Thursday, April 28, 2016

CMS Releases New Resource Guide for Quality Improvement Tools

Holly Harmon, RN, MBA, LNHA
AHCA Senior Director of Clinical Services


CMS has posted a new Resource Guide for Quality Improvement Tools related to new April 2016 Nursing Home Compare Quality Measures. This guide includes a description and link to multiple tools and resources that are available to centers, including some resources from AHCA. The tools in this guide are sorted into the following five categories:
  • Resources for Systems Approaches to Quality Improvement
  • Resources for Antianxiety or Hypnotic Medication Measure
  • Resources for Mobility Measure (Short Stay or and Long Stay)
  • Resources for Emergency Department Visits and Rehospitalization Measures
  • Resources for Community Discharge Measure
Check out the Resource Guide for Quality Improvement Tools to review and consider using resources that already exist to help centers with quality improvement.

Wednesday, April 27, 2016

Living the Mission: A Day for Not for Profit (NFP) Providers from AHCA/NCAL

Dana Halvorson

AHCA/NCAL’s constituency education program for NFP providers will be held on Tuesday, October 18, in Nashville, TN, and is packed with motivational and educational speakers. The keynote speaker, John O’Leary (pictured), was a curious nine-year-old boy. Playing with fire and gasoline, he created a massive explosion in his garage and was burned on 100% of his body. Given less than 1% chance of survival, John is proof of the power of the human spirit.

Using his fire story as a backdrop, John will inspire you to take back your life, see the abundant possibility within your professional and personal challenges, and change the world. Participants will also have the opportunity to hear from other top-notch speakers. More information about this day and where to register can be found here. Registration opened on April 6. If you have any questions, please don’t hesitate to contact AHCA’s Senior Director of Not for Profit & Constituent Services, Dana Halvorson.

President Obama Signs the Older Americans Act Reauthorization Act

Lilly Hummel

On April 19, 2016, President Obama signed the reauthorization of The Older Americans Act (OAA), which promotes the well-being of older individuals by providing services and programs designed to help them live independently in their homes and communities. The Department of Health and Human Services’ Administration on Aging oversees the majority of OAA-funded programs, including supportive services, congregate and home-delivered nutrition services, family caregiver support and the long-term care ombudsman program, among many others. These grants to states and organizations are a critical component of long term services and supports.

DOJ Launches Ten Elder Justice Task Forces

Dianne De La Mare


The Department of Justice (DOJ) has launched 10 regional Elder Justice Task Forces, which bring together federal, state and local prosecutors, law enforcement and agencies that provide services to the elderly to coordinate and enhance efforts to pursue nursing centers that provide substandard care to residents. Participants in the regional tasks forces will include the state Medicaid Fraud Control Units (MFCUs), US Attorneys’ offices, HHS, state Adult Protective Services agencies, Long Term Care Ombudsman programs, and various other law enforcement agencies.

The task forces will focus on protecting nursing center residents from serious abuse, neglect, and other harmful care resulting in “grossly substandard care,” by prosecuting individuals and companies involved in such care. These task forces will play an integral role in DOJ’s future investigation and enforcement activities against nursing centers.

AHCA is monitoring this effort carefully, and will continue to keep the membership informed of any new developments. Read the announcement at https://www.justice.gov/opa/pr/department-justice-launches-10-regional-elder-justice-task-forces.

Brown University Survey on Camera Use

Clara Berridge, PhD, MSW
Center for Gerontology and Healthcare Research
Brown University School of Public Health


Researchers at Brown University are conducting a short, 8-question multiple choice national anonymous survey to learn about nursing center and assisted living policies regarding camera use in resident rooms.

As you know, there has been renewed attention in the media on the use of cameras in resident rooms in nursing centers or assisted living facilities. While there is no federal law, some states now have regulations allowing private individuals to install cameras in nursing center resident rooms, and others are considering adopting similar laws. This survey will help estimate how widespread the use of cameras is in resident rooms. It also will help provide information on how requests for cameras are handled by facilities, how staff feel about cameras observing their behavior, and the unintended negative consequences of using cameras in this way.

Please use the attached link to complete this short online survey even if your facility has no policy or doesn’t permit cameras in resident rooms.  They do not collect your name or the name of your facility. They guarantee that your answers are entirely anonymous (e.g., they have no way to link your response to you or your facility). 

Please follow this link to complete this 2-minute online survey:

https://brown.co1.qualtrics.com/SE/?SID=SV_2hI3Hu084qiSuQl


You can read more information about the survey here.

Senator Flake Introduces Necessary Workers Bill

Drew Thies
Senator Jeff Flake (R-Ariz.) introduced legislation last week that would create a pilot guest working program to address crucial worker shortages.

The Willing Workers and Willing Employers Act (S. 2827) seeks to address the gap between immigrants seeking temporary, seasonal work in the U.S. and those seeking longer stays for highly skilled labor under the H-1B visa and other similar programs.

The American Health Care Association (AHCA)/National Center for Assisted Living (NCAL) applauded the Senator’s efforts in a press release, saying the bill “makes it easier for foreign nurses and other health care workers to get jobs” in a sector that is experiencing a workforce shortage that only grows worse as the country ages.

“Recruiting, training, and retaining caregiving staff are the biggest challenges facing skilled nursing care centers today,” said Clifton J. Porter II, senior vice president of government relations for  AHCA/NCAL.

The program allows for the U.S. to admit workers with less than a bachelor’s degree to do year-round, non-farm work under flexible caps determined by market needs.

AHCA/NCAL members can travel to Washington D.C. to advocate for Sen. Flake’s bill and other issues, such as Medicaid and Observation stays, during the annual Congressional Briefing, May 23rd-24th. Due to increased demand, registration has been extended to April 29th, but slots are filling up fast so those interested are encouraged to register soon.

A long-standing member of the Essential Worker Immigration Coalition (EWIC), AHCA is one of 37 organizations that has worked closely with key Congressional members to shape and draft practical immigration reform legislation.

#ProviderChats on Tuesday, May 10th

Katherine Merullo


On Tuesday, May 10th Provider Magazine will host the next Twitter chat on Elder Care and the Women at 1 PM Eastern Time.  Follow along for the hour on Twitter using #ProviderChats.  During this chat we will discuss the importance of female caregivers both in the family caregiver and the professional roles.  We will hear from experts who talk about innovative ways to provide care for the working women who are also the family caregivers.  We will also discuss the way the US is managing aging and elder care services and how we compare to others.

There is also the important role that employers play with regard to time off, educational programs and non-financial support that is needed.  This is sure to be an informative discussion with a guest panel of experts to guide us. We will also have nursing staff and providers join the conversation with the expertise from the National Association of Health Care Assistants (NAHCA) and The Evangelical Lutheran Good Samaritan Society

Panelists Include:

Ellen Belk, CDP is president of Keep In Mind Inc., specializing in holistic dementia care solutions and caregiving resources. With more than 15 years of professional dementia care leadership, Belk is known for her operational expertise, executive leadership development, creative activity initiatives and caregiver training.

She authored the 360° Dementia Care Operational Manual™ for professional dementia care partners who seek a comprehensive operational tool that exceeds industry expectations. 
Robin L. Hillier, CPA, STNA, LNHA, RAC-CT, is a health care executive dedicated to post-acute and long term care. Throughout her career she has been involved in all aspects of facility operations, including ownership roles. She is currently the director of reimbursement and quality metrics for Welcome Nursing Home in Oberlin, Ohio; co-owner of Quality Life Services, a home health agency; and president of RLH Consulting, which provides operational and reimbursement consulting to providers of skilled nursing, assisted living and intellectual or developmental disabilities.
Nancy L. Kriseman, L.C.S.W, is a licensed clinical social worker who has worked with older people and their families for over 30 years. Nancy is currently in private practice and presents workshops on caregiving, loss and grief and dementia across the country. As an adjunct faculty member at Kennesaw State University and Mercer University, she taught courses on aging and death and dying. She has published two books, The Mindful Caregiver: Finding Ease in the Caregiving Journey, Feb 2014, Roman and Littlefield publishers & The Caring Spirit Approach to Eldercare: A Training Guide for Professionals and Families 2005 Health Professions Press.
Follow the conversation using #ProviderChats on Twitter and learn about services, programs and ideas to better meet the needs of the female caregiver. Submit your own questions to @ProviderMag or @ahcancal ahead of time or ask during the discussion live.

Webinar: How to Run Reports in LTC Trend Tracker

Christy Sharp


Attention all Independent Owners. On Thursday, June 9 we will host training on How to Run Reports in LTC Trend Tracker and How to Set up your Dashboard. Utilizing the tools within LTC Trend Tracker will help members keep track of progress towards achieving goals of the AHCA/NCAL Quality Initiative and to prepare for mandatory reporting.  There is also a helpful Resource Center with additional guides, videos and help documents to assist you in the program.
LTC Trend Tracker Training 
Thursday, June 9, 2016  
10:00 AM  | Eastern Daylight Time   | 1 hr



Join by phone
+1-415-655-0003 US TOLL
Access code: 731 826 594

New Measures are Live on Nursing Home Compare!



Holly Harmon, RN, MBA, LNHA
AHCA Senior Director of Clinical Services



The CMS Nursing Home Compare website now includes six new quality measures, four short-stay and two long-stay measures. The measures are:

Short-Stay

  • Percentage of short-stay residents who made improvement in function (MDS-based)
  • Percentage of short-stay residents who were successfully discharged to the community (Claims-based)
  • Percentage of short-stay residents who were rehospitalized after a nursing home admission (Claims-based)
  • Percentage of short-stay residents who had an outpatient emergency department visit (Claims-based)
Long-Stay
  • Percentage of long-stay residents whose ability to move independently worsened (MDS-based)
  • Percentage of long-stay residents who received an antianxiety or hypnotic medication (MDS-based)
Five of the six new measures (not including antianxiety/hypnotic use) will be added to the Five-Star quality measure component starting in July. Although CMS has not yet announced the specific schedule for when these new measures will affect the Five-Star rating, a phase-in of the measures is expected.

Four key points to consider and explore regarding these changes:


1) Accountability after Discharge - Recognize that three of the new short-stay measures include outcomes after discharge from the center. The three measures are discharge to community, rehospitalization and emergency department use. Traditional discharge planning and assumed release of responsibility after the day of discharge will not position a center for success in this changing healthcare environment. 

What can you do? Evaluate your systems and processes around care transitions and pursue performance improvement opportunities to achieve improved outcomes. 

2) Influence of Short-Stay Outcomes - As the new measures are added to Five-Star starting in July, the quality measure component will be more influenced by quality measure performance for the short-stay population than it has in the history of the Five-Star rating system for nursing centers. Eventually, there will be seven short-stay measures versus three short-stay measures contributing to the Five-Star quality measure component.

What can you do?
Know the person, each individual served in your center from day one. Understand the needs of your short-stay population. Use root cause analysis often to support continuous improvement.

3) Claims Based - This is the first time claims based measures will be used on Nursing Home Compare and eventually the Five-Star Quality Rating System. Hospital claims for Medicare Part A and Medicare Part B are a source of information for the new short-stay claims based measures.

What can you do? Verify that the right systems and processes are in place in your center for timely submission of MDS and claims. Develop channels with local hospitals to foster timely communication and coordination as individual patients and residents move to and from hospitals and nursing centers.

4) Quality Strategy - Pursuing the AHCA Quality Initiative goals position members for success in this changing world where quality and payment are becoming one and successful patient and resident outcomes determine business success.

What can you do?
Embark on the AHCA Quality Initiative today! Explore the Getting Started Guide.

AHCA offers several resources to help members along the journey of quality improvement. Visit LTC Trend Tracker to dig into your data, ahcancalED for online education specifically tailored to post-acute and long term care and AHCA Quality Initiative goals for many resources available to apply into every day practice.

To learn more about what you can do to prepare for upcoming Five-Star changes, click here.


Read more about the CMS additions here and here.

Tuesday, April 26, 2016

Advanced Registration Extended

meetings@ahca.org

Come to Congressional Briefing and advocate for the continued funding of Medicaid. Congress is looking for ways to save money so it is a critical time to meet with your Members of Congress and tell them not to reduce provider assessment rates.

During the May 24th morning Congressional Briefing session, AHCA/NCAL will have a panel discussion on best practices for successfully advocating with elected officials. You'll hear from your peers about what has worked for them and learn specific strategies that you can use in your own advocacy efforts.

Reserve your hotel by the April 28th deadline to get the special AHCA/NCAL rate.

Don't miss this opportunity to go to Capitol Hill and use your voice to fight for the quality of care that you are able to provide in your centers. The Advance Registration has been extended until Thursday, April 28. 

See the complete agenda and register for Congressional Briefing today.

The conference registration fee is complimentary to AHCA/NCAL Members and AHCA/NCAL Associate Business Members, and their spouses, and is accepted on a first-come basis. All registrations include continental breakfast, networking lunch, and cocktail reception.


Official Sponsor: Medline
Supporting Sponsors: Navigator, LTC REIT

Monday, April 25, 2016

Nursing Home Compare Quality Measures on CMS Agenda This Thursday



AHCA Vice President, Quality & Regulatory Affairs

On CMS' Open Door Forum call this Thursday, April 28 at 2 p.m. Eastern Time (ET), the agency will update long term and post-acute care providers on the six new Quality Measures (QMs) that will be published on the Nursing Home Compare website on Wednesday, April 27. The new measures (four short-stay and two long-stay) are: 

  • Percentage of short-stay residents who were successfully discharged back to the community (claims-based) 
  • Percentage of short-stay residents who have had an outpatient emergency department visit (claims-based) 
  • Percentage of short-stay residents who were rehospitalized after a nursing care center admission (claims-based) 
  • Percentage of short-stay residents who made improvements in function (MDS-based) 
  • Percentage of long-stay residents whose ability to move independently worsened (MDS-based) 
  • Percentage of long-stay residents who received an antianxiety or hypnotic medication (MDS-based) 
In July, all but one measure - hypnotics/anxiolytics - will be added to Five-Star and may have an impact on the overall star rating.

In addition to Nursing Home Compare QMs, other agenda topics include:

  • FY 2017 Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities - Proposed Rule 
  • FY 2017 Skilled Nursing Facility PPS NPRM - SNF Value Based Purchasing 
  • FY 2017 Skilled Nursing Facility PPS NPRM - SNF Quality Reporting 
  • Self-Identified Overpayment Final Rule CMS-6037-F 
  • Electronic Staffing Data Submission PBJ Update 
To review the complete agenda and for more information, click here.

For Open Door Forum schedule updates, click here.



Friday, April 22, 2016

Nominate Your Champion of Quality By June 9!

Erin Prendergast


Do you know an individual who has made significant national contributions to advancing quality performance in long term and/or post-acute care? Then nominate them today! Nomination forms can be found on Champion of Quality Award page, and must be submitted via email to by June 9, 2016.

Previous recipients, including Dr. Alice Bonner (2015) and Ed McMahon (2014), 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 an AHCA/NCAL member of good standing. 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 67th AHCA/NCAL Annual Convention ​and Expo​ on Wednesday, October 19th in Nashville, TN.

Please contact Erin Prendergast with questions, or visit the Champion of Quality award page for more information.


Thursday, April 21, 2016

Five-Star Preview Reports Available Now!

AHCA Senior Director of Clinical Services

The Five-Star Preview Reports are now available through the CMS QIES System. This report includes a preview of data for each center on the new quality measures that will be added to the Nursing Home Compare website on April 27, 2016. Providers can review this report to see how the center is performing on the new measures and compare to the national average. Instructions on how to access the report can be found on the ahcancalED website here.

The Five-Star Help line (800-839-9290) will be available from April 25, 2016 through April 29, 2016. CMS will continue to make Provider preview reports available on a monthly basis in advance of public posting and will include the dates and hours of helpline availability. BetterCare@cms.hhs.gov is an alternative way to direct inquiries.

To learn more about what you can do to prepare for upcoming Five-Star changes, click here.

Wednesday, April 20, 2016

New Guidance on HCBS Final Rule Implementation

Lilly Hummel

The Centers for Medicare and Medicaid Services (CMS) posted new FAQs on the Home and Community-Based Services (HCBS) waiver rule implementation. CMS notes that further technical assistance is forthcoming to detail how the home and community-based settings requirement can be implemented for individuals with dementia or Alzheimer's disease. The guidance provided some information on modifications to the HCB settings requirement, in particular acknowledging that providers serving individuals with dementia have to take into account safety concerns. It emphasizes, however, that modifications must be highly individualized and cannot be made for a class of individuals.

 CMS also clarified that it will not issue pre-approval for a setting under development or new construction. According to CMS, a setting presumed to have the qualities of an institution cannot be determined to be compliant until it is operational and occupied. States may request a heightened scrutiny review of newly operational settings that will be presumed to be institutional, but CMS "strongly encourages states to limit the growth of these settings." CMS expects that stakeholders instead create new programs that promote full community integration.


 

Congressional Briefing a Key Time to Advocate on Medicaid

Drew Thies


The upcoming 2016 AHCA/NCAL Congressional Briefing is a critical time for skilled nursing and assisted living providers to advocate for the preservation of Medicaid in front of Members of Congress and their staff.

One House committee has already voted this year to cut Medicaid by reducing the provider assessment rate by half a percent in some states. This provision, if passed, represents over $8 billion cut from the Medicaid program nation-wide.

The bill, H.R. 4725, passed out of the Energy and Commerce committee in March, though has not made its way to consideration on the House floor.

Members of Congress will be looking for ways to save the government money as current appropriations expire at the end of September. Additionally, the November election sets up a so-called “lame duck” Congress, which can be legislatively unpredictable.

Coming to Washington and sharing with Members of Congress the value of Medicaid and the care it funds is one of the best ways to ensure the continued preservation of this safety net for millions of Americans.

Medicaid is reimburses only 90 cents for every dollar of care provided in skilled nursing facilities. More cuts are not sustainable given the already-underfunded nature of the program.

For assisted living providers, nearly half of communities are Medicaid-certified and taking part in their state’s Medicaid waiver program to provide home and community-based services (HCBS) to vulnerable seniors. A final rule issued by CMS in 2014 defines HCBS under the waiver program and will be implemented in 2019. We must ensure that assisted living continues to be included and considered an HCBS, so that Medicaid recipients can continue to access these services and remain in their assisted living homes.

AHCA/NCAL urges all members to make the trip to D.C. on May 23-24 to hear from political thought leaders and impress upon Members of Congress the importance of continued funding for Medicaid.

Registration is open until April 22. Spillover space is open but is filling up fast, so quick registration is highly encouraged.

Rural Health Care Access Legislation Approved out of House Subcommittee

Dana Halvorson


Last week, Dan Holdhusen, Director of Government Relations at the Evangelical Lutheran Good Samaritan Society and AHCA member, testified in front of the Energy and Commerce Subcommittee on Communications and Technology during a hearing in support of the Rural Health Care Connectivity Act of 2015. Dan encouraged swift passage of this important legislation. Yesterday, the Subcommittee cleared and passed H.R. 4111. More details about the markup can be found here.

AHCA is in full support of the Rural Health Care Connectivity Act of 2015 (S. 1916/ H.R. 4111). This legislation would amend the Communications Act to permit eligible not for profit and public skilled nursing facilities (SNFs) to apply for support from the Universal Service Fund’s Rural Health Care Program (RHCP). The RHCP provides funding for telecommunications and broadband services used to provide health care in rural areas and communities. S. 1916/H.R. 4111 specifies that SNFs be included in the definition of health care providers that are eligible to receive RHCP support. By Federal Communications Commission (FCC) interpretation, SNFs are currently not eligible to receive these funds as, we believe, the Telecommunications Act of 1996 intended. S. 1916 passed unanimously by the Senate Commerce Committee on November 18, 2015.

AHCA will keep its membership apprised on further updates relating to this legislation as we have them.   


 

Leading the Charge for Compassionate Care: A Day for ID/DD Residential Services Providers from AHCA/NCAL

Dana Halvorson
AHCA/NCAL’s constituency education program for Intellectual and Developmental Disabilities (ID/DD) Residential Services providers will be held on Tuesday, October 18 in Nashville, TN, and is packed with motivational and educational speakers. The keynote speaker, John O’Leary (pictured), was a curious nine-year-old boy. Playing with fire and gasoline, he created a massive explosion in his garage and was burned on 100% of his body. Given less than 1% chance of survival, John is proof of the power of the human spirit. Using his fire story as a backdrop, John will inspire you to take back your life, see the abundant possibility within your professional and personal challenges, and change the world. Participants will also have the opportunity to hear from other top-notch speakers.

More information about this day and where to register can be found here. Registration opened on April 6. If you have any questions, please don’t hesitate to contact AHCA’s Senior Director of Not for Profit & Constituent Services, Dana Halvorson.     





Tuesday, April 19, 2016

Go Where the LTC Profession Goes

Dave Kyllo


It’s no secret that the AHCA/NCAL web site is where thousands of long term care professionals go for information every week. It’s also where they see the latest job vacancy postings from the Long Term Care Career Center.

Employers who utilize the site now get increased exposure through rotating job listings on AHCA’s home page. In addition, employers who post vacancies through the center receive bonus rotating listings on the Long Term Care Career Center home page.

The Long Term Care Career Center is the premier site for those interested in the long term and post-acute care positions. Rates for posting job vacancies are affordable and give prospective employers far greater exposure than local ads and job boards by connecting to a network of 330 health care organizations and societies. Employers are also able to post vacancies as they occur and search resumes on the network. And, of course, the Long Term Care Career Center is always free for job seekers.

If you want to reach talented health care professionals, check out the LTC Career Center today.

IPPS/LTCH Proposed Payment Rule



On April 18, 2016 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update fiscal year (FY) 2017 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed rule, which would apply to approximately 3,330 acute care hospitals and approximately 430 LTCHs, would affect discharges occurring on or after October 1, 2016.

CMS projects LTCHs will experience a decrease of $355 million, or 6.9%, to $4.757 billion in 2017 compared to 2016, even though these facilities are set to experience a net 1.3% increase in reimbursements for care provided to patients meeting the statutory LTCH patient criteria. The challenge is the two-year transition to the patient criteria that was finalized last year and began to be implemented in 2016, depending on a facility’s cost reporting calendar year. The agency long has indicated that slightly more than half of the patients treated at LTCHs would qualify under the patient criteria. CMS estimates that spending on care provided to site-neutral patients will decline by $367 million, or 21%, in FY17.

The proposed Medicare inpatient hospital reimbursement regulation included few unexpected elements with one exception. Specifically, CMS proposed larger than expected recoupment to mitigate the short-stay policy known as the “two midnight rule.” In the IPPS proposed rule, CMS projects total inpatient hospital spending would rise by $539 million over

To view the rule, click here and to view the CMS factsheet click here. If you have questions, suggestions or concern, feel free to contact us.


AHCA/NCAL Convention & Expo Heads to Music City USA

meetings@ahca.org

Great entertainment. Friendly people. Unforgettable experiences. All of this describes Nashville, Tennessee, known as Music City USA. But this also describes the AHCA/NCAL 67th Annual Convention & Expo, to be held in Nashville on October 16-19.

This is the gathering place for long term and post-acute care professionals, where leaders in the field gather to share ideas, learn about new techniques and services, network, and have fun. Educational sessions are designed to help you provide for your residents in the most efficient and effective way; keynote talks will inspire you; visits to the Expo Hall will expose you to the very latest in products and services for your business; and networking events will help you make new friends.

Registration is now open. Online registration is easy and you can make your housing reservation online once you register for the event. Early bird registration continues through July 22.

Protect Your Funding and Reimbursement Rates

Raise Your Voice at Congressional Briefing 

Come to Congressional Briefing and use your voice to oppose any legislative proposal that reduces the Medicaid provider assessment rate or quality assessment fee. If you haven't yet registered, do it today. Don't miss this chance to meet with your Representatives in person. It's critical that you speak up now and help AHCA/NCAL send a strong message to Capitol Hill as we fight for quality long term and post-acute care on May 23-24, 2016.

In addition to meeting with your Members of Congress, you can earn CEUs, network with your peers, and discuss the critical issues that matter to you.

See the complete agenda and register now.

The advance registration deadline is this Friday, April 22.

The conference registration fee is complimentary to AHCA/NCAL Members and AHCA/NCAL Associate Business Members, and their spouses, and is accepted on a first-come basis. All registrations include continental breakfast, networking lunch, and cocktail reception.


Official Sponsor: Medline

Supporting Sponsors: Navigator, LTC REIT

NPUAP Announces Revisions to Pressure Ulcer Staging System


This week, the National Pressure Ulcer Advisory Panel (NPUAP) announced changes to the Pressure Ulcer Staging System including the following:

· Change in terminology from pressure ulcer to pressure injury. The change in terminology more accurately describes pressure injuries to both intact and ulcerated skin.

· The use of Arabic numbers in the names of the stages instead of Roman numerals.

· The term “suspected” has been removed from the Deep Tissue Injury diagnostic label.

· Pressure injury definitions for Medical Device Related Pressure Injury and Mucosal Membrane Pressure Injury.

The press release provides further detail. More information will be forthcoming from NPUAP on teaching points for the new stages and the rationale for the changes in staging system.




Learn about the SNF Value-Based Purchasing Program at Open Door Forum

SNFVBPinquiries@cms.hhs.gov

The Skilled Nursing Facilities / Long-Term Care Open Door Forum (ODF) addresses the concerns and issues of both the Medicare SNF, the Medicaid NF, and the nursing home industry generally. The types of issues that come up during this forum are often related to the Minimum Data Set, SNF Consolidated Billing, the roles and responsibilities of different SNF, NF or LTC professional staff under CMS regulations, clarifications of issues that are covered during a survey and certification process, and the many rules and requirements under which different related services can be payable.

Thursday, April 28 
2:00 PM to 3 PM Eastern Time


The next Skilled Nursing Facility (SNF)/Long-Term Care Open Door Forum is rescheduled for Thursday, April 28. Learn about the SNF Value-Based Purchasing Program, which will begin in FY 2019. Timely announcements and clarifications regarding important rulemaking, quality program initiatives, and other related areas are also included in the forums.


CMS has not posted the dial-in information yet on their website but readers can click on the following to sign up for timely email updates from CMS: Skilled Nursing Facilities/Long Term Care Open Door Forum Mailing List Sign-Up For questions, contact SNFVBPinquiries@cms.hhs.gov.

Future Leaders of Long Term Care Program

Christy Sharp

Recommend a candidate to your State Executive to participate in the annual “Future Leaders of Long Term Care in America” program. Candidates will be selected for this professional training and mentorship program, which begins at the September 21 - 23 symposium in Washington, DC. Each state may nominate one person.

ALL nominations must be submitted by AHCA State Affiliates. Each State Affiliate may submit one nomination. Before contacting your State Association to recommend a candidate for this year’s class of Future Leaders, please discuss the following requirements and responsibilities with your nominee. Future Leaders will be expected to:

  •  Attend a three-day training session, which will be held in Washington, DC September 21 - 23;
  • Complete any assigned reading – typically 4 or 5 books during the year – and be prepared to discuss on conference calls; 
  • Participate in a majority of scheduled conference calls and activities, including an event hosted by AHCA/NCAL leadership at the AHCA/NCAL Annual Convention & Expo, which will be held October 15 - 18 in Las Vegas, NV;
  • Demonstrate an interest in working on LTC issues at the national level, which may include participating on AHCA/NCAL workgroups or committees; and
  •  Consider active participation in the AHCA PAC and promoting its importance to other members.

AHCA will absorb the costs related to the 2016/2017 “Future Leaders of Long Term Care in America” symposium, including a two-night hotel stay, airfare, and a fixed stipend of $100.00 for miscellaneous travel expenses.


Once you have discussed the responsibilities and requirements with your nominee, please contact your State Association with your recommendation. AHCA State Executives will be asked to submit a nomination for one person by June 13, 2016.

Should you have any questions, please contact Christy Sharp at csharp@ahca.org or 202-898-2839.

Nursing Center Influenza Study Opens Enrollment

David Gifford, MD, MPH

A team of nationally-recognized long-term care researchers from Brown University and Case Western Medical Center is undertaking a national quality improvement study to evaluate the impact of the annual influenza vaccine on rates of hospitalization among long-term care residents during the 2016-2017 influenza season.

Nursing centers whose leaders agree to participate will receive free vaccine for 2016-2017 and be randomized to receive either the standard annual trivalent influenza vaccine or the adjuvanted trivalent influenza vaccine, Fluad. Both vaccines are FDA-approved and recommended by the CDC for annual protection against influenza infection in adults so no patient consent is necessary. Centers will receive free vaccine for residents and staff, as well as compensation for data entry.

If you are interested in participating in this important project, please notify Dr. Vincent Mor and Dr. Stefan Gravenstein by contacting our study coordinating center, Insight Therapeutics, LLC, at 757-625-6040, or edavidson@inther.com. They can provide you more details about the study objectives and procedures. Please note that you are contacting them as an AHCA member from this announcement.

Wednesday, April 13, 2016

NCAL Releases 2015 NCAL Performance Measure Survey Results

Lindsay Schwartz

In 2015, NCAL members had the opportunity to complete the 6th annual NCAL Performance Measure Survey online. The results of the survey demonstrate some of the ways NCAL members are achieving the four Quality Initiative goals.

Over 96% of respondents had a missions statement and over 90% measure resident satisfaction. Improving staff stability starts with measuring satisfaction and almost 85% of respondents are measuring staff satisfaction. Find out more about the survey and the results on the NCAL website.

AHCA Member Testifies on Capitol Hill Supporting Rural Health Care Access Legislation

Dana Halvorson 

Dan Holdhusen, Director of Government Relations at the Evangelical Lutheran Good Samaritan Society and AHCA member, testified (pictured at left) in front of the Energy and Commerce Subcommittee on Communications and Technology during a hearing in support of the Rural Health Care Connectivity Act of 2015. Dan encouraged swift passage of this important legislation. The Evangelical Lutheran Good Samaritan Society has been ahead of the curve regarding the exchange of health information through their programs such as the LivingWell@Home technology, which helps seniors maintain their wellness and continue to live in their homes. With more than 240 locations across the country, The Evangelical Lutheran Good Samaritan Society is the largest not for profit provider of senior care and services in the United States. 

As noted in the past, AHCA is in full support of the Rural Health Care Connectivity Act of 2015 (S. 1916/ H.R. 4111). This legislation would amend the Communications Act to permit eligible not for profit and public skilled nursing facilities (SNFs) to apply for support from the Universal Service Fund’s Rural Health Care Program (RHCP). The RHCP provides funding for telecommunications and broadband services used to provide health care in rural areas and communities. S. 1916/H.R. 4111 specifies that SNFs be included in the definition of health care providers that are eligible to receive RHCP support. By Federal Communications Commission (FCC) interpretation, SNFs are currently not eligible to receive these funds as, we believe, the Telecommunications Act of 1996 intended. S. 1916 passed unanimously by the Senate Commerce Committee on November 18, 2015.

House Subcommittee on Communications & Technology hearing 4/13/16



Tuesday, April 12, 2016

Rep. Walden to Speak at Congressional Briefing


Drew Thies

Representative Greg Walden (R-OR) will be speaking to post-acute and long term care providers at the 2016 AHCA/NCAL Congressional Briefing on May 23rd.

Rep. Walden is in his 9th term of Congress and serves on the powerful Energy and Commerce Committee, which controls Medicaid, where he is chairman of the subcommittee on Communications and Technology.

Walden also serves as the current Chair of the National Republican Congressional Committee, the group tasked with growing and maintaining the Republican Majority in the House of Representatives. He is currently serving in his second term at the post, having grown the Republican lead in the House to its largest margin since 1931 during his stint in 2014.

Hailing from the large 2nd district in western Oregon, away from the more densely-populated coast Walden prioritizes issues affecting rural communities. The district is Oregon’s only Republican seat, and Walden enjoys good relations with most Democrats, despite the partisan nature of his job at the head of the NRCC.

The Congressional Briefing allows AHCA/NCAL members a chance to discuss critical PAC/LTC policies with key lawmakers like Rep. Walden.

Hotel rooms are booking quickly and overflow has been added. Registration is free and participants are encouraged to reserve their spots as soon as possible, as the conference is expected to have record attendance. Book before April 22 to reserve at the special group rate.

Recognize a Pioneer in Assisted Living



Nominations are now open for NCAL’s 2016 Jan Thayer Pioneer Award. ​The award recognizes an individual who has moved the senior care profession forward, positively affecting the lives of those served and those who serve. Recipients must demonstrate dedication, leadership and considerable contributions to the senior care profession.

Nominations must be submitted online and include a 500-word or less essay, along with a copy of the candidate’s resume. Nominators must be members of AHCA/NCAL; however, candidates are not required to be members. All nominations must be received by June 9, 2016. The recipient is selected by the NCAL Executive Committee and will be honored at NCAL Day at the AHCA/NCAL Convention & Expo in Nashville this October.

The Jan Thayer Pioneer Award is posthumously named after the first Board Chair of NCAL Jan Thayer. A provider for more than 25 years, Thayer owned and operated Riverside Lodge in Grand Island, Nebraska. She also founded and headed up the Excel Development Group, which owned and managed retirement communities throughout the Midwest and employed hundreds.

This is the second year NCAL is honoring an individual in the assisted living profession. The inaugural award was bestowed to Howie Groff of Tealwood Senior Living last year.

Gero Nurse Prep Fills the Senior Care Training Gap for RNs



It’s startling but true. Two-thirds of nurses working in the U.S. have had no training in senior care. The AHCA/NCAL Gero Nurse Prep program was created to help fill this gap in geriatric nursing expertise. This unique program prepares RNs for the American Nurses Credentialing Center board certification test in gerontological nursing. Consider this:

· Gero Nurse Prep is a smart and effective use of training dollars. RNs can study on their own schedules and earn 30 CEUs by completing the program. The cost of the program is current sale price of $690 or $23 per CEU.

· Gero Nurse Prep Alums boast a 96% pass rate on the ANCC gerontological nursing certification exam. ANCC board certification (RN-BC) is the gold standard for demonstrating clinical excellence in geriatric patient care and only costs an additional $395. 

· Gero Nurse Prep and ANCC board certification sets you apart from your competition. Less than one percent of nurses have this prestigious credentialing in gerontological nursing. So, for an investment under $1,100 per nurse leader, providers can have a clinical competitive edge when negotiating with ACOs, MCOs and hospitals. 

· Gero Nurse Prep and ANCC certification are great tools for attracting and retaining great RNs. Offering credentialing can be more appealing than the traditional “sign-on” bonuses everyone else offers and it can even be packaged as an additional bonus to the traditional monetary “sign-on” bonus. Certification is also a great incentive for those talented RNs that you want to keep. 

Clinical competency is fundamental in today’s value-based purchasing marketplace. The AHCA/NCAL Gero Nurse Prep program is a pathway to demonstrating your geriatric nursing expertise. Watch this video to learn more and try a free demo of the AHCA/NCAL Gero Nurse Prep program today.  

‘Keep Connected’ Revealed as 2016 Theme for National Assisted Living Week




National celebration to take place Sept. 11-17, 2016

The National Center for Assisted Living (NCAL) announced today the 2016 theme for National Assisted Living Week® is “Keep Connected.” The annual, national observance provides a unique opportunity for residents, their loved ones, staff, volunteers, and surrounding communities to celebrate the individuals served in assisted living and learn more about this sector of the long term care profession. ​​​​​

Established by NCAL in 1995, National Assisted Living Week® will be held Sept. 11-17, 2016. Assisted living communities across the country are encouraged to use the theme and logo as inspiration for celebrations leading up to and during the week.

The “Keep Connected” logo may be downloaded from www.NALW.org, and assisted living communities, stakeholders, and members of the public may use the logo on materials, such as calendars, flyers, and invitations to support the national observance.

In the coming months, NCAL will issue a planning guide and product catalog centered on ways to “Keep Connected.” Please visit www.NALW.org for updated information and resources.

How I Plan on Succeeding with Payroll Based Journal


Urvi Patel

Save the Date! This webinar will be presented by providers who have successfully submitted data to CMS during the voluntary period. They will share the steps they took, the challenges they faced, and the lessons they walked away with. Attendees will get tips on how to successfully prepare their organization to submit the mandatory staffing data and answers to their questions.


What: How I Plan on Succeeding with Payroll Based Journal
When: Friday, April 29th 11am ET

Where: Register here.

Presenters:

Nathan Dikes, Doctorate in Podiatric Medicine
CEO of Sunshine Health Facilities, Inc.

Mary Savoy RN,MS, LNHA, Administrator
ForestHills of DC

Lois McCaskey, VP Labor Management - Genesis HealthCare
Nursing Home Administrator – PA
MBA

National Healthcare Decisions Day is April 16, 2016

National Healthcare Decisions Day is April 16, 2016.

National Healthcare Decisions Day (NHDD) exists to inspire, educate and empower the public and providers about the importance of advance care planning.  We wish to highlight the importance of advance healthcare decision-making—an effort that has culminated in the formal designation of April 16 as National Healthcare Decisions Day. As a participating organization, AHCA/NCAL is providing information and tools for the public to talk about their wishes with family, friends and healthcare providers, and execute written advance directives (healthcare power of attorney and living will) in accordance with your state laws. These resources are available at www.nationalhealthcaredecisionsday.org.

As a result of National Healthcare Decisions Day, many more people in our community can be expected to have thoughtful conversations about their healthcare decisions and complete reliable advance directives to make their wishes known.  Fewer families and healthcare providers will have to struggle with making difficult healthcare decisions in the absence of guidance from the patient, and healthcare providers and facilities will be better equipped to address advance healthcare planning issues before a crisis and be better able to honor patient wishes when the time comes to do so.

For more information about National Healthcare Decision Day, please visit www.nhdd.org.
You can share on Facebook (www.facebook.com/nationalhealthcaredecisionsday) or on Twitter @NHDD/#NHDD. 

Friday, April 8, 2016

MedPAC Approves Conceptual Model for a Unified PAC Payment System

Mike Cheek

On Thursday, April 7, the Medicare Payment Advisory Commission (MedPAC) unanimously approved a conceptual model for a unified cross-setting post-acute care (U-PAC) payment system. The prototype U-PAC proposal will be submitted to Congress in June.

The MedPAC report is the first of three PAC payment reform reports statutorily mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The initial MedPAC report is intended to lay the foundation for more detailed DHHS work on the development of a unified PAC, cross-setting payment system.

In follow up to the report, the U.S. Department of Health and Human Services (DHHS) is required respond to the June 2016 MedPAC document by 2020. A final proposal for a U-PAC payment system is due to Congress no later than 2023.

Of note, the June 2016 report is not binding in any way. Congress and DHHS may or may not adopt or act upon, respectively, the contents of the report. Considerable further research and policy development is needed before delivery of a final U-PAC proposal.

Highlights
In their comments to the Commissioners, MedPAC staff laid out the topics of the report:
  • Feasibility of a PAC PPS; 
  • Impacts on payments; 
  • Implementation issues; 
  • Possible changes to regulatory requirements; 
  • Companion policies to implement with PAC PPS; 
  • Importance of monitoring provider responses; and 
  • Need to move toward episode-based payments. 
As during the March 3rd discussion, Commissioners lauded the report and reiterated the need to include a recommendation to accelerate development and implementation of a U-PAC system. A summary of the session is available here and a copy of the MedPAC slides are available here.

Wednesday, April 6, 2016

New AHRQ Report Updates Findings on C-diff

Farah Englert
Agency for Healthcare Research and Quality



A new AHRQ research review updates findings on treatment of C. difficile (C-diff) infections, a type of serious healthcare-associated infection that can be difficult to treat. The review looked at results from 93 studies and concludes that the antibiotic vancomycin is more effective than metronidazole for treatment of initial C-diff. But for prevention of recurrent C-diff, fidaxomicin is more effective than vancomycin.

C-diff is growing in the United States and globally, and extremely infectious strains have emerged since 2000. There were an estimated 293,000 cases of C-diff in the United States in 2011. About 55 of every 100,000 infected people 65 and older will die, making C-diff the 17th leading cause of death in this age group. Early diagnosis and effective treatment, including appropriate use of antibiotics, is essential.

The review also concluded that nucleic acid amplification tests are effective for diagnosing C-diff; and that, while research is limited, fecal transplantation and probiotics may be effective treatments. Please visit http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2208&utm_source=Partners&utm_medium=Email&utm_term=Partners&utm_content=3&utm_campaign=AHRQ_CERCDIFF_2016 to download the report.

How I Plan on Succeeding with Payroll Based Journal

Urvi Shah


Save the date! AHCA’s webinar titled “How I Plan on Succeeding with Payroll Based Journal” is scheduled for 11 AM Eastern Time on April 29th. The webinar will be presented by providers who have successfully submitted data to CMS during the voluntary period.
 
Friday, April 29, 2016
11:00 AM- 12:00 PM Eastern Time
 

Register here.

 

Tuesday, April 5, 2016

New CMS Report Shows Deficiency-Free Surveys Increased in Nursing Centers

Lyn Bentley, MSW


The percentage of nursing center surveys that were deficiency-free increased from 8.8% in 2009 to 10.2% in 2014, according to a report released by the Centers for Medicare & Medicaid Services (CMS).

Similarly, the percentage of surveys resulting in the determination of substandard quality of care has also declined from 4.4% in 2008 to 3.2% in 2014.

The 2015 Nursing Home Data Compendium captures survey outcomes and characteristics for more than 15,000 Medicare- and Medicaid-certified nursing centers, and captures information on the demographic, functional and clinical characteristics of more than 1.4 million residents who reside in these centers.

Other highlights from the report include:

· The percentage of surveys resulting in one or more citations for deficiencies at the actual harm level or higher (“G”-“L”) fell each year between 2006 and 2013, reaching a 10-year low in 2013 of 10.3%; it was slightly higher in 2014 (10.6%).

· The prevalence of pressure ulcers declined by 10% between 2011 and 2014, to 5.9%.

Data for the report was collected using three main sources including, the CMS CASPER database for survey and certification information, the Minimum Data Set, and population data from the U.S. Bureau of the Census.

The survey score/health inspection rating is the foundation of the Five-Star Quality Rating System. AHCA members are encouraged to continue to improve their score by going to AHCA’s LTC Trend Tracker to know where they stand and to set a goal to perform even better. Members can learn more about how to access their report by clicking here and/or contacting help@ltctrendtracker.com for assistance.

Click here to see the full Nursing Home Data Compendium for 2015.

Large Employers Must File 1094 & 1095-C Forms with IRS by May 31

Dave Kyllo

All applicable large employers – employers with 50 or more full-time employees, including full-time equivalents – are required to submit Forms 1094-C and 1095-C to the IRS by May 31, 2016, if filing on paper, or June 30, 2016, if filing electronically. The IRS has developed instructions for completing these forms.

The IRS continues to publish useful tax tips for applicable large employers. It is worth noting that these reporting requirements apply regardless of whether health coverage was offered to employees.

AHCA/NCAL members are saving money on their employee health benefit programs through AHCA/NCAL Insurance Solutions. One not-for-profit member is saving more than $2,100 annually per employee. Concerned about your employee health insurance costs? AHCA/NCAL Insurance Solutions may be able to save you money. For more information about health plan options available through AHCA/NCAL Insurance Solutions, contact Dave Kyllo at 202-898-6312 or email ahcainsurancesolutions@ahca.org.



2016-2017 AHCA Elections and Solicitation for Candidates

Christy Sharp


The 2016-2017 election cycle has officially opened for AHCA members in good standing interested in running for the AHCA Board of Governors. The AHCA elections are for three officer positions (Chair, Vice Chair, Secretary/Treasurer), one Not-for-Profit Representative, one Multifacility Representative and three At-large Representatives. AHCA members interested in running for an AHCA Board position may obtain the necessary candidacy materials online. Applicants must complete and electronically submit the AHCA candidacy materials by close of business on June 6, 2016. Candidates will submit completed materials by sending an e-mail to Christy Sharp.


The AHCA elections will take place during the second Council of States meeting at the AHCA/NCAL 67th Annual Convention & Expo, October 16 - 19 in Nashville, TN. Once the application phase has ended, the AHCA/NCAL Credentialing Committee will hold an in-person meeting to conduct a certification process for each candidate. Once certification occurs, AHCA will announce the slate of candidates to the membership. If you have further questions, contact Christy Sharp.



Check Updated LEIE Database

Dianne De La Mare


The US Department of Health and Human Services, Office of Inspector General (OIG) has 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 November 2015. 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 at http://www.oig.hhs.gov/exclusions/exclusions_list.asp, 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 at http://oig.hhs.gov/exclusions/download.asp. Given the penalties and recent government warnings, long term care providers should check the LEIE on a regular basis.

Get a Head Start on Improving Infection Prevention & Control

Holly Harmon, RN, MBA, LNHA

There is a growing emphasis on infection prevention and control in nursing homes. It is seen in the proposed reform of requirements of participation, CMS/CDC infection control pilot project, release of CDC core elements of antibiotic stewardship in nursing homes and more. This is an opportune time for nursing homes to take a look at current infection prevention and control systems and processes to celebrate areas of strength and take action on opportunities for improvement.

Here are five steps to get started:

1. Review your current infection prevention and control program, ideally with a multidisciplinary team. At a minimum involve the Medical Director, Director of Nursing, Administrator and Consultant Pharmacist. As a starting point, consider the CDC Infection Control Assessment Tool used by state health departments to assess infection prevention practices.

2. Compare your current program to the proposed reform of requirements of participation, infection prevention and control related sections.

3. Be sure you are using the latest guidelines. Look to CDC as a resource.

4. Review the Core Elements of Antibiotic Stewardship for Nursing Homes released by CDC late last year. Listen to an AHCA member webinar from Dr. Nimalie Stone of the CDC. Consider taking action on one element at a time to improve Antibiotic Stewardship in your center.

5. Collaborate with other providers and partners such as local hospitals, state health department or others to share ideas, resources and capture opportunities for coordination.

Take action today on this national priority of improving infection prevention and control and directly impact the health and well-being of the many individuals served in your center.

OCR Releases New Privacy Audit Protocol

Dianne De La Mare


The US Department of Health and Human Services (HHS), Office of Civil Rights (OCR), has released its new privacy audit protocol, which will measure compliance with the Health Insurance Portability and Accountability Act’s (HIPAA) privacy, security and breach notification protocols by covered entities (including nursing care centers). 

OCR’s HIPAA Audit program analyzes processes, controls, and policies of selected covered entities (including nursing care centers) pursuant to the Health Information Technology for Economic and Clinical Health (HITECH) Act audit mandate. In March 2016, OCR launched its Phase 2 HIPAA Audit Program, and the agency has now established a comprehensive audit protocol describing the requirements to be assessed during those performance audits. 

The entire audit protocol is organized around modules, representing separate elements of privacy, security, and breach notification, and covers Privacy Rule requirements for:
(1) notice of privacy practices for PHI 
(2) rights to request privacy protection for PHI 
(3) access of individuals to PHI 
(4) administrative requirements 
(5) uses and disclosures of PHI
(6) amendment of PHI; and 
(7) accounting of disclosures. 

Security Rule requirements for administrative, physical, and technical safeguards requirements for the Breach Notification Rule.  The combination of these multiple requirements may vary based on the type of covered entity selected for review.

CMS is soliciting feedback from affected stakeholders at OSOCRAudit@hhs.gov.

District Court Holds Conflicting Medical Opinions Cannot Prove False Claim



In closely watched litigation, a federal district court judge struck down a $200 million False Claims Act (FCA) case against a hospice provider, “holding that the government’s second guessing of physicians’ medical judgment alone cannot prove false claims” (US ex rel Paradies v AseraCare). 

Last May, an Alabama federal district court judge granted AseraCare’s motion to divide its False Claims Act (FCA) trial into Phase I, which would focus on “falsity;” and Phase II, which would focus on “knowledge” and other FCA elements. Phase I was initiated, and after an eight week trial, Judge Karon Bowdre dismissed the case on March 31, 2016. Judge Bowdre held that much of the evidence in the trial consisted merely of conflicting expert testimony about patient eligibility, and the federal government failed to prove its case, as “[a] mere difference of opinion between physicians, without more, is not enough to show falsity.”