Friday, October 31, 2014

Antipsychotic Drug Use in Nursing Homes: Trend Update from CMS

Holly Harmon

The National Partnership to Improve Dementia Care in Nursing Homes is committed to improving the quality of care for individuals with dementia living in nursing homes. The Partnership has a mission to deliver health care that is person-centered, comprehensive, and interdisciplinary, with a specific focus on protecting residents from being prescribed antipsychotic medications, unless there is a valid, clinical indication and a systematic process to evaluate each individual’s need.

CMS is tracking the progress of the Partnership by reviewing publicly reported measures. The official measure of the Partnership is the percent of long-stay nursing home residents who are receiving an antipsychotic medication, excluding those residents diagnosed with schizophrenia, Huntington's Disease, or Tourette’s Syndrome. In the fourth quarter of 2011, 23.9% of long-stay nursing home residents were receiving an antipsychotic medication. Since then, there has been a decrease of 18.8% to a national prevalence of 19.4% in the second quarter of 2014. Success has varied by state and CMS region, with some states and regions having seen a reduction of greater than 20%. For more information on the Partnership, please send correspondence to

AHCA’s Skilled Nursing Progress Report for First Quarter 2014 can be found on the Quality Initiative website or by clicking here:

Important 2015 Marketplace Info

Dana Halvorson

According to an October 31, 2014, email alert from the team, there are a few items individuals should be doing now to get ready for November 15th. That is the date in which you can return to to find a new health insurance plan or re-enroll in your current plan. The 3 things you can do right now to get ready include:

Download this Marketplace checklist to gather the documents you’ll need to apply
Learn more about getting covered in 2015
Mark your calendar: Come back on or after November 15th

If you have any questions relating to the Affordable Care Act (ACA), please submit them to, and be sure to check out AHCA/NCAL’s ACA website.

Wednesday, October 29, 2014

Important Post-Convention Information

Jon Patrick Ewing

If you attended the AHCA/NCAL 65th Annual Convention & Expo, please note this important information.

Complete the Convention & Expo Survey: Please take a moment to give us your feedback by taking the Post-Convention Survey. When you send back a completed survey, you will automatically be eligible to win a $200 cash card. The deadline to complete the survey is Friday, November 7.

Claim Your CEUs for 2014: AHCA/NCAL Convention & Expo attendees can retrieve their CEU certificates by clicking on the following link: 

User ID: Please use your first and last name – all one word – all lower case (i.e.: johndoe)
Password: Please use the email that you used to register for convention (i.e.:

If you find a mistake in your certificate, please email the issue to Adrienne Riaz-Khan ( Please provide a detailed description of what needs correcting. For example, “I attended the closing general session but missed my out scan”. Certificates were emailed to attendees yesterday. This link will be live for one year should you need to reprint or did not get your certificate.

Session Evaluations: In addition, we ask that you complete convention education session evaluations by going to the following link:

Event Photos: All events are available in the AHCA/NCAL Convention & Expo 2014 Folder on Flickr. There are multiple albums with different event names to view your selections.

Claim Your CEUs for 2014

Teresa Eyet

AHCA/NCAL Convention & Expo attendees can retrieve their CEU certificates by clicking on the following link: 

User ID: Please use your first and last name – all one word – all lower case (i.e.: teresaeyet)
Password: Please use the email that you used to register for convention (i.e.:

If you find a mistake in your certificate, please email the issue to Adrienne Riaz-Khan ( Please provide a detailed description of what needs correcting. For example, I attended the closing general session but missed my out scan.

Certificates were emailed to all attendees October 28, 2014. This link will be live for one year should people need to reprint or did not get their certificates. 

Registration open for free NPUAP webinar

Holly  Harmon

On November 20 at 2:00 PM Eastern, in honor of World Wide Pressure Ulcer Prevention Day, the NPUAP is pleased to offer a FREE webinar, hosted by Dr. Nancy Bergstrom, titled “Repositioning as a Pressure Ulcer Prevention Strategy: A Multi-site Clinical Trial.” Dr. Bergstrom will introduce findings from the TURN Study conducted at UT Health School of Nursing, where researchers looked at optimal frequency of patient repositioning for pressure ulcer prevention.

This webinar is only open to the first 1,000 registrants so register today!

For more information on the webinar and how to register please view website.

Medicare “Improvement Standard” Returns to Courts

Dan Ciolek and Dianne De La Mare

In a landmark court agreement in 2012, the Centers for Medicare and Medicaid Services agreed to settle a class-action lawsuit filed by Glenda Jimmo, a 78 year old woman from Vermont who was denied Medicare coverage due to a “lack of improvement”. In the settlement agreement, and in subsequent updates to Medicare policy manuals, CMS agreed that beneficiaries cannot be denied coverage based solely on the lack of improvement in health or function. Coverage instead is based upon the need for skilled care, and that the care can only be safely and effectively be performed by qualified nursing or therapy professionals.

In the settlement agreement, beneficiaries that were previously denied care due to the improper “improvement standard” were offered an opportunity to appeal claims denied only due to lack of improvement. In April 2014, Ms. Jimmo received a decision from the Medicare Appeals Council (the 4th level of appeal) which upheld the earlier denials agreeing with the original medical review decision that her condition was not improving. As reported in Kaiser Health News, Ms. Jimmo with the support of the Center for Medicare Advocacy (CMA) have filed a lawsuit (Jimmo v. Burwell) seeking a reversal of Medicare’s decision to deny coverage.

AHCA continues to monitor this situation. For more information, contact Dan Ciolek or Dianne De La Mare       

Tuesday, October 28, 2014

Submit Your Posters

Urvi Patel

Have a story to share? Have an outstanding practice? Have stellar results?

Come share your success with your peers! Submit a Poster Session Proposal for the 2015 AHCA/NCAL Quality Symposium.

We are particularly interested in proposals showing how improvements in the Quality Initiative Goals have led to positive business outcomes.

Safely Reducing Hospital Readmissions
Safely Reducing Off-Label Antipsychotic Drug Use
Reducing Staff Turnover
Improving Customer Satisfaction

The deadline to submit is November 17th, 2014. Applicants will be notified on December 15th, 2014.

For questions contact Urvi Patel at

White House Prepares Upcoming Conference on Aging

 The Obamas on South Lawn (Official White House Photo by Pete Souza)
Drew Thies

The White House continues to prepare for its Conference on Aging, set to be held in Washington next year. The conference, which occurs every 10 years, is hosted as an opportunity for those in aging and care-giving communities to provide advice and policy recommendations to the executive departments and beyond on how to secure a better future for aging Americans.

AHCA/NCAL is happy to announce that we have already had contact with the administration about the subject matter of the conference. We will continue to work with the White House to showcase the skilled nursing profession during this event.

White House staff has met with advocates nationwide to develop a framework for the series of events. Topics covered will focus broadly on preserving finances as Americans age, maintaining healthy aging, providing the appropriate support to the disabled and elderly, as well as protecting aging Americans from negligence and exploitation.

Specific dates for the conference have not yet been set, but we will continue to update members with news as we work with the administration. You can learn more about the White House Conference on Aging at their website.  

Our Quality Award Journey

By Lori Cooper, Administrator, Stonebrook Healthcare Center
2014 Gold Quality Award Recipient

 (L to R) Neil Pruitt, Jr,, AHCA Immediate Past Chair, Lori Cooper, Len Russ, AHCA Chair 
As an independent facility, taking the Quality Award journey is one of the best decisions we ever made. We utilized the criteria and feedback at every stage to identify, develop and implement systems to make us a high performing organization and a leader in our marketplace. Like most independent facilities, Stonebrook has limited resources for the various layers of consulting that can be found in multi-operations. This did not prevent us from making a commitment to quality. To address this challenge, we assigned champions to each category of the application. These champions became experts in their assigned areas.   

We soon realized there are numerous advantages to participating. We learned about our organization; the good, the bad and the ugly. With that information, we were able to identify what we do best and identify areas where we needed to improve our processes. We came to understand the importance and value of being a data-driven organization. The quality award process prompted us to look at our outcomes as compared to our competitors. By being willing to address the areas where we were not as good as our competitors, our results improved over time.  

For us, the benefits of participating in the Quality Award Program are evident in every aspect our organization. Here are the top five benefits for us:

1. We now have an engaged leadership team that understands the need to focus on our strategy and customers. Our leadership team sets the direction for our organization and seeks out future opportunities. They understand the importance of creating a culture that delivers a consistently positive experience for our customers that is in alignment with our mission. This level of leadership keeps our operations current and responsive to the needs of our stakeholders.

2. We have systems and processes in place that can be replicated. In the event that we would lose a key employee or knowledge holder, we would be able to continue our day-to-day functions with minimal impact. As an independent organization, this continuity is vital for us to survive and thrive long-term.  

3. The Quality Award Program made us aware of the importance of listening to our customers and stakeholders. The communication throughout the organization has become essential to us. We listen to our customers and use their feedback to make improvements to our processes. As a result, our customer satisfaction scores are consistently in the top 10 percentile of the My InnerView national data base.

4. The morale, unity and engagement of our employees have been positively impacted by our participation in the Quality Award Program. We purposefully focus on our employees and their work environment and well-being. We used the criteria as a tool to identify workplace factors that could enhance our workplace environment. For the past three years, our organization has been recognized as a “Top Workplace” in the San Francisco Bay Area out of all industries.

5. By achieving the Gold Quality Award, our independent organization has earned more credibility, an enhanced reputation and increased marketability in the local area. This is imperative to us as we do not have the deep pockets for advertising. We are able to attain a higher market share based on our reputation.  

Our journey through the Quality Award Program has had a dramatic impact on our organization. It proves that independent operators can achieve and maintain the highest level of performance. I encourage every independent operator to take the journey with us. You won’t be sorry.

Submit your Intent to Apply for the 2015 AHCA/NCAL National Quality Award Program by November 13, 2014!

Preparing to Comply with Employer Requirements under the Affordable Care Act

Since the enactment of the Affordable Care Act (ACA) in 2010, there have been some administrative delays and a number of regulations published, making it at times challenging for employers (including long term and post-acute care providers) to keep up and comply with the relevant employer shared responsibility provisions that go into effect on January 1, 2015. As an employer, a key aspect of the health reform law is understanding and complying with these provisions. Nicole Fallon of CliftonLarsonAllen will explain what these provisions are, and what you need to do to ensure you are prepared. A timeline of key ACA requirements will be provided, and you will have the opportunity to get your pressing questions answered. 

Tuesday, December 2, 2014
2:00 PM- 3:00 PM Eastern Time

Learning Objectives:

· Review and gain a better understanding of key employer reporting requirements
· Learn more about the employer “shared responsibility” penalties and IRS reporting requirements
· Receive a better understanding for determining when an employee is full-time
· Learn about key ACA compliance dates
Nicole O. Fallon, Consultant/Director Health Care, CliftonLarsonAllen LLP.