UPDATE Weekly

Last week, the President signed the permanent Sustainable Growth Rate (SGR) bill.

What’s Included:

• Stability – A Permanent Fix to the Annual SGR Battle. The doc-fix limped along year-to-year for a total of 17 patches since 2003. We estimate that skilled nursing has been cut by more than $27 billion to pay for short-term SGR fixes.

• Therapy Reforms. The bill includes a 33-month extension of the therapy cap exceptions process (through December 31, 2017). This allows providers to continue delivering therapy above the current $1,940 threshold as long as supporting coding and documentation show the services were medically necessary.

• The legislation also mandates a proposed therapy review process to take the place of current manual medical review (MMR). The new structure will be in place within 90 days of enactment of the bill. It will target providers with high denial rates and outlier billing patterns as well as new providers, certain medical conditions and certain group practices. It also takes RACs out of the review process. The new system is limited to $10 million in funding across all provider settings for FY 2015-2016, which will substantially limit the regulatory burden on skilled nursing therapy services.

• One (1%) Percent Market Basket Update. Skilled nursing is part of the pay-for in this bill. AHCA staff worked closely with Congressional leadership to push the cut back to FY 2018 with the understanding that we can avoid the cut if we provide a better alternative in the interim. Under the proposal, skilled nursing providers will receive a 1 percent market basket increase, net of other adjustments, in FY 2018. This increase takes into account the productivity adjustment within the Affordable Care Act.

• Beginning on April 15th, 2015, CMS released held MPFS claims, paying at the reduced rate, based on the negative update, on a first-in, first-out basis, while continuing to hold new claims as they were received. The MACs will automatically reprocess any claims paid at the reduced rate. No action is necessary from providers who have already submitted claims for the impacted dates of service.

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NCHCFA Summer Symposium. The three-day event will be August 26-28, 2015 at the Embassy Suites Resort at Kingston Plantation, Myrtle Beach, SC. Call the Embassy Suites Resort at (800) 876-0010 to reserve your overnight room. Use group code “HCF” to identify yourself as a NC Health Care Facilities Association Convention attendee! To make your reservation on-line, visit http://tinyurl.com/2015symposiumreservation.

Please note that when our room block is full, rooms will be on a first come, first served basis at prevailing published rates. Please call the Association office at (919) 782-3827 with any questions. Brochures will be mailed to members in June!

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AHCA’s consultant for OSHA matters prepared the following summary:

OSHA recently released an update to its Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. Information pertaining to this subject can be found at https://www.osha.gov/Publications/osha3148.pdf. The publication includes industry best practices and provides some insight on how to reduce the risk of violence in various healthcare and social service settings. In the document, OSHA recommends that healthcare providers develop an effective workplace violence prevention program that includes: (1) Management commitment and employee participation, (2) Worksite analysis/Tracking and Trending, (3) Hazard prevention and control, (4) Safety and health training, and (5) Recordkeeping and program evaluation.

The new guidance does include helpful charts and guides related to the five key program components that provide additional guidance on how to implement these elements. Of particular note and worthy of checking out are the specific suggestions related to hazard prevention including engineering, administrative, and work practice controls that can be implemented (see pages 13-21). While some of these may be costly or difficult to implement, there are some suggestions that could easily be implemented.

OSHA also recommends that all incidents of workplace violence be investigated that include determining the root cause, involving employees in the investigation, and identifying near misses too (see pages 23-24). In addition, there is a list of training topics that OSHA recommends be covered with employees, supervisors, and security officials (see pages 25-27).

OSHA also provides a detailed program evaluation/risk assessment checklist that you may find useful (see pages 30-39) to review your program.

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“Bring on the Fiesta!” is this year’s theme for National Nursing Home Week! Speak the language of Familia, Vida and Amor during National Nursing Home Week 2015! Imagine an event that brings the long-term care (LTC) community of residents, rehab patients, families and care center staff together for a weeklong festival in 2015. Think of all the fun your LTC community can have, which is precisely why the American Health Care Association (AHCA) will designate National Nursing Home Week (NNHW) as “Bring on the Fiesta!” week. National Nursing Home Week products are selling out! Hurry and place your orders today and “Bring on the Fiesta!” Visit AHCA’s on-line store to place your order before it’s too late! National Nursing Home Week is May 10-17, 2015!

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Thank you to those who were able to attend one of the four 30 minute webinars last week to review information and pre-work related to the collaborative. Over 50% of participating homes were able to call in. We reviewed the following:

• Collaborative Goals
• Performance Improvement Project Topics
• QAPI Self-Assessment Tool
• Composite Score
• Discovery Assignment to be completed prior this month

Please find documents posted at ~ http://www.alliantquality.org/content/education-and-presentations

• Slide Set from 4/14 & 4/16 webinars.

• QAPI Self-Assessment Tool – please complete your initial assessment or review/revise a previous assessment
o Provide to Alliant Quality by 4/30/15 if possible
—– Via fax – 678-527-3030
—– Via email to Nancy Fendler, nancy.fendler@alliantquality.org
o Use the following:
—– QAPI Self-Assessment Tool Fillable Document 2015

• Discovery Assignment – The state rate for Low Risk Residents with Loss of Bladder or Bowel is EXTREMELY HIGH
o Upcoming Educational Topic
o Please run a 6 month Resident Level CASPER Report
o Please complete the Discovery Assignment for 5-10 residents who flag on this Quality Measure

• NH Data – please email Nancy Fendler, nancy.fendler@alliantquality.org, if you would like to see your most recent data related to:
o 30 day hospital readmissions
o Composite Score
o Antipsychotic Rate
o 5 other Quality Measures

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Join the North Carolina Culture Change Coalition for a symposium that features an Interactive Theater performance on unnecessary wheelchair use in nursing homes. This event is open to medical directors, administrators, nursing, therapy, restorative aides, nurse aides, state surveyors and Ombudsmen.

This symposium is funded through CMP funds and FREE to four members of your certified nursing home to register. At least one of the attendees must be a certified nursing assistant. CEU credits may be provided for Administrators and nurses. Any additional registrants will be considered based on availability.

• May 8th – Crowne Plaza Asheville
• May 21st – Sheraton Imperial Hotel
• May 28th – Embassy Suites Charlotte/Concord
• June 4th – Double Tree by Hilton New Bern-Riverfront

To secure a spot for this career-enhancing workshop, click here.

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Mark your calendar for the North Carolina Health Care Facilities Association’s “Audit Survival in Long-Term Care/The Roadmap to Success.” This program will provide strategies for managing the people, records, and processes for responding to an auditor’s request for records and appealing denials. The role each person plays during this process includes coordination, preparation, documentation, and tracking. Preventing denials in the first place is part of a comprehensive compliance program as an internal QA function.

Topics include, but not limited to the following:

• Audits impacting nursing homes
• Who may audit you
• How to respond to audit requests
• Appealing audits
• The parts your employees play
• How to reduce/prevent audits

This program will be presented by The Polaris Group on May 28th, 2015 at the Doubletree By Hilton in Greensboro, NC! Brochures will be mailed to all facilities this week!

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Please plan to join your friends and colleagues in beautiful Pinehurst, North Carolina, on September 16th and 17th for the Fourth Annual Autumn Classic Golf Tournament. The event will begin Wednesday with golf, a reception, dinner and program held at the world famous Pine Needles Lodge and Golf Club. The Pinehurst Autumn Classic is being sponsored by the NC Health Care Facilities Association to benefit our political action committee (PAC).

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This book will show you the true financial consequences of unchecked resident readmission and provide you with the tools to do something about it! It delivers several practical strategies your facility can employ, such as enhanced resident assessment and documentation policies, provider partnerships that improve transitions of care, staff education tools, and methods to achieve resident and staff involvement. You’ll learn how to ensure smooth care transitions through resident education and effective communication with staff and other care providers, reduce costs associated with re-hospitalizations, and maintain or improve the resident’s quality of life.

To order, visit http://www.AHCApublications.org or call (800) 321-0343.

Product #8238
AHCA MEMBERS $129.00

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Important information for residents and families… This brochure outlines what physical restraints are, when they should be used, rules and regulations concerning restraints, and making decisions about using them. To order, e-mail your request to Amy Suggs at amys@nchcfa.org.

• NCHCFA Member: $30.00 per 100 brochures plus tax and shipping
• Non-Members: $60.00 per 100 brochures plus tax and shipping

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Experts list warning signs of Alzheimer’s disease:

http://www.newsobserver.com/living/health-fitness/article19072881.html

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The Civil War Ended In Durham. April 9, 1865 is widely known as the day the American Civil War ended. Confederate Gen. Robert E. Lee handed his sword over to Union Gen. Ulysses S. Grant in Appomattox, Va. But 89,000 of Gen. Joseph E. Johnston’s men were still scattered across the South, willing and able to continue fighting the North.

Skirmishes broke out in present-day Morrisville, N.C., before President Abraham Lincoln was assassinated, prompting a truce between Johnston and Union Gen. William T. Sherman. They negotiated the surrender of Johnston’s men at a farmhouse called Bennett Place in Durham. The surrender of 89,000 troops on April 26, 1865 was the war’s largest.

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