Tuesday, April 29, 2014

AHCA/NCAL Convention: Earn Up to 19 CEUs With 60+ Education Sessions to Choose From

Jon-Patrick Ewing

Although some content is still under development, you can now preview education sessions for AHCA/NCAL's upcoming Convention & Expo online. This year's education sessions are designed to reflect the issues that are on the minds of long term and post-acute care providers. We'll address these issues with best practices, expert opinions, case studies, new ideas, and inspiration.

New for 2014 are tracks designed to focus on the four Quality Initiative goals: FOCUS on Antipsychotic Reduction, Rehospitalization Reduction, Staff Stability, and Customer Satisfaction.
Attendees can boost their CEU count by attending one of several Constituency Education Programs* scheduled during the event. Learn more about these highly-targeted education programs and how you can participate. 

*Some programs require a separate ticket or may be invitation only.

Registration for the AHCA/NCAL 65th Annual Convention & Expo is now Open. Early bird registration through July 18.

Updated AHCA/NCAL Observation Stays Hill Fact Sheet

Dana Halvorson 

http://www.ahcancal.org/advocacy/solutions/Pages/Observation-Stays.aspx
AHCA/NCAL continues its support and advocacy for legislation, The Improving Access to Medicare Coverage Act of 2013 (S. 569/H.R. 1179), introduced by Reps. Joe Courtney (D-CT) and Tom Latham (R-IA), along with Sen. Sherrod Brown (D-OH), which seeks to count all hospital days spent in observation towards the three-day stay requirement.

Currently, S. 569 has 25 bipartisan cosponsors, while H.R. 1179 currently has 141 bipartisan cosponsors.

AHCA/NCAL has an updated fact sheet on the issue. For more information about observation stays and related legislation, please visit the AHCA/NCAL website.

Living the Mission: A Day for Not for Profit Providers

Dana Halvorson

Mark your calendar! The second annual Not for Profit (NFP) Day at AHCA/NCAL’s 65th Annual Convention & Expo will be held on Tuesday, October 7, 2014. NFP Day and the entire convention will be held at the Gaylord National Harbor just outside of Washington, D.C. this year. Registration is now open, and the full agenda can be found on our convention website.

This constituency education program for NFP providers is packed with motivational and educational speakers, including representatives from the Department of Veterans Affairs and the Centers for Medicare and Medicaid Services.

Tony Decker, VP of Westcare Management Inc., Salem, OR (pictured), is the keynote speaker, and will uncover with the attendees the philosophies and leadership principles that drive virtually limitless possibilities for positive change, growth, and continuous improvement. An NFP reception will cap off the day. If you have any questions about this exciting event, please contact AHCA’s Senior Director for NFP & Constituent Services, Dana Halvorson.

ACA: Small Business Health Care Tax Credit

Dana Halvorson 

When you buy health coverage for your employees through the Small Business Health Options Program (SHOP) Marketplace, you may qualify for a tax credit worth up to 50% of your premium contributions. As noted in previous communications, SHOP was created in the Affordable Care Act (ACA), and is a new way for small businesses to buy health insurance for their employees. Healthcare.gov has the following SHOP resources available:
If you have any questions relating to the ACA, please submit them to insurancecoverage@ahca.org, and be sure to check out AHCA/NCAL’s ACA website.

Grants Available for Advancement of Person-Centered Care

Ruta Kadonoff

The Harvey Picker Center of Innovation Applied Research Program is seeking proposals for their 2014/2015 grant cycle that aim to advance person-centered care in post-acute and long-term care supports and services. Proposals attending to transitions and coordination of care, communication, critical interpersonal, interprofessional, and inter-organizational relationships, including relationships between long-term care residents, long-term care residents and staff, long-term care staff and residents’ family members, long term care staff and other professionals, and across sites of care are encouraged.

Successful proposals will address one or more of both the Planetree and Picker Principles of Patient-Centered Care, will be aligned with Always Events® (see details below), and will embody the following four characteristics:
  • Applicable across a range of long-term services and supports
  • Replicable implementation and evaluation processes
  • Affordable for long-term services and supports with limited financial resources
  • Sustainable beyond the life of the grant
The center will award up to five grants in this cycle of up to $10,000 each. Grantees are required to provide a minimum of a 100% matching contribution to the work. Eligible applicants include post-acute and long term care service providers, higher education institutions and non-profit organizations whose mission is specific go providing post-acute and long term care services and supports.

Potential applicants must submit a letter of intent by May 16.

Visit the Harvey Picker Center website for more details and the complete Request for Proposals.

Wednesday, April 23, 2014

Billing Changes from CMS

Daniel Ciolek

From CMS, AHCA learned that providers should take note because the Coordination of Benefits Contractor (COBC) is now the Benefits Coordination and Recovery Center (BCRC). For new contact, address, and Web address information, please visit this website. Other CMS billing changes, include:
  • PC Print software version 4.3.0, released in April 2014, is not compatible with Windows XP because Microsoft support for Windows XP ended on April 8. Providers using Windows XP. should continue to use version 4.2.6 of PC Print until they upgrade their operating system. Read more here.
  • SNF Consolidated Billing: Exclusion of HCPCS Code G0463 for Certain Outpatient Hospital Clinic Visits. If you previously received a SNF CB rejection for HCPCS G0463, you should contact your MAC to verify if you can adjust or resubmit your previously processed claim. Read more here.

Tuesday, April 22, 2014

Paul Ryan to Speak at Congressional Briefing

Drew Thies

AHCA/NCAL is excited to announce that Rep. Paul Ryan (R-WI) will be speaking at the annual Congressional Briefing on Tuesday, May 20th.

Ryan, a young star in the Republican Party, is currently Chairman of the House Budget Committee as well as a member of the Ways and Means Subcommittee on Health. He is considered a top contender to take over chairmanship of Ways and Means after the 2014 election, when current Chairman Dave Camp retires.

Often the face of the Republican fiscal agenda, Ryan was at the forefront of the December 2013 budget agreement, alongside Senate Budget Chairwoman Patty Murray, to keep the government funded through 2015.

Prior to his recent work on the budget, Ryan became a household name when he ran as Vice President alongside Mitt Romney in the 2012 Presidential election.

Come visit Washington, D.C. see Ryan, Sen. Ron Wyden, and Charles Kauthammer speak; and meet with your representatives at AHCA/NCAL’s Congressional Briefing, May 20-21.

Registration is extended and hotel rooms are booking fast, so make your plans today!

Check Updated LEIE Database - March 2014

Dianne De La Mare

The US Department of Health, Office of Inspector General (OIG) has just released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in March 2014.

This new file is meant to replace the updated LEIE database file available for download last month.  Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

The updated files are posted on OIG’s website, and healthcare providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or face significant fines.

Instructional videos explaining how to use the online database and the downloadable files are available online. Given the penalties and recent government warnings, long term care providers should check the LEIE on a regular basis.

2014 SNF PEPPERs Available in May Via Electronic Portal

Dianne De La Mare

TMF Health Quality Institute, the Centers for Medicare & Medicaid Services (CMS) contractor responsible to produce and distribute the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for various professional groups, including skilled nursing facilities (SNFs), has just announced a WebEX entitled The SNF Program for Evaluating Payment Patterns Electronic Report (PEPPER) on May 8, 2014, at 2:00PM, Central Daylight Time.

The WebEX will focus on:
  1. Updates for the new SNF PEPPER, summarizing statistics for FYs 2011-2013; and 
  2. the new method for accessing the 2014 SNF PEPPER via the Secure PEPPER Access portal on http://PEPPERresources.com. 
Registration is not required to join the event. Simply go to this link about 15 minutes prior to the start time of the WebEX. The event number is: 924 457 628 and the event password is: flower.

AHCA has advocated strongly for this process and is pleased that CMS is making this change.

Currently, the SNF PEPPERs are scheduled for release on May 5, 2014; however, TMF will send an email to announce the formal release when the SNF PEPPERs are available to access. To receive this email, join the email list at http://PEPPERresources.org.

SNFs do not have to register to receive a PEPPER report; however, TMF has asked us to share the following specific information:
  • Access to the SNF PEPPER will be restricted to the provider’s Chief Executive Officer, President or Administrator. Note: Corporate offices and/or facility management companies will need to obtain PEPPERs from each individual provider in their organization.
  • Requestors will be required to enter their 6-digit CMS certification number (also referred to as a provider number or PTAN) (third digit of “5” or “6” for SNFs). This is *not* the same number as the tax identification number or national provider identification number. 
  • For verification purposes, requestors will be required to enter either a Patient Control Number (form locator 03a on the UB04 claim form) *or* a Medical Record Number (form locator 03b on the UB04 claim form) for a patient who received services at the provider during September 2013 (“from” or “through” date is between September 1-30, 2013).
Note: If providers use only letters in both of these fields they must contact TMF to request assistance. Patient names cannot be entered due to patient privacy laws.

If you have individual or specific questions regarding the 2014 PEPPER reports, please visit PEPPERresources.org to submit questions.

CMS to Implement Fingerprint-Based Background Checks for High-Risk Providers and Suppliers in 2014

Reed Smith, AHCA/NCAL General Counsel

Check out a recent posting to Health Industry Washington Watch by Reed Smith, AHCA/NCAL's General Counsel:
More than three years after publication of final regulations to implement Affordable Care Act (ACA) provisions that strengthen provider and supplier enrollment screening provisions under federal health care programs, the Centers for Medicare & Medicaid Services (CMS) has selected a Fingerprint-Based Background Check Contractor (FBBC) and intends to phase in fingerprint-based background checks beginning in 2014.  

READ MORE

Two More Organizations Join Observation Stays Coalition Efforts

Dana Halvorson

AHCA/NCAL continues its support and advocacy for legislation, The Improving Access to Medicare Coverage Act of 2013 (S. 569/H.R. 1179), introduced by Reps. Joe Courtney (D-CT) and Tom Latham (R-IA), along with Sen. Sherrod Brown (D-OH), which seeks to count all hospital days spent in observation towards the three-day stay requirement.

Currently, S. 569 has 25 bipartisan cosponsors, while H.R. 1179 currently has 140 bipartisan cosponsors.

AHCA/NCAL also continues its work as part of the Observation Stays Coalition, which now consists of 30 organizations advocating for this important legislation. The National Council on Aging and the Catholic Health Association of the United States are the most recent organizations to add their names to the Coalition efforts. The updated Coalition fact sheet can be found here.

For more information about observation stays, please visit the AHCA/NCAL website.

ACA Webinar this Thursday

Dana Halvorson 

This month, the health care industry saw its first round of open enrollment numbers for the Affordable Care Act (ACA) and next month many expect insurers to release their prices for 2015 exchange policies. What does this data tell us about the state of the industry today? Where do we go from here?

Bloomberg Government will be holding a free webinar this week on Thursday, April 24, at 2pm EST, on these topics where their health care analysts will offer an exclusive look at this month’s data and preview what lies ahead for the ongoing reform effort.

According to the Bloomberg Government website on the webinar, specific topics covered will include:
  • An analysis of the first open enrollment numbers under the ACA
  • Detail of the law’s Medicaid expansion and what it means for industry 
  • A preview of insurers pricing decision for exchange policies 
Further details about the webinar, including registration, can be found here.

If you have any questions relating to the ACA, please submit them to insurancecoverage@ahca.org, and be sure to check out AHCA/NCAL's ACA website.

Updates to Healthcare.gov and New ACA Materials

Dana Halvorson

April 15, 2014, marked the end of the “in-line” Special Enrollment Period for those enrolling in the federally-facilitated marketplace. As a result, several changes have been made to healthcare.gov. New information has been added that you may find helpful.

New Blog Posts:
Updates to healthcare.gov:
If you have any questions relating to the Affordable Care Act (ACA), please submit them to insurancecoverage@ahca.org, and be sure to check out AHCA/NCAL's ACA website.

Recognize Your Champion of Quality Care

Courtney Bishnoi

AHCA is now accepting applications for the 2014 Mary K. Ousley Champion of Quality Award! This award recognizes an individual who has made significant national contributions to advancing quality performance in long term and/or post-acute care, including either skilled nursing or assisted living settings. Previous recipients have demonstrated exemplary achievements in long term and post-acute care, including, but not limited to:
  • leadership in education and advocacy for quality improvements,
  • dedication to performance improvement, 
  • significant additions to long term and post-acute care research or interventions, and 
  • initiative in innovation for quality care.
Recipients of the award are not required to be AHCA/NCAL members, but the nomination must be submitted by an individual with an organization that is in a member of good standing of AHCA/NCAL.

In addition, the nomination must demonstrate how the nominee has made a significant impact on a national scale.

The recipient will be honored at the 2014 AHCA/NCAL Annual Convention & Expo in Washington, DC. Nomination forms can be found on the Champion of Quality Award page, and must be submitted via email to Courtney Bishnoi by June 13, 2014.

Please contact Courtney Bishnoi for questions, or visit the Champion of Quality Award page for more information.

AHRQ Expands Data Collection Period on Patient Safety Culture

Lyn Bentley

Earlier this month we alerted you that the Agency for Healthcare Research and Quality (AHRQ) was collecting data related to a patient safely culture in nursing centers. AHRQ has extended its data collection date for the Nursing Home Survey on Patient Safety Culture until May 31 (see notice from the AHRQ below). According to the AHRQ, “One of the purposes of the database is to produce comparative results to help nursing homes identify strengths and opportunities for improvement in their patient safety culture.” Topics covered in the survey include:
  • Teamwork; Training & Skills;
  • Non-Punitive Response to Mistakes; 
  • Communication Openness; and 
  • Feedback & Communication About Incidents. 
Results of the survey are made public in the aggregate with no identifying information about specific nursing centers or staff who responded. Centers are able to compare their individual responses to the results in the data base, providing an opportunity to assess their strengths and opportunities for improvement.

Note: This tool and the results are helpful for a center moving forward in its QAPI efforts – they may provide ideas for improvement projects.

Here's the notice from AHRQ...

Data Submission Extended to May 31 for AHRQ Nursing Home Survey

Data submission has been extended for the Agency for Healthcare Research and Quality (AHRQ) Nursing Home Survey on Patient Safety Culture Comparative Database until May 31, 2014. Nursing homes that have administered the AHRQ nursing home safety culture survey can now voluntarily submit their data.

To submit data, please go to http://www.sops-database.org/nursinghome.
  • Data submission is open from April 1 - May 31, 2014;
  • Nursing homes must have licensed nursing home beds;
  • Nursing homes must be in the U.S. or U.S. territories; and
  • Assisted living, community care, or independent living facilities are not eligible to participate.
This database is a central repository for survey data from nursing homes, or survey vendors, that have administered the AHRQ nursing home survey instrument. One of the purposes of the database is to produce comparative results to help nursing homes identify strengths and opportunities for improvement in their patient safety culture. Comparative results are reported in the aggregate and do not include any information identifying participating nursing homes.

Please feel free to contact us with any questions or concerns at DatabasesOnSafetyCulture@westat.com or 1-888-324-9790.
Thank you,
The Nursing Home Survey Database Submission Team

Wednesday, April 16, 2014

Provider Mag: Getting the End Game Right

Meg LaPorte, Managing Editor of Provider Magazine

Aging sucks, and there’s not much we can do about it, according to nearly anyone who thinks about it. But as Senior Editor Bill Myers finds in this month’s cover story, this prevailing attitude can be changed for the better. In his examination of how pop culture and, yes, baby boomers, have advanced the youth-obsessed media that we have today, Myers finds that although we have a long way to go in facing aging gracefully here in the United States, we may be ahead of the game in terms of policies that help elders, not hurt them.

North American Health Care, a long term and post-acute care provider, has achieved something for its client nursing centers that most providers only dream about—extremely high quality ratings from CMS. In this month’s feature, Contributing Editor Kathleen Lourde breaks down the science and the culture behind this company’s phenomenon.

This month’s Focus on Caregiving, looks at the Quality Assurance and Performance Improvement (QAPI) initiative and the important role that teamwork and Performance Improvement Projects play in successful caregiving.

Home care staffing agencies must prepare for changes to the longstanding “companionship exemption” rule under the Fair Labor Standards Act. As of January 2015, a strict new definition of “companionship services” will in all likelihood bar most employees from being exempted from minimum wage and overtime requirements, according to this month’s Legal Advisor.

Volunteers are valuable to any enterprise, and in long term and post-acute care these “free” workers are more valuable than ever. In Management, we find out how several communities in Colorado have created value with the establishment of a permanent volunteer program that benefits residents, the volunteers themselves, and the bottom line.

The technology field is bursting with tempting new “toys” that promise fast, amazing results. This is not necessarily a case of buyer beware, says Jim Rubadue, but it is a case of buyers making sure that they have a system in place to manage all the new devices and the people who use them. See Technology in Health Care.

Provider Mag: Top 50 & Top 40 Surveys Are Out

Meg LaPorte, Managing Editor of Provider Magazine

It’s that time of year again—for Provider’s annual rankings of the nation’s largest nursing facility and assisted living companies. To ensure your company’s inclusion in this year’s lists of the Top 50 Nursing Facility Companies and/or the Top 40 Assisted Living Companies, please complete our survey as soon as possible.

If you prefer to complete a Word version of the survey, please email Meg LaPorte at mlaporte@providermagazine.com.

Nursing facilities are ranked by the number of beds owned, operated, and/or managed. Assisted living residences are ranked by occupant capacity. Survey results will appear in the June 2013 issue of Provider magazine.

Please respond by Wednesday, April 23, 2014.

If you have any questions, feel free to call Meg (202) 898-2845.

Tuesday, April 15, 2014

Ensuring Your Staff Are Equipped with Critical Knowledge & Skills

Ruta Kadonoff

The CARES® Online training program and EssentiALZTM certification are a great place to begin if you are looking for a pathway to improve staff skills and competencies in person-centered caring for persons with dementia. Your AHCA membership provides you with discounted access to these resources – a valuable member benefit!

http://www.ahcancal.org/quality_improvement/qualityinitiative/Documents/essentiALZcustomizable_9-6-13.pdf

The CARES program is an engaging, interactive set of online training modules including both basic and advanced care strategies as well as two targeted programs, covering dementia-related behavior and support for activities of daily living. After completing the course material, caregivers have the option of accessing the EssentiALZ certification program, sponsored by the Alzheimer’s Association and providing an avenue for staff to demonstrate their new competencies.

Ensuring that staff are capable, comfortable and confident in providing excellent care for persons with Alzheimer’s disease and related dementias is a critical step in continuing to improve the quality of care and quality of life for these individuals and to reduce the off-label use of antipsychotic medications in our centers.

Univ of Iowa Webinar: Participating in Independent or Collaborative Research Projects

Holly Harmon

From the University of Iowa’s School of Social Work...

Participating in Independent or Collaborative Research Projects
Tuesday, April 22nd
2:00-3:15 PM (EST)
Click HERE to register (no cost)

The best clinical practice is grounded in evidence – evidence that is informed by the reality of practice and the organizational setting in which it is provided. Nursing home social workers who work with researchers to better understand the needs of their clients and organization, evaluate their current practices, and implement and evaluate new practices, are positioned to provide the best care.

This session will empower frontline social workers to implement best practices by learning how and why to be active participants in research that can benefit their clients and organization. Attendees will learn about:
  1. different types of research projects most relevant to their practice and the related research considerations; 
  2. the administrative issues involved when deciding whether to conduct a research project; and 
  3. “rubber-meets-the-road” realities related to engaging with residents, families, staff, and researchers when working to develop, implement, and evaluate best practices.
Presenters:
  • Sheryl Zimmerman, PhD, MSW, School of Social Work, University of North Carolina at Chapel Hill
  • Elsie Norton, MBA,Vice President & Chief Operating Officer ,Carolina Meadows CCRC
  • Kim Broucksou, MSW, MPA, Cognitive Care Director, Carolina Meadows CCRC, Chapel Hill, NC

Sebelius Resigns as Secretary of Health and Human Services

Drew Thies

Kathleen Sebelius announced late last Thursday she will be stepping down from her post as Secretary of Health and Human Services (HHS). Sebelius was originally tapped for the position nearly five years ago.

Current head of the Office of Budget and Management (OMB) Sylvia Matthews Burwell has already been announced as the nominee for replacement and is widely expected to be confirmed in the Senate by a large margin. She was confirmed to the OMB by a 93-0 vote.

Sebelius’s resignation came as a surprise to many. She abruptly made the announcement mere hours before appearing at a hearing before the powerful Senate Finance Committee to discuss the President’s budget for fiscal year 2015.

The decision, which Sebelius said Sunday was her own, comes on the heels of the May 31st sign-up deadline to the Affordable Care Act—the policy which has largely defined the Secretary’s tenure at the helm of HHS.

White House Press Secretary Jay Carney predicted a “May transition” for Burwell. Sebelius said she’d be making the final move “in the coming months.” Much of the timing will depend on when the Senate agrees to take up the nomination and the degree of resistance Burwell meets in the initial proceedings.

Registration is OPEN for AHCA/NCAL Convention & Expo

Jon-Patrick Ewing

Registration for this year’s 65th Annual AHCA/NCAL Convention & Expo is now open! Occurring October 5-8, 2014, at the Gaylord National Resort & Convention Center (which is located on the banks of the Potomac River near Washington, D.C.), this is a must-attend event for all long term and post-acute care professionals.

General Colin L. Powell, USA (Ret.)
Opening Keynote Sponsored by McKesson


 Our keynote speakers include General Colin L. Powell, USA (Ret.) and Captain Richard Phillips.

Captain Richard Phillips
Closing Keynote Speaker
When you register, make plans to attend the Gala Dinner & Show with headliner Pat Benatar and Neil "Spyder" Giraldo.

With plenty of professional networking opportunities, education sessions, new Constituency Education Programs and an Expo Hall full of cost-saving products/services you don’t want to miss a thing.

Register today! More information can be found on the official Convention & Expo website.

Note: All attendees must register for convention before housing reservations can be made. If you register online, you can make a housing reservation at the same time.

Pat Benetar and Neil "Spyder" Giraldo

ACA Resource: From Coverage to Care Resources

Dana Halvorson 

http://www.ahcancal.org/facility_operations/affordablecareact/Pages/default.aspx
The Centers for Medicare and Medicaid Services (CMS) has developed From Coverage to Care Resources to help newly enrolled individuals better understand how to use their insurance most effectively.

A Roadmap to Better Care and a Healthier You (also available in Spanish) walks individuals through a step-by-step guide on what having health insurance means, how to use an insurance card, and how to set up a first visit with a health care provider such as a doctor or a nurse practitioner.

It also provides information on what to expect during that first visit, what to look for in a provider that meets their needs, and how to keep up regular health care visits. This guide includes a glossary to help explain insurance terms. There’s also a checklist at the end of the Roadmap that helps individuals track their health screens and visits.

Your Roadmap to Health posters are available in both English and Spanish.

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

Call for Submissions - 2015 NCAL Spring Conference

Teresa Eyet

The call for presentations for the 2015 NCAL Spring Conference is now live. We are looking for topics to be considered for concurrent sessions that address the conference theme - Thriving in a New Healthcare Environment.

To review the complete submission guidelines and to submit your ideas, please visit www.conferenceabstracts.com/NCAL2015.htm.

Submissions will be accepted through May 9, 2014.

The 2015 NCAL Spring Conference will be held in March at the Westin Beach Resort in Ft. Lauderdale, FL.

Antipsychotic Webinar Series Available On-Demand

Lyn Bentley

Still facing challenges in safely reducing the off-label use of antipsychotic medications? AHCA has just what the doctor ordered: free webinars for members that address various topics to help your nursing center reach your antipsychotic reduction goal!

All are available on-demand. Watch one or watch them all.

http://www.ahcancal.org/quality_improvement/qualityinitiative/Pages/AntipsychoticWebinarSeries.aspx
“What’s Up Doc?!” let’s you know how to best communicate with your Medical Director – from the perspective of a former Medical Director.  There is one specifically for CNA’s - "The Keys to Success!” And how about your frontline workers – your “Special Ops." How can “Mining for Family Gold” provide the information and family engagement that can be so instrumental in providing individualized care? “Quality is Our Business Model” links the Quality Efforts from the past (TQM, CQI, QI, QA&A) to QAPI, specifically in the area of dementia care.

Each webinar is 30 minutes... perfect for busy long term and post-acute providers. Find details and links to all 6 webinars here (member login required).
  • Part 1: The Good, the Bad and the QAPI
  • Part 2: What's Up Doc?!
  • Part 3: Mining for Family Gold
  • Part 4: Frontline Workers or "Special Ops"?
  • Part 5: CNAs - the Keys to Success!
  • Part 6: "Quality is Our Business Model" - M.K. Ousley

Tuesday, April 8, 2014

NNHW T-Shirts: Buy 25+ and SAVE!

Karah DeMarco

Show your “Aloha Spirit” throughout National Nursing Home Week® and the rest of the year by wearing these vivid and colorful shirts. They feature the “Living the Aloha Spirit logo” on the back and front right pocket.

Purchase 25 or more t-shirts of any size and color combination on any single order and get a 10% savings!

Purple and Light Blue t-shirts are available in sizes M-XXXL and can be found on our online store.

**Discount applies to t-shirts only and no other NNHW merchandise. Multiple purchases of 25 or more t-shirts are eligible for the discount. Combining orders to total 25 or more are not eligible. Past orders are excluded from this discount.**

Orders may be placed at www.ahcapublications.org or by phone at 800-321-0343.

Don’t wait until the last minute. Our National Assisted Living Week® products are very popular and will sell out. Plan ahead and place your order early to ensure product availability, size, and color selection and timely delivery.

Congress Out for Easter

Drew Thies

Action on Capitol Hill will be calming down next week as both the House and the Senate leave Washington for the Easter recess. Neither chamber will conduct legislative business during the weeks of April 14-18th and April 21st-25th.

This break comes on the tails of a renewal and patch of the sustainable growth rate (SGR), or “doc fix,” which was signed by the President April 1st. The patch avoided a 24% drop in Medicare payment for physicians, instituted a new readmissions policy for skilled nursing, and extended the therapy exceptions process.

The AHCA/NCAL DC office will be using the time to continue preparing for Congressional Briefing, which is nearly a month away. Registration is open and hotel rooms are filling fast, so sign up today.

This is a great opportunity for you to contact you Members of Congress while they are back in your districts. The AHCA/NCAL Grassroots team has everything members need to reach out to a Representative or Senator and schedule a facility tour. These are one of the best ways to show those in Washington just how much your work matters.

The Grass is Greener: Calling All Advocates to New Grassroots Website

Michael Cowden

http://cqrcengage.com/ahca/home
Now with the click of a button you can send a tweet to your Member of Congress detailing the importance of fixing the observation status conundrum. This is thanks to our brand new Advocacy Hub which is the go-to site for all future advocacy calls to action.

With social media an ever growing and necessary tool for our collective grassroots action, this site takes all the work out of tweeting and sends your message to your Members of Congress directly. It’s also the place to send your friends and colleagues if they wish to sign up to join our advocacy database and to search for information on Members of Congress in your state.

So bookmark it right now!

Also, please like us on Facebook at www.facebook.com/careadvocacy and follow us on Twitter at www.twitter.com/careadvocacy for the latest news from Washington. With a doc fix decided for the next year, it’s more important than ever to continue to be proactive with these new tools to build long lasting relationships with your Members of Congress. And by sending tweets today, you can engage in conversations to defeat this loophole which has caused problems in Medicare access for so many of our patients.

CMS Reinforces That PTs and OTs can Perform Power Wheelchair Examinations

Dan Ciolek

In the April 2014 Medicare Quarterly Provider Compliance Newsletter, CMS noted that rehab professionals may perform and document evaluations that become part of the documentation necessary to support Medicare coverage of group 2 power wheelchairs for beneficiary use after they return home.

On page 10 of the newsletter, CMS states:
“The physician may refer the beneficiary to a licensed/certified medical professional (LCMP), such as a physical therapist (PT) or occupational therapist (OT), who has experience and training in mobility evaluations to perform part of the face-to-face examination. This person may have no financial relationship with the supplier.”
The booklet provides information on coverage and documentation requirements, as well as links to resources that SNF PTs and OTs can refer to when asked to perform part of the face-to-face examination prior to a beneficiary’s discharge to home.

Contact Dan Ciolek at dciolek@ahca.org if you have questions or comments.

Monday, April 7, 2014

New Medicaid Site Offers Solutions, Resources

Amy Mendoza

AHCA recently launched a new and improved version of its Medicaid site. With this new user-friendly structure, members have easy access to resources and solutions to Medicaid issues across the country.

Toolkits, webinars, policy principles, and Medicaid reports are just a click away.

Don’t forget to check out the Medicaid Information Clearinghouse, a members-only resource.

New information will be added to the site periodically throughout the year.

http://www.ahcancal.org/facility_operations/medicaid/Pages/default.aspx

Observation Stays Issue Update

Dana Halvorson

AHCA/NCAL continues its support and advocacy for legislation, The Improving Access to Medicare Coverage Act of 2013 (S. 569/H.R. 1179), introduced by Reps. Joe Courtney (D-CT) and Tom Latham (R-IA), along with Sen. Sherrod Brown (D-OH), which seeks to count all hospital days spent in observation towards the three-day stay requirement.

Currently, S. 569 has 25 bipartisan cosponsors, while H.R. 1179 currently has 140 bipartisan cosponsors.

AHCA/NCAL also continues its work as part of the Observation Stays Coalition, which now consists of 28 organizations advocating for this important legislation (download the Coalition Fact Sheet).

For more information about observation stays, please visit the AHCA/NCAL website.

Take Your Pulse with the QAPI Self-Assessment

Courtney Bishnoi

The Affordable Care Act includes a statute that requires that all skilled nursing care centers develop Quality Assurance and Performance Improvement (QAPI) programs. QAPI is a hot topic right now in the post-acute care profession. The anticipated release date for the regulations is this year. One year after a final rule for QAPI is issued, all nursing centers must have in place and implement an acceptable QAPI plan.

The time to get started on QAPI is now! Many centers across the country have begun to incorporate QAPI in their centers daily operations, and have even begun to write their QAPI plan. CMS has begun posting tools, resources and some guidance on their QAPI website.

One of the key ways AHCA is encouraging members to get started is by completing the QAPI Self-Assessment. The QAPI Self-Assessment is a simple but effective tool that will provide centers an understanding of where they are in their QAPI readiness, and identify strengths and opportunities for improvement relative to the QAPI elements. Organizations at all levels of preparedness will find this tool helpful.

There are three easy steps to completing the QAPI Self-Assessment
  1. Download and complete the QAPI Self-Assessment. Use this as a team building exercise by involving key staff from your center. Make sure to retain a copy of the completed self-assessment.
  2. Submit your results to AHCA through the online survey. AHCA will use the results of the survey to help target future training efforts. Please note that the results are completely anonymous.
  3. Download the QAPI Self-Assessment Resources to find resources in areas that you identified as "not started" or "just starting," or in other areas where you feel improvement is needed.
Learn more about QAPI on AHCA's website.

Questions? Contact Courtney Bishnoi, Director of Quality & Quality Award at cbishnoi@ahca.org.

Friday, April 4, 2014

Why Joining the PSO is Needed to Get Recognized

Lindsay Schwartz

Until May 1st, assisted living members have the opportunity to get recognized for meeting Quality Initiative goals. Just like AHCA, NCAL’s four Quality Initiative goals are reducing hospital readmissions and antipsychotic use, as well as increasing staff stability and customer satisfaction. But in order to be recognized for readmissions and antipsychotic use, assisted living members must first join the National Patient Safety Organization for Assisted Living (PSO), which was launched at the beginning of 2014. Why? Because unlike skilled nursing centers, assisted living communities are not required to publicly report readmission and antipsychotic data.

AHCA can easily look up skilled nursing centers’ data in these two areas from the MDS to see if members are meeting the goals, but assisted living does not have a similar, government tool which reports this information. That’s why NCAL is turning to the new PSO.

http://www.ahcancal.org/ncal/quality/qualityinitiative/Pages/NCALRecognitionProgram.aspxThe Quality Initiative is built around the idea that not only must we say that the long term and post-acute care profession is committed to improving quality, but that we must show that we are committed to improving quality. That’s why there are concrete numbers tied to each goal, including a 15% reduction of hospital readmissions and antipsychotic use. Without a public reporting system for assisted living communities on these two areas, NCAL had no way to demonstrate members are reaching their specified targets. Not until the PSO.

The primary function of a PSO is to allow healthcare providers to report quality and patient safety data without fear of legal discovery. So, through the National PSO for Assisted Living, members can electronically submit their performance on clinical performance outcomes (including readmits and antipsychotics use) and processes while still protecting themselves from any liability issues as a result of their data. If NCAL were to ask you for your communities’ readmission and antipsychotic data directly, this information would not be protected and could be used against your community punitively.

In order to protect communities but still recognize them for their amazing efforts, NCAL is asking assisted living members to join the PSO and then submit their rehospitalization and antipsychotic data for the First Quarter of 2014. (Get started now!) Then, members must notify NCAL that they have met either of these two goals through separate online surveys in order to signify their interest in being honored through the Quality Initiative Recognition Program. Again, in order to protect assisted living communities from legal discovery, NCAL cannot access individual data reported in the PSO.

Let NCAL know you have achieved a 15% reduction or hold only a 5% rate for hospital readmissions and for antipsychotic use in Q1 2014, and you could be recognized through the 2014 Quality Initiative Recognition Program!

Reporting quality and patient safety data is key for any organization - assisted living or skilled nursing - to identify areas for improvement and monitor their progress. Even if your community has not met the Quality Initiative goals, joining the PSO is a great way to get started on your quality journey. Beyond readmissions and antipsychotic use, the PSO will track medication errors, falls, pressure ulcers, pain management and more. And it’s more than a tracking tool – the PSO also provides exclusive materials on best practices and other education to help you improve in these areas. NCAL is even covering the start-up costs to keep costs to members as minimal as possible. Learn more about potential costs.

You can also learn more about the PSO in an upcoming webinar:


So, get recognized now for meeting your antipsychotic and readmissions goals by joining the PSO today. And build the roadmap to continue on your quality journey for tomorrow.

One Quarter Down! Time to Submit Your Data to the PSO

Lindsay Schwartz

The First Quarter of 2014 came to a close last week, which means that NOW is the time to submit your results to the National Patient Safety Organization for Assisted Living (PSO)! The PSO tracks hospital readmissions, the off-label use of antipsychotics, medication errors, falls, pressure ulcers, pain management and more – providing assisted living members a unique way to monitor their progress in these areas and identify areas for improvement. Reporting your readmission and antipsychotic data could also earn you recognition through the NCAL Quality Initiative Recognition Program, if you’ve demonstrated your achievement of the goals.

Once you have your data compiled in these areas, log in to the PSO and submit it for analysis. Don’t delay! Consistently submitting your data can ensure you stay on top of your improvement efforts and benchmark your outcomes regionally and nationally.

If you’re an NCAL member, but not a member of the PSO, what are you waiting for? This online experience is the first of its kind for assisted living providers nationwide. You can report quality and patient safety data without fear of legal discovery. You can also access communication tools aimed toward improving safety and quality measures, making your community more desirable to residents and families, as well as fellow providers in integrated health care models. Plus, NCAL is covering the start-up costs for members to keep costs as minimal as possible. And you must join the PSO if you wish to be recognized for your hospital readmission and antipsychotic success through the Quality Initiative Recognition Program.

Want more information? You can learn more about the PSO in an upcoming webinar:

Thursday, April 3, 2014

Nutrition & Foodservice Education Foundation Seeks to Shine a Light on Emerging Trends

Dana Halvorson

The Nutrition & Foodservice Education Foundation (NFEF), philanthropic arm of the Association of Nutrition & Foodservice Professionals (ANFP), has re-launched itself, with a new mission and strategic plan that focuses on support for research, new educational programs and scholarships for students. Through its work, the new Foundation is encouraging and supporting development of innovations and best practices in nutrition and foodservice, designed to help the profession adapt to demographic changes and other societal trends.

The Foundation recently completed its first major research project since its re-launch last year, providing findings about the food and dining preferences of residents in long-term care facilities.  It has also launched a survey of Certified Dietary Managers and other nutrition and foodservice professionals to help identify key research needs and opportunities. To participate in the survey, please go here.  In January, the Foundation announced funding from its first major corporate partner, Reinhart Foodservice, L.L.C. 

For more information, visit www.NFEFoundation.org or call the Foundation directly at 800-323-1908.

CMS Booklet Describes Medicare Review Programs

Dan Ciolek

Earlier this year, CMS released a booklet designed to provide education on the different CMS claim review programs and assist providers in reducing payment errors; in particular, coverage and coding errors.

The “Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and Recovery Audit Program” booklet includes frequently asked questions, resources, and an overview of the various programs, including Medical Review, Recovery Audit Program Contractor, and the Comprehensive Error Rate Testing Program.

AHCA members should note that this booklet does not include a description of the Part B therapy manual medical review (MMR) conducted by Recovery Auditors for claims surpassing the $3,700 annual per-beneficiary threshold. Therapy MMR falls under different provisions than the Recovery Audit Program described in this booklet. See the AHCA Therapy MMR webpage for updated information.

Please contact Dan Ciolek if you have questions or comments.

Wednesday, April 2, 2014

Part B Therapy Service Benefit Stabilized by Congress

Dan Ciolek

On April 1 the President signed into law the ‘Protecting Access to Medicare Act of 2014’ providing assurances for at least the next 12 months that Medicare beneficiaries may continue to receive medically necessary physical therapy, occupational therapy, and speech-language pathology services under the Part B benefit.

While AHCA was aggressively lobbying with numerous beneficiary and provider group coalition partners for permanently replacing the therapy caps with a more sensible patient-centered medical review and payment system, Congress was only able to agree to stabilize procedure payment rates, and add another one-year extension of the current therapy cap exceptions process and associated manual medical review (MMR) program.

In short, the provisions impacting Part B therapy services include:
  • The Medicare Physician Fee Schedule (MPFS) rates will remain unchanged through the remainder of 2014. Your charge masters need not change.
  • The MPFS rates for at least January through March 2015 will be established through rulemaking (around November) with a 0% Sustainable Growth Rate (SGR) adjustment. 
  • The therapy caps exceptions process is extended through March 31, 2015. You can continue to use exceptions to furnish necessary Part B therapy services above the $1,920 caps using usual procedures.
  • The associated MMR process is extended through March 31, 2015. Although CMS has currently ‘paused’ MMR reviews, and a resumption date has not been established yet, you should be prepared to respond to Additional Development Requests (ADRs) for ALL therapy services furnished beyond the $3,700 threshold since the ‘pause’ began in February. The Centers for Medicare and Medicaid Services (CMS) has indicted that they expect Recovery Audit contractors to conduct post-payment review on these claims once the MMR reviews resume. 
AHCA continues to advocate for a permanent replacement of the therapy caps before these provisions expire on March 31, 2015. We are also working with CMS to fix administrative problems with the MMR process and will provide updates as they occur.

Tuesday, April 1, 2014

OIG MFCU FY 2013 Report

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG), released its annual report, Medicaid Fraud Control Units FY 2013 Annual Report, which highlights statistical achievements from the investigations and prosecutions conducted by the 50 Medicaid Fraud Control Units (MFCUs) nationwide.

According to the report, MFCUs reported a total of 1,341 convictions in cases involving Medicaid fraud and patient abuse and neglect. Criminal convictions involved a variety of provider types, most notably home health agencies; and recoveries reached nearly $1 billion. MFCUs also obtained 879 civil settlements and judgments, and civil recoveries totaled over $1.5 billion. Civil settlements and judgments involved a variety of provider types, most notably pharmaceutical companies; and recoveries reached over $1.5 billion.

Further, the OIG took up further action with 1,000 Medicaid providers due to provider exclusions violations. Further, the report found that there are a lack of fraud referrals to MFCUs regarding Medicaid Managed Care Organizations (MCOs), and there is concern that MCOs may not have incentive to refer providers suspected of fraud.

To obtain a copy of the complete report go to OIG’s website.

OIG Compendium of Priority Recommendations

Dianne De La Mare

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG) has released a core publication, Compendium of Priority Recommendations (Compendium), which used to be titled Compendium of Unimplemented Recommendations. The Compendium identifies significant recommendations described in previous OIG reports with respect to problems, abuses or deficiencies for which corrective actions have not been completed. Further, the Compendium lists OIG’s top 25 unimplemented recommendations, that it believes would best protect the integrity of HHS programs if implemented.

Some of the recommendations that apply directly to our profession include:
  • Improve controls to address improper payments to SNFs (Inappropriate Payments to SNFs Cost Medicare More Than $1 Billion in 2009 and Questionable billing by SNFs);
  • Detect and recover improper Medicare payments for services to incarcerated, unlawfully present or deceased individuals (Medicare Improperly Paid Providers Millions of Dollars for Incarcerated Beneficiaries Who Received Services During 2009 Through 2011 and Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011);
  • Maximize recovery of Medicare overpayments (Obstacles to Collection of Millions in Medicare Overpayments and Collection Status of Medicare Overpayments Identified by Program Safeguard Contractors);
  • Ensure that Medicare Advantage Organizations are implementing programs to prevent and detect waste, fraud and abuse (Medicare Advantage Organizations’ Identification of Potential Fraud and Abuse);
  • Improve care planning and discharge planning for beneficiaries in nursing facility settings (Plans for Care and Discharge—Skilled Nursing Facilities Often Fail to Meet Care Planning and Discharge Planning Requirements)
  • Address harm to [SNF] patients, questionable resident hospitalizations and inappropriate drug use (Adverse Events in SNFs: National Incidence Among Medicare Beneficiaries, Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring and Drug Utilization—Medicare Atypical Antipsychotic Drug Claims for Elderly Nursing Home Residents);
  • Improve [Nursing Facility] emergency preparedness and response (Emergency Preparedness—Gaps Continue to Exist in Nursing Home Preparedness and Response During Disasters);
  • Address Medicaid managed care fraud and abuse concerns (Medicaid Managed Care: Fraud and Abuse concerns Remain Despite Safeguards);
  • Ensure that [Medicaid home- and community-based care settings] service providers comply with quality and safety requirements (Medicaid—Oversight of Quality of Care in Medicaid Home- and Community-Based Services Waiver Programs); and
  • And Reduce improper payments and fraud (US Department of Health and Human Services Met Many Requirements of the Improper Payments Information Act of 2002 But Was Not Fully Compliant).
You can obtain a copy of the entire Compendium go to OIG’s website.

Upcoming Webinar: Improving Quality in Assisted Living - An Introduction to the PSO

Adrienne Riaz-Khan

In 2013, NCAL began a collaboration with the New Jersey Hospital Association’s Patient Safety Organization (PSO) to collect clinical performance measures. The National Patient Safety Organization for Assisted Living (PSO) officially launched in January 2014. Patient Safety Organizations serve as a group of independent, external experts who collect and analyze data related to quality and patient safety. All PSOs are certified by the Agency for Healthcare Research and Quality (AHRQ).

This exciting new collaboration will enable NCAL members to benchmark outcomes and process measures nationally. By gaining access to this previously unavailable national data, assisted living communities can gain a better understanding of their unique strengths and weaknesses, and set specified improvement goals.

Join us Wednesday, April 16th for a webinar explaining the PSO and how it can benefit your assisted living community!

Improving Quality in Assisted Living:
An Introduction to the National Patient Safety Organization for Assisted Living
Wednesday, April 16, 2014
2:00pm – 3:30pm (EST)

Speakers:
  • Margaret Murphy Carley, JD, Long Term Care Consultant
  • Helen Crunk, RN, Assisted Living Consultant
  • Lindsay B. Schwartz, Ph.D, Director, Workforce and Quality Improvement
Learning Objectives:
  • Understand what a Patient Safety Organization is and background of PSOs
  • Learn about how the National Patient Safety Organization for Assisted Living can help your community improve quality 
  • Understand what kind of data the PSO will be collecting and the tool that will be used to collect data

Tragedy Strikes a Member Facility Employee in Washington State Mudslide

Dave Kyllo

We have all watched the devastating mudslide in Oso, Washington on television. One of our members and our Washington affiliate notified us that an employee who works at two member assisted living communities has been devastated by the mudslide. Jonielle Spillers lost her home, her husband and three of her four children. The communication below from our Washington affiliate explains it all. This is an important time to show our support for Jonielle with our thoughts, prayers and wallets.
March 31, 2014: An American flag hangs from the only cedar post left standing at the scene of a deadly mudslide in Oso, Wash. (AP Photo/The Herald, Sofia Jaramillo, Pool)

-----

Many of us have followed the news of the mudslide that took place in Oso, Washington, last weekend. The story is close in some ways and yet so far away in others. Little did we know until today, this story has hit very close to home.

One family tragically impacted by this catastrophic event is that of Jonielle Spillers, an employee at Cascade Valley, an assisted living community in Arlington, Washington. While caring for the residents she serves, Jonielle’s family was devastated by the mudslide. Her four-year old son was narrowly rescued, but her husband and three other children are missing, presumed dead, and her family home was destroyed. The heroic rescue of her son has been shown on CNN.

Cascade Valley is owned by Milestone Retirement Communities, and they have established a fund to support Jonielle and her son, Joshua, who are currently staying at a shelter. They have lost everything. We want to provide information to all of our contacts in the long term care community on how you can support Jonielle and Joshua as well. If you would like to make a contribution, you may do so at any US Bank. Simply drop into a branch near you and utilize the account name and number below or mail your contribution to the address provided:

“The Jonielle Spillers Family Fund”
The Account Number is 153564726179

US Bank
Fisher’s Landing Office
PD-WA-4577
16415 Se McGillivray Blvd
Vancouver, WA 98683
At times like these, we reflect on just how much people matter—how different life could be if we lose those we love. We encourage each of you, as a community, to surround this family and support them during this time of loss, uncertainty, and sadness. We, as a community, can be strength and help to this family. WHCA will be making a contribution to support this family—part of our long term care family—and we hope you will consider doing the same. Our thoughts and prayers are with Jonielle and Jacob and all of those touched by this tragic event.

Place These Tropically-Colored Balloons All Over Your Center!

Karah DeMarco

Add a splash of vibrant color and fun to your center and the sites of your National Nursing Home Week® events with these balloons.

10-pack Yellow - Product #8318Y
  • AHCA Member: $5.95
  • Non-member: $7.95
10-pack-Lime Green - Product #8318G
  • AHCA Member: $5.95
  • Non-member: $7.95
10-pack-Magenta - Product #8318M
  • AHCA Member: $5.95
  • Non-member: $7.95
30-pack (10 of each color) - Product #8318A
****SAVE $3.90 when ordering the 30 pack**
  • AHCA Member: $13.95
  • Non-member: $15.95

Don’t wait until the last minute. Our National Nursing Home Week products are very popular and will sell out. Plan ahead and place your order early to ensure product availability, size and color selection and timely delivery.

Phone Orders: 800-321-0343

Online Orders: www.AHCApublications.org

Patient Safety Culture Survey from AHRQ

Lyn Bentley

The Agency for Healthcare Research and Quality (AHRQ) is accepting submissions on its Patient Safety Culture Comparative Database from April 1 – April 21, 2014. See their notice below!

According to the AHRQ, “One of the purposes of the database is to produce comparative results to help nursing homes identify strengths and opportunities for improvement in their patient safety culture.” Topics covered in the survey include:
  • Teamwork; Training & Skills; 
  • Non-Punitive Response to Mistakes; 
  • Communication Openness; and 
  • Feedback & Communication About Incidents. 
Results of the survey are made public in the aggregate with no identifying information about specific nursing centers or staff who responded. Centers are able to compare their individual responses to the results in the data base, providing an opportunity to assess their strengths and opportunities for improvement. 

Note: This tool and the results are helpful for a center moving forward in its QAPI efforts – they may provide ideas for improvement projects.


Here's the notice from straight from AHRQ:

Data Submission Open for AHRQ Nursing Home Survey
Data submission is now open for the Agency for Healthcare Research and Quality (AHRQ) Nursing Home Survey on Patient Safety Culture Comparative Database. Nursing homes that have administered the AHRQ nursing home safety culture survey can now voluntarily submit their data.

To submit data, please go to http://www.sops-database.org/nursinghome.
  • Data submission is open from April 1 - April 21, 2014;
  • Nursing homes must have licensed nursing home beds;
  • Nursing homes must be in the U.S. or U.S. territories; and
  • Assisted living, community care, or independent living facilities are not eligible to participate.
This database is a central repository for survey data from nursing homes, or survey vendors, that have administered the AHRQ nursing home survey instrument. One of the purposes of the database is to produce comparative results to help nursing homes identify strengths and opportunities for improvement in their patient safety culture. Comparative results are reported in the aggregate and do not include any information identifying participating nursing homes.

Please feel free to contact us with any questions or concerns at DatabasesOnSafetyCulture@westat.com.
Thank you,
The Nursing Home Survey Database Submission Team



Congress Passes “Doc Fix,” Includes AHCA-Influenced Readmissions Plan

Drew Thies

The Senate voted 64-35 Monday night to pass a one-year patch of the Medicare physician payment schedule, known as the sustainable growth rate (SGR). The Senate adopted the House’s version, the 'Protecting Access to Medicare Act of 2014,’ which was passed late last week. Included in the legislation is a value-based purchasing program for skilled nursing centers that establishes a hospital readmission reduction program for the profession.

Long term and post-acute care providers have been a target for funding previous SGR patches, which frequently cost in the tens of billions of dollars. This year, with the counsel of AHCA, Congress developed a method of saving $2 billion by creating an incentive structure for reducing hospital readmissions from skilled nursing centers. This new program was used in lieu of a straight cut, such as a market basket reduction.

Under the provision, the Secretary of Health and Human Services will withhold 2% of Medicare payments annually beginning in FY 2019 in order to generate an incentive pool and savings to Medicare. More than half (50-70%) of the withheld funds will then be distributed among high-performing providers, which will be determined by the Secretary in the coming years. Depending on performance, it could be possible for providers to avoid any penalty and potentially, some could achieve a greater payment rate.

The financial implications of the program are not set to start for another four years at the beginning of FY 2019, which begins October 1, 2018. Before then, CMS will be creating the readmission measure, scoring system, incentive pool and monitoring structure needed to implement this program.

Going forward, AHCA will begin to work closely with CMS and the Secretary in order to insure that the monitoring and incentive structure put in place is best for the profession. When the next administration takes office, AHCA will lobby hard to ensure the maximum amount of the incentive pool—70%—is returned to providers.

Other provisions in the one-year doc fix impacting SNFs included:
  • Extension of the therapy caps exception to the April 1, 2015 deadline. Though AHCA’s language to improve the Manual Medical Review (MMR) process was not included in the short-term patch, AHCA’s administrative advocacy efforts continue to move CMS towards alleviating these burdens internally. More on that here.
  • A one-year implementation delay of the new ICD-10 code sets. The new code sets used to report medical diagnoses and inpatient procedures will now take effect October 1, 2015.
The one-year doc fix will preserve physicians’ Medicare payments until April 1, 2015, at which point another patch will have to be passed unless the SGR is repealed and replaced.

The Senate vote came on the heels of a controversial voice vote for the bill in the House last Thursday. President Obama signed the legislation into law yesterday evening.

Many in both the House and the Senate attempted to pass a permanent fix to the SGR, but the price tag sparked controversy that derailed previously bipartisan negotiations. “We don't have the votes to do what would be the better thing to do,” said Senate Majority Leader Harry Reid before the patch was passed in the Senate.

The remainder of the 2014 legislative calendar is, as of now, risk-free for long term and post-acute care providers. AHCA’s team, however, will continue to build lasting relationships on The Hill in order to ensure that if unknowns do arise, we will be well-prepared to respond to them.

Hotel Rooms For the 2014 Congressional Briefing Are Going Fast!


Danielle Levitan

http://cb.ahcancal.orgThe Hyatt Regency Washington on Capitol Hill is sold out.

AHCA/NCAL has secured additional rooms at the Fairfield Inn & Suites located just a short walk to all meetings and events at the Hyatt Regency Washington on Capitol Hill. Take advantage of the special AHCA/NCAL rate of $279 for a single or double occupancy plus 14.5% occupancy tax and make your reservation today.

Fairfield Inn & Suites
500 H Street, NW
Washington, D.C. 20001

To secure your reservation, call (202) 289-5959 and reference Congressional Briefing. You can also reserve online.

The deadline to reserve at this special rate is April 21st, but don't wait. Rooms are filling up very fast, and spring is a very popular time for visitors in Washington, D.C. Make your reservation as soon as possible!

The AHCA/NCAL Congressional Briefing offers an excellent opportunity to have your voice heard so don’t miss out. Get an update on what's happening on the Hill and hear from multiple speakers including key Members of Congress. Pulitzer Prize-winning Washington Post columnist Charles Krauthammer kicks things off as the Opening Keynote Speaker and Senate Finance Committee Chair Ron Wyden (D-OR) will also be speaking.

Meet with Your Members of Congress

Set up meetings with your Members of Congress for Wednesday, May 21, 2014. Once you have scheduled a meeting, please tell us your scheduling information so we can have materials ready for your visit and have an AHCA lobbyist attend with you if needed. If you have trouble setting up your own meetings or are unfamiliar with setting up meetings with Members of Congress, e-mail us at congressionalbriefing@ahca.org and we can assist you in scheduling a meeting with your legislator.


See the complete agenda and learn more at cb.ahcancal.org. The advance registration deadline is Monday, April 21, 2014, so register today!

The conference registration fee is complimentary. Registration for this event is exclusively for long term and post-acute care provider members of AHCA/NCAL and AHCA/NCAL Associate Business Members only.

Thank you to our official sponsor, Medline and supporting sponsors: HealthCap, LTC Properties, and ParMerica!