all the pieces in place to ensure smooth transitions of care is easier than it used to be because value-based care principles and technology are available. However, transitions aren’t yet as smooth as they can be. Everyone has been stretched, but there will be greater opportunities to improve care transitions as the entire health care industry gains bandwidth. Then, all the lessons learned will present ways and means to re-evaluate and re-engineer gaps in care and communication. <br></p><p>Read More&#58; <a href="/Topics/Special-Features/Pages/Make-Advance-Directives-Mobile.aspx">Make Advance Directives Mobile</a></p><p><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.​</em></p>2021-10-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2021/1021/1021_CF1.jpg" style="BORDER&#58;0px solid;" />Culture Change;QualityJoanne KaldyCare coordination between nursing homes and hospitals is critical to ensure a timely exchange of clinical information.
Becoming a Proactive Provider in a Value-based World<p>​What do accountable care organizations (ACOs), hospitals, and health systems participating in value-based payment models (such as the Bundled Payment Care Improvement Advanced) look for when referring patients to a post-acute care (PAC) facility? They want a reliable partner who not only shares their goals of well-coordinated care, improved patient outcomes, and reduced costs but also delivers with proven results.&#160; </p><p>It’s no secret that post-acute providers, especially skilled nursing facilities (SNFs), are facing more challenges than ever before. The steady decline in occupancy and critical staffing shortages were exacerbated by the pandemic. According to the NIC MAP Data Service, SNF census hit an all-time low last December, and while the numbers are stabilizing, occupancy is down 13 percent from pre-COVID levels.<br></p><p>Recruiting and retaining quality physicians, nurses, and certified nurse assistants post-COVID will only get tougher with nursing homes in almost every state reporting significant staffing limitations. These issues, compounded with the actual cost of fighting the pandemic, further escalate rising operational expenses. <br></p><p>Yet, as value-based care models (VBC) continue to evolve, ACOs, hospitals, and other payers expect their post-acute network partners to improve the quality of care and deliver better clinical and financial outcomes. This puts SNFs under even more scrutiny in their efforts to gain referrals, operate efficiently, and retain staff. </p><p>To remain an essential provider in the market and earn steady hospital referrals, SNFs must adopt a value-based care mindset across the entire organization. Technology is one of the keys to this VBC transformation—in the form of data analytics. By using meaningful data to better manage patient care, SNFs can become a stronger partner for their residents, referral sources, payers, and the communities they serve. <br></p><h3>Moving the needle on key performance metrics using live data </h3><p>In order to perform well under bundled and other VBC payment models, ACOs and hospitals are inherently tied to their post-acute facilities’ ability to improve patient outcomes—namely readmission rates and length of stay. That’s why these entities are turning to their high-performing network partners to improve the patient experience and maximize potential savings. <br></p><p>And because acute care providers are responsible for managing patients during the post-acute stay, they are targeting the costliest line item—skilled nursing facilities—to reduce costs. As reported in the MedPAC July 2020 Data Book, skilled nursing alone accounts for almost half of Medicare fee for service post-acute hospital expenditures, thus representing a prime target for payers to reduce total health care dollars. &#160;</p><h3>There’s a real opportunity for SNFs too. <br></h3><p>Many SNFs have a massive amount of patient and facility data readily available in their electronic health record (EHR) that—when gathered and analyzed in real-time—can reveal meaningful information and help move the needle on key performance measures. They just need the right software to use it to their advantage. <br></p><p>By using data analytics to leverage EHR data, post-acute facilities gain valuable insights that empower care teams to make more informed clinical decisions. Equipped with actionable patient and facility-level data, SNFs can improve coordination efforts among transitioning providers and shorten patient stays. <br></p><p>For example, care teams can proactively identify and stratify residents at high risk for readmissions, particularly during the first 72 hours of transition to the SNF when they are most vulnerable. With timely, evidence-based, and actionable alerts, the care team can treat them in the facility before the patient’s status worsens. <br></p><p>And with the right data, SNFs can establish clinical pathways to reduce variability in the way conditions are treated. By using interventional analytics to understand how the patient is doing in the moment compared to an established clinical baseline of when they arrived, clinicians can intervene in a more timely fashion to mitigate the risk of decline and need for hospitalization. With a better clinical line of sight based on live data, SNFs can also reduce length of stay by making even more informed decisions on when the resident would be safe to transition back to the community. </p><h3>Proving value as an ideal PAC partner</h3><p>Aging adults entering nursing homes and assisted living are sicker and frailer than ever before, which makes the PAC facilities that care for them an increasingly vital component of the health care continuum. <br></p><p>Simply relying on claims or the Minimum Data Set (MDS) to inform patient care is no longer an option; instead, staff need immediate access to actionable information at the point of care. The typical SNF EHR is so fragmented, finding the “must have” clinical information is like searching for a needle in a haystack. <br></p><p>Clinicians need live, continuous data analysis that helps keep the entire team well-informed on the highest risk patients based on their status today and not based on their most recent claims or their latest MDS, often weeks to months old. With actionable data that helps care teams assess and prioritize patient needs in real time, staff can target specific at-risk residents on rounds while offering a brief greeting to others. <br></p><p>To see the big picture—and prove their value as a preferred network provider—SNFs also need dashboards and reports based on information as recent as the day the data is entered into the EHR instead of pulling data from the MDS that may be three months old.<br></p><p>And SNFs need to share that data with their health care partners. Data transparency and interoperability allows all providers invested in patient care to monitor clinical status along the care continuum and drive collaboration when needed. &#160;<br></p><p>With interventional analytics software that assesses live patient EHR data 24/7/365, SNFs can better coordinate with their referral partners to effectively transition patients between care settings, shorten length of stay, and keep residents out of the hospital, ensuring patients return to their homes safely. <br></p><p>Do you have the right technology in place to effectively coordinate care, improve patient outcomes, and reduce costs so that you can get the referrals you measurably deserve? <br><br><em>As chief medical officer, <strong>Steven Stein, MD,</strong> draws upon his vast knowledge of both the post-acute and payer markets to guide the clinical advancements of Real Time Medical Systems’ Interventional Analytics platform for post-acute providers, health systems, accountable care organizations, physician groups, and managed care organizations. Stein served on the White House Council on Aging for both the Clinton and Obama administrations. Stein is board-certified in internal medicine and geriatrics.</em></p>2021-08-04T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2021/SteveStein.jpg" style="BORDER&#58;0px solid;" />QualitySteven Stein, MDWhat do ACOs, hospitals, and health systems participating in value-based payment models look for when referring patients to a post-acute care facility?