UPDATE Weekly

As our members are aware, starting October 1, 2018, all Skilled Nursing Facility (SNF) Medicare Part A rates will be cut by 2 percent to fund an incentive payment pool. At that time, the Centers for Medicare & Medicaid Services (CMS) will adjust payments and return some amount to providers based on how well they do in managing hospital readmissions by meeting or exceeding performance standards. This CMS effort, the SNF Value Based Purchasing (VBP) Program, links financial outcomes to quality performance.

While the SNF VBP program does not affect payment until 2018, CMS is currently collecting rehospitalization data that will be used to determine how much facilities earn back.

The American Health Care Association (AHCA) has several resources designed to support members in reducing rehospitalizations. Each week we will spotlight one of those resources in a new 10-part series. The first resource in this series is Reducing Rehospitalization: Practical Strategies for Success.

Hospital readmissions affect SNF payment, Five-Star ratings, access to participation in preferred networks, and quality measures. In these changing times, to be competitive, you must have a low readmission rate.

Check out Reducing Rehospitalization: Practical Strategies for Success to learn specific strategies to reduce rehospitalizations.

For more information about the SNF VBP program and to access additional resources and tools, visit the AHCA SNF VBP Web Site here.

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On July 7th, the Survey and Certification Group (S&C) at the Centers for Medicare & Medicaid Services (CMS) issued a memorandum, “Revision of Civil Money Penalty (CMP) Policies and CMP Analytic Tool.” The new CMP Analytic Tool, included in the memorandum, must be used by all CMS Regional Offices (ROs) to choose the appropriate CMP type and amount to impose when the RO determines that a CMP is the appropriate remedy. CMS notes that statute and regulations outline a variety of federal enforcement remedies to address compliance and encourages the use of the remedy that will best achieve swift and sustained compliance. The S&C memo provides a summary of revisions to the CMP Analytic Tool, including how CMPs are applied in instances of past noncompliance, the use of Per Instance versus Per Day CMPs, the timing of the revisit survey to certify compliance, and CMS Central Office (CO) review of high CMPs. The new CMP guidance goes into effect July 17, 2017, for all enforcement cases where the CMS RO determines that a CMP is an appropriate enforcement remedy.

CMS is revising the CMP Analytical Tool in several ways:

• Past noncompliance: ROs will use Per Instance CMPs for past noncompliance when a CMP would be recommended (for example, when something occurred before the survey, but the issue has been fully addressed, and the facility is back in compliance).
• Default for noncompliance that existed before the survey: ROs will generally impose a Per Instance CMP retroactively for noncompliance that still exists at the time of the survey, but began earlier. However, a Per Day CMP will be used to address instances of noncompliance when:
  • There is actual serious harm at an IJ level;
  • There was abuse; or
  • The facility had persistent deficient practices violating federal regulations.
• Default for noncompliance existing during the survey and beyond: Per Day CMPs will be the default CMP for noncompliance identified during the survey and beyond. However, exceptions allowing Per Instance CMPs will be made for facilities with good compliance history and where a single isolated incident causes harm (unless abuse is cited).
  • Factors that will be considered in determining a good compliance history include whether the facility is a Special Focus Facility; whether it has not had findings a scope and severity of “G” or above within the past three calendar years, unless those were cited as past noncompliance; whether the facility has a pattern of achieving compliance prior to or at the time of the first revisit; and/or the facility has a history/pattern of sustaining compliance with previously cited deficiencies (that is, no repeat deficiencies).
• Revisit timing: ROs should consider the timing of the revisit survey to certify compliance when imposing the final CMP amount.
• Review of high CMPs: CO will Review CMPs of $250,000 or greater.

Note: The complete 32-page memorandum was also sent to facilities and corporations on July 11, 2017, via e-mail.

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AHCA/NCAL Gero Nurse Prep is designed to prepare RNs to take the American Nurses Credentialing Center (ANCC) board certification exam in gerontological nursing. AHCA/NCAL Gero Nurse Prep does that and much more. It increases RNs’ knowledge of gerontological nursing practice. Gero Nurse Prep students see a whopping 23 percentage point increase on average on their pre-and post-test scores.

That increased knowledge could be a big help to nursing facilities under the next phase of CMS’ Requirements of Participation that takes effect in late November 2017. Under the Phase II Requirements of Participation, nursing facilities will be required to demonstrate that they have the staff competencies and skill sets necessary to provide the level and types of care to meet the individual needs of their resident population.

Given that two out of three RNs in the United States have had no geriatric nursing training, AHCA/NCAL Gero Nurse Prep and ANCC Board Certification are great ways to demonstrate to surveyors that your RNs have the knowledge and skill sets necessary to meet your residents’ needs through specialized geriatric training and board certification.

ANCC is the world’s largest and most prestigious nurse credentialing organization and a subsidiary of the American Nurses Association. Less than one percent of America’s RNs are board certified in gerontological nursing. That means having an ANCC Board certified RN can easily give providers an edge in the marketplace as well as demonstrate to survey teams that your facility has staff with strong geriatric nursing competencies.

AHCA/NCAL’s Gero Nurse Prep program is outstanding in preparing RNs to pass the ANCC gerontological certification exam. RNs who complete the AHCA/NCAL Gero Nurse Prep program have a passing rate of 96 percent on the ANCC exam and receive 30 CEUs. RNs who are interested can become board certified for less than $1,100 ($690 for AHCA/NCAL Gero Nurse Prep and a separate $395 to take the ANCC exam).

Watch this video to learn more about AHCA/NCAL Gero Nurse Prep or click on the course preview to get a quick view of this engaging on-line curriculum designed to help RNs pass the ANCC exam. Be ready to demonstrate your geriatric nursing talent and check out AHCA/NCAL’s Gero Nurse Prep today!

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The State Health Coordinating Council has released the Proposed 2018 State Medical Facilities Plan (SMFP). The SMFP is prepared annually and includes the need determinations for various medical services and providers, including nursing facilities. The information on nursing facilities in Chapter 10, concludes that there is no need determination for additional nursing facility beds. Policies pertaining to nursing care facilities are located in Chapter 4. This report and older reports can be accessed at https://www2.ncdhhs.gov/dhsr/ncsmfp.

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The 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 June 2017 has been posted. The updated files are posted on OIG’s Web site 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.

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Introduced in May 2016, the overtime rule would have greatly increased the salary threshold for overtime exemptions to $47,476, making more than 4 million more workers eligible for overtime compensation.

Implementation of the overtime rule was halted late last year by an injunction from the US District Court for the Eastern District of Texas, which was soon followed by an appeal by the Department of Labor, as well as a lawsuit from states and business advocates claiming regulators had overreached with the rule.

The government’s appeal was effectively dropped recently, with the submission of a court brief by the Department of Labor in the U.S. Court of Appeals for the Fifth Circuit requesting the court approve its authority to set a new, likely lower, salary threshold.

The DOL is now expected to publish a request for public comments to assist in the development of a new overtime rule proposal, according to federal officials.

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A reminder is sent by CMS to facilities in advance of the renewal date. It is the facility’s responsibility to renew their ePOCs every 60 days. For questions, please contact Shonda Kelly at shonda.kelly@dhhs.nc.gov.

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Recently, it was brought to the attention of KEPRO that some Medicare notices have incorrect contact information, including the Important Message from Medicare and the Notice of Medicare Non-Coverage. It is important that the correct information be on these notices, so that Medicare beneficiaries are able to access KEPRO if they would like to file an appeal. Please take a moment to review your organization’s notices and make sure that the information has been updated. For the correct phone number for your state, or for additional information on the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) Program, please visit the KEPRO Website at http://www.keproqio.com/bene/helpline.

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NCHCFA has exceeded its block of rooms at the Embassy Suites Resort for the Annual Summer Symposium. NCHCFA is working with the hotel to secure a few additional rooms for our event. Please call Allison Dew at the Association office at (919) 782-3827 as soon as possible if you need an overnight reservation. NCHCFA will do our best to accommodate all attendees for the event within the hotel properties!

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The North Carolina Health Care Facilities Association would like to thank our 2017 Summer Symposium Corporate Sponsors for supporting the upcoming sixth annual Summer Symposium in Myrtle Beach, SC: Healthcare Services Group, Poyner Spruill LLP and QMX Mobile Health. We appreciate your support!

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Register today to attend the sixth annual NCHCFA Summer Symposium August 9-11, 2017, at the Embassy Suites Resort at Kingston Plantation, Myrtle Beach, SC. Cindy Deporter, MSSW, State Agency Director, Assistant Section Chief Acute and Home Care Section, and Quality Evaluative Systems Manager, Nursing Home Licensure and Certification, DHSR, will present on Wednesday, August 9th at 1:00 PM. Ms. Deporter will discuss the newly released revisions to State Operations Manual (SOM) Appendix PP for Phase 2, F-Tag Revisions, and related issues.

You can register and pay on-line. Visit http://NursingHomesNC.com and click on Sixth Annual Summer Symposium Registration. Administrators and registered nurses will be able to earn up to 11.5 hours of continuing education. Early registration ends July 21, 2017.

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The leadership workshops NCHCFA held in January and April were so well-received and sold out each time, that we have decided to offer the session again on July 20, 2017, in Wilmington, NC.

SAVE THE DATE!

We will also be offering this workshop in Asheville, NC on October 17, 2017, for our members in the western part of the state.

Empowerment Leadership for LTC is an interactive dynamic developmental session that focuses on what it truly means to serve others as a leader. Discuss what employees, customers, and others truly need from leaders. Learn how to operate most effectively in a leadership role using the core principles of servant leadership.

Servant leadership is a set of behaviors and practices that turn the traditional “power leadership” model upside down; instead of the people working to serve the leader, the leader exists to serve the people. When leaders shift their mindset and serve first, they unlock purpose and ingenuity in those around them, resulting in higher performance and engaged, fulfilled employees. As servant leaders, your purpose is to inspire and equip those you influence.

The goal of this workshop is to provide attendees with information and tools that are relevant, transformative, memorable, and actionable. You will learn and practice execution of the most critical skills needed for leading by serving first. You will come out of this course feeling energized and have a number of tools and skills you can start to apply immediately to empower your teams.

What You’ll Learn

• Why Lead This Way?
• Top Skills of Servant Leaders
• Practical Tips for Shifting to Servant Leadership
• Creating a Shared Vision and Getting Engagement
• Leading Through Change

This seminar will be facilitated by Mark Gogal, a Human Resources Leader with over 25 years of progressive, global, and diverse human resources experience, practical business partnering expertise, strong organizational and analytical skills, and proven strategic management experience. He has a multi-faceted background in developing and implementing core HR policies/practices to meet the changing business, legal, and labor compliance environment. He has worked in a variety of industries in the public and private sectors including healthcare.

Mark is an enthusiastic, energetic, and passionate leader and presenter who truly enjoys developing others to reach their fullest potential both professionally and personally.

For the complete brochure and registration information, click here.

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If you still haven’t registered for the AHCA/NCAL 68th Annual Convention & Expo, do it today! Register before July 21st for maximum savings! The Convention & Expo is the winning deal – four days of top-notch education, national speakers, networking, special events, and an Expo Hall packed with all the best products and services for long-term care and post-acute care professionals. When registering, make sure to get your tickets for the Gala Dinner & Show with Huey Lewis and the News. It will be a night you won’t forget!

Early bird registration and savings continue through July 21.

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Free test drives are available for HealthCare Interactive’s CARES® online dementia care training programs and the Alzheimer’s Association essentiALZ® individual certification programs. CARES® is recommended by the American Health Care Association/National Center for Assisted Living to help reduce the off-label use of antipsychotics and the on-line training program is available 24/7.

These on-line training programs, offered by leaders in the dementia care field, are available to AHCA/NCAL members at a 10 percent discount. Use the code AHCA10 at checkout to apply your 10 percent savings off any individual course or site license purchase.

Each program is unique with different video and narrative educational content that teaches the learner about all stages of thinking decline, different approaches, and person-centered care. To test drive any of the CARES® programs, go to http://www.hcinteractive.com/testdrive.

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Alliant Quality wants to encourage SNFs to keep signing up for the National Collaborative – or SPACE. Alliant recommends having as much time as possible to get started on Quality Assurance Performance Improvement (QAPI) work and improving facility quality measures in a systems approach to improve their five star and composite scores.

Alliant Quality is the Medicare Quality Innovation Network (QIN)-Quality Improvement Organization (QIO) for North Carolina. Under contract with the Centers for Medicare & Medicaid Services (CMS), Alliant Quality invites your nursing home to participate in a collaborative designed to ensure that every nursing home resident receives the highest quality of care.

The Collaborative offers an exciting opportunity to learn from high performing nursing homes regarding their processes as they pertain to consistent/permanent staff assignment, teamwork and communications, leadership, regulatory compliance, clinical models, and quality of life indicators. The Collaborative aligns national nursing home quality initiatives and partnerships such as the Advancing Excellence in America’s Nursing Homes Campaign, The Partnership to Improve Dementia Care, and QAPI. Targeted focus areas will include increasing mobility, decreasing unnecessary use of antipsychotics in residents with dementia, decreasing potentially avoidable hospitalizations and decreasing healthcare acquired infections and conditions.

To register, click here for the Participation Agreement and fax or e-mail it back to Lisa Klemis, contact information is on the Participation Agreement. For more details, e-mail Leighann Sauls at Leighann.Sauls@area-F.hcqis.org or call (919) 745-4730.

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Alliant Quality, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for North Carolina is seeking central North Carolina skilled nursing facilities interested in collaborating on the Special Innovation Project (SIP) Improving Access to Palliative Care in the Long Term Care Facility.

Palliative care focuses on comfort and improving quality of life. A team of professionals helps residents and families navigate through the health care system and make health care decisions that are right for them. Goals of this project not only include providing quality of life and satisfaction for residents of skilled nursing facilities (SNFs), but also provision of services that minimize risks of potentially avoidable transfers to acute care.

Often, nursing home residents lack advance directives that would assist them at the end of life. When a resident, without an advanced directive, suffers a worsening of their clinical condition, a cascade of care is put into motion and can trigger unwanted emergency room visits and admissions, which can lead to other complications. The provision of palliative care services for SNF residents supports person-directed care in a proactive way to honor the patient and their choices.

Alliant Quality, in partnership with SNFs and palliative care organizations, will develop customized education and learning sessions for SNF leaders to better understand palliative care and its beneficial role for the residents whom they are caring for each day. This educational offering will be pilot-tested in central North Carolina with SNFs who are interested in this Special Innovation Project offered through the Centers for Medicaid & Medicare Services.

Participating SNFs will have the opportunity to:

• Receive free training programs designed to improve their SNF staff competency and knowledge related to end-of-life care
• Join a learning network with experts on palliative care in the SNF setting
• Partner with palliative care providers in order to improve the quality of life of their residents
• Implement low-burden measurement strategies that monitor resident and family satisfaction with end-of-life care
• Improve rates of avoidable acute care transfers and hospital admission and readmission rates

For more information, contact:
Jennifer Judson RN, BSN
Project Lead, Palliative Care
Office: (678) 527-3473
Jennifer.Judson@alliantquality.org

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While the scope of long term care settings has expanded from nursing homes and home care agencies to assisted living facilities and community-based health services, the training for nurses, managers and administrators, medical directors, and other professionals who work in these facilities is often fragmented. This book was developed to fill a widely-recognized gap in the management and leadership skills of RNs needed to improve the quality of long term care.

To order, visit http://www.AHCApublications.org or call (800) 321-0343. Fax orders may also be placed at (800) 869-5605.

Product # 8398
AHCA Members (on-line price) $85.00

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This DVD, Mobility and Safe Movement of the Elderly, Improving Your Skills to Prevent Injuries and Reduce Falls, by Teepa Snow, MS, OTR/L., FOTA, Dementia Care & Training Specialist, was developed in conjunction with Wake Allied Health Education Center, Durham Technical Community College and the University of North Carolina School of Medicine, Office of Information Systems. The content is formatted in separate segments in order to customize the delivery of content to your learning objective. Handouts developed by Teepa accompany each video and may be reproduced. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org. The price is $35.00 (tax and shipping included).

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Action Planning for Successful Retention – Developing employees to their fullest potential is a critical element in the quest for better retention.

http://www.providermagazine.com/archives/2017_Archives/Pages/0717/Action-Planning-for-Successful-Retention.aspx

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It doesn’t matter if you call it “pee-can” or “puh-cahn,” but on July 12th we celebrate National Pecan Pie Day.

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