provider training long term care agenda ltc provider training handouts.pdf1:15 p.m. – 2:00 p.m....

48
7:30 a.m. – 8:15 a.m. Registration 8:15 a.m. – 8:30 a.m. Welcome 8:30 a.m. – 9:30 a.m. Decision Making: Fire or Strategy? Dr. Mac McCrory 9:30 a.m. – 9:45 a.m. Break 9:45 a.m. – 10:15 a.m. LTC Updates Mike Cook 10:15 a.m. – 10:45 a.m. Incident Reports – Changes and Updates Glenn Box 10:45 a.m. – 11:00 a.m. Emergency Preparedness Brent Maroney 11:00 a.m. – 12:00 p.m. Disaster Preparedness and Response : Kari Beggs A Guide for Planning 12:00 p.m. – 1:15 p.m. Lunch 1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite Score Report Mike Cook 2:20 p.m. – 2:40 p.m. The National Partnership to Improve Paula Terrel Dementia Care 2:40 p.m. – 3:00 p.m. Elevate Care: Protecting Resident and Julie Myers Empowering Staff 3:00 p.m. – 3:15 p.m. Break 3:15 p.m. – 3:35 p.m. TMF Health Quality Institute - Sandy Terry Quality Programs for Long Term Care 3:35 p.m. – 3:55 p.m. Destroying Drugs: The Proper Way Lisa McAlister 3:55 p.m. – 4:25 p.m. Q&A OSDH Panel 4:25 p.m. – 4:30 p.m. Wrap up Provider Training Long Term Care Agenda June 28 th - Oklahoma City, August 30 th - Tulsa

Upload: others

Post on 25-Aug-2020

6 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

7:30 a.m. – 8:15 a.m. Registration 8:15 a.m. – 8:30 a.m. Welcome 8:30 a.m. – 9:30 a.m. Decision Making: Fire or Strategy? Dr. Mac McCrory 9:30 a.m. – 9:45 a.m. Break 9:45 a.m. – 10:15 a.m. LTC Updates Mike Cook 10:15 a.m. – 10:45 a.m. Incident Reports – Changes and Updates Glenn Box 10:45 a.m. – 11:00 a.m. Emergency Preparedness Brent Maroney 11:00 a.m. – 12:00 p.m. Disaster Preparedness and Response : Kari Beggs A Guide for Planning 12:00 p.m. – 1:15 p.m. Lunch

1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays

2:00 p.m. – 2:20 p.m. QM/Composite Score Report Mike Cook 2:20 p.m. – 2:40 p.m. The National Partnership to Improve Paula Terrel Dementia Care 2:40 p.m. – 3:00 p.m. Elevate Care: Protecting Resident and Julie Myers Empowering Staff 3:00 p.m. – 3:15 p.m. Break 3:15 p.m. – 3:35 p.m. TMF Health Quality Institute - Sandy Terry Quality Programs for Long Term Care 3:35 p.m. – 3:55 p.m. Destroying Drugs: The Proper Way Lisa McAlister 3:55 p.m. – 4:25 p.m. Q&A OSDH Panel 4:25 p.m. – 4:30 p.m. Wrap up

Provider Training

Long Term Care

Agenda June 28th - Oklahoma City, August 30th - Tulsa

Page 2: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

1

SLIDE 1

Decision Making:

Fire or Strategy?

Dr. Mac McCrory

Oklahoma State Department of

Health

Long Term Care

OSU Center for Executive and

Professional Development

June 2018

SLIDE 2

Why

What

How

SLIDE 3

How do we make decisions?

• History (the way we’ve always done it)

• Fire ( Sudden, without thought)

• Unilaterally (some one higher up says so)

• Policy, procedure (are they effective, updated)

• Purposeful

• Inclusive, collaborative, all stakeholders represented

• All of the above (% effort)

Page 3: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

2

SLIDE 4

Our decision??? Or

• Our interpretation of decision from above

• Implementation of existing policy, procedure

• Application of our practices to past decisions

• Interpretation of laws, rules, regulations

• Creation of process or procedure to deal with

existing problem, situation, or dilemma

SLIDE 5

ACE: formula for decision making

• Assessment

• Calibration

• Evaluation

• “Ready Break” the action

SLIDE 6

Assessment

• Assimilation of data, facts, background, history

• Acquiring input

• Inclusive communication

• What challenges need to be met (collaborative)

• Cost benefit analysis

• Predictable outcomes

• Unbounded Creativity

Page 4: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

3

SLIDE 7

Calibration

• Versus known “exacts”

• Laws, rules, regulations

• Policies & procedures

• Done it before (status quo)

• What worked, what didn’t

• Can (or how) we pay for it

• Collaboration =?? friendly

SLIDE 8

Evaluation

• As applied to this situation, personalities,

shared goals,

• Plan

• Output

• Outcomes

• Measurement tools

• How do we know when we get there?

• Next time?

SLIDE 9

Ready Break

• Execute the plan

• Tactical adjustments

• Formative evaluation

• Information for next time

• Dealing with the glitches….

Page 5: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

4

SLIDE 10

Glitches

-a Techno Term

• A sudden, brief surge of energy

• Usually disruptive

• Minor malfunction

• Any problem

– a wrench in the gears

– a fly in the ointment

– a burr in our saddle

– a wedgey in our wear

SLIDE 11

Solutions to Glitches uses:

• Conflict Resolution

• Inclusive, collaborative communication

• Problem Solving

• Decision making

• Assertiveness

• Time Care

• Stress Ease

SLIDE 12

Critical thinking??

• See above

• “we” may not always like the answer

Page 6: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

5

SLIDE 13

Dr. Mac McCrory

• 405-996-8428

[email protected]

Page 7: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

1

CMSCMSCMSCMS

Emergency Preparedness Rule:Emergency Preparedness Rule:Emergency Preparedness Rule:Emergency Preparedness Rule:Oklahoma Health and Medical SystemOklahoma Health and Medical SystemOklahoma Health and Medical SystemOklahoma Health and Medical System

Oklahoma Health and Medical System Oklahoma Health and Medical System Oklahoma Health and Medical System Oklahoma Health and Medical System

• Assistant Secretary for Preparedness and Response (ASPR)

• Oklahoma State Statute

• Healthcare Coalition

• Funding

Page 8: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

2

Region 5 Healthcare CoalitionRegion 5 Healthcare CoalitionRegion 5 Healthcare CoalitionRegion 5 Healthcare CoalitionMedical Planning Group (RMPG)Medical Planning Group (RMPG)Medical Planning Group (RMPG)Medical Planning Group (RMPG)

Emergency Preparedness Program: Emergency Preparedness Program: Emergency Preparedness Program: Emergency Preparedness Program: 4 Core Elements4 Core Elements4 Core Elements4 Core Elements

• Risk Assessment and Planning

• Policies and Procedures

• Communication Plan

• Training and Testing Program

Risk Assessment and PlansRisk Assessment and PlansRisk Assessment and PlansRisk Assessment and Plans

• Hazard Vulnerability Analysis (HVA)• Agency/Facility Specific

• County Emergency Operations Plan (EOP)

• Regional Health and Medical

• Emergency Preparedness Plan

• Based on Risk Assessment (HVA)

• Update annually

Page 9: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

3

HVAHVAHVAHVA

Policies and ProceduresPolicies and ProceduresPolicies and ProceduresPolicies and Procedures

• Based on Plan • How

• Specifics

• Staff/Patient tracking

• Evacuation• Shelter In Place

• Update annually

Communication Plan Communication Plan Communication Plan Communication Plan

• Develop a Plan

• Coordinate with external partners

• Local • Regional

• State

• Update annually

Page 10: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

4

Training and TestingTraining and TestingTraining and TestingTraining and Testing• Develop a training and testing program

• Ensure staff can demonstrate knowledge

• Conduct 2 drills annually • Full Scale or Real World

• Community OR Facility Based • Full Scale, Table top, or Real World

• Facility Based

***After Action Reports (AAR)

QuestionsQuestionsQuestionsQuestionsKari Beggs RN, BSN

Region 5 Medical Response System Director

Medical Emergency Response Center

Coordinator

Phone: 405-226-5329

Fax: 918-423-7691

[email protected]

Page 11: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

Long‐Term Care Rule | F‐Tag:  Job Aid

* Substandard quality of care = one or more deficiencies with s/s levels of F, H, I, J, K, or L in RedFederal Regulatory Groups for Long Term Care Facilities

F540 Definitions

483.10  Resident RightsF550 *Resident Rights/Exercise of RightsF551 Rights Exercised by RepresentativeF552 Right to be Informed/Make Treatment DecisionsF553 Right to Participate in Planning CareF554 Resident Self‐Admin Meds‐Clinically AppropriateF555 Right to Choose/Be Informed of Attending PhysicianF557 Respect, Dignity/Right to have Personal PropertyF558 *Reasonable Accommodations of Needs/PreferencesF559 *Choose/Be Notified of Room/Roommate ChangeF560 Right to Refuse Certain TransfersF561 *Self DeterminationF562 Immediate Access to ResidentF563 Right to Receive/Deny VisitorsF564 Inform of Visitation Rights/Equal Visitation PrivilegesF565 *Resident/Family Group and ResponseF566 Right to Perform Facility Services or RefuseF567 Protection/Management of Personal FundsF568 Accounting and Records of Personal FundsF569 Notice and Conveyance of Personal FundsF570 Surety Bond ‐ Security of Personal FundsF571 Limitations on Charges to Personal FundsF572 Notice of Rights and RulesF573 Right to Access/Purchase Copies of RecordsF574 Required Notices and Contact InformationF575 Required PostingsF576 Right to Forms of Communication with PrivacyF577 Right to Survey Results/Advocate Agency InfoF578 Request/Refuse/Discontinue Treatment;Formulate Adv DiF579 Posting/Notice of Medicare/Medicaid on AdmissionF580 Notify of Changes (Injury/Decline/Room, Etc.)F582 Medicaid/Medicare Coverage/Liability NoticeF583 Personal Privacy/Confidentiality of RecordsF584 *Safe/Clean/Comfortable/ Homelike EnvironmentF585 GrievancesF586 Resident Contact with External Entities

483.12  Freedom from Abuse, Neglect, and ExploitationF600 *Free from Abuse and NeglectF602 *Free from Misappropriation/ExploitationF603 *Free from Involuntary SeclusionF604 *Right to be Free from Physical RestraintsF605 *Right to be Free from Chemical RestraintsF606 *Not Employ/Engage Staff with Adverse ActionsF607 *Develop/Implement Abuse/Neglect, etc. PoliciesF608 *Reporting of Reasonable Suspicion of a CrimeF609 *Reporting of Alleged ViolationsF610 *Investigate/Prevent/Correct Alleged Violation

483.15  Admission, Transfer, and DischargeF620 Admissions PolicyF621 Equal Practices Regardless of Payment SourceF622 Transfer and Discharge RequirementsF623 Notice Requirements Before Transfer/DischargeF624 Preparation for Safe/Orderly Transfer/DischargeF625 Notice of Bed Hold Policy Before/Upon TransferF626 Permi ng Residents to Return to Facility

483.20  Resident AssessmentsF635 Admission Physician Orders for Immediate CareF636 Comprehensive Assessments & TimingF637 Comprehensive Assmt A er Significant ChangeF638 Quarterly Assessment At Least Every 3 MonthsF639 Maintain 15 Months of Resident AssessmentsF640 Encoding/Transmi ng Resident AssessmentF641 Accuracy of AssessmentsF642 Coordina on/Cer fica on of AssessmentF644 Coordina on of PASARR and AssessmentsF645 PASARR Screening for MD & IDF646 MD/ID Significant Change Notification

483.21  Comprehensive Resident Centered Care PlansF655 Baseline Care PlanF656 Develop/Implement Comprehensive Care PlanF657 Care Plan Timing and RevisionF658 Services Provided Meet Professional StandardsF659 Qualified PersonsF660 Discharge Planning ProcessF661 Discharge Summary

483.24  Quality of LifeF675 *Quality of LifeF676 *Ac vi es of Daily Living (ADLs)/ Maintain Abili esF677 *ADL Care Provided for Dependent ResidentsF678 *Cardio‐Pulmonary Resuscita on (CPR)F679 *Ac vi es Meet Interest/Needs of Each ResidentF680 *Qualifica ons of Ac vity  Professional

483.25  Quality of CareF684 *Quality of CareF685 *Treatment/Devices to Maintain  Hearing/VisionF686 *Treatment/Svcs to Prevent/Heal  Pressure UlcersF687 *Foot CareF688 *Increase/Prevent Decrease in  ROM/MobilityF689 *Free of Accident Hazards/Supervision/DevicesF690 *Bowel/Bladder Incon nence, Catheter, UTIF691 *Colostomy, Urostomy, or  Ileostomy CareF692 *Nutri on/Hydra on Status  MaintenanceF693 *Tube Feeding  Management/Restore Ea ng  SkillsF694 *Parenteral/IV FluidsF695 *Respiratory/Tracheostomy care  and Suc oningF696 *ProsthesesF697 *Pain ManagementF698 *DialysisF699 *{PHASE‐3} Trauma Informed Care F700 *Bedrails

483.30  Physician ServicesF710 Resident's Care Supervised by a PhysicianF711 Physician Visits ‐ Review Care/Notes/OrderF712 Physician Visits ‐Frequency/Timeliness/Alternate NPPsF713 Physician for Emergency Care, Available 24 HoursF714 Physician Delega on of Tasks to NPPF715 Physician Delega on to Die an/Therapist

483.35  Nursing ServicesF725 Sufficient Nursing StaffF726 Competent Nursing StaffF727 RN 8 Hrs/7 days/Wk, Full Time DONF728 Facility Hiring and Use of Nurse F729 Nurse Aide Registry Verifica on, Retraining

Friday, July 14, 2017Page 1 of 2Report‐30: LTC‐Rule Job Aid

Page 12: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

* Substandard quality of care = one or more deficiencies with s/s levels of F, H, I, J, K, or L in RedFederal Regulatory Groups for Long Term Care Facilities

F730 Nurse Aide Perform Review – 12Hr/Year In‐ serviceF731 Waiver ‐Licensed Nurses 24Hr/Day and RN CoverageF732 Posted Nurse Staffing Informa on

483.40  Behavioral Health ServicesF740 Behavioral Health ServicesF741 Sufficient/Competent Staff‐Behav Health NeedsF742 *Treatment/Svc for Mental/Psychosocial ConcernsF743 *No Pattern of Behavioral Difficulties Unless UnavoidableF744 *Treatment /Service for DementiaF745 *Provision of Medically Related Social Services

483.45  Pharmacy ServicesF755 Pharmacy Svcs/Procedures/Pharmacist/RecordsF756 Drug Regimen Review, Report Irregular, Act OnF757 *Drug Regimen is Free From  Unnecessary DrugsF758 *Free from Unnec Psychotropic Meds/PRN UseF759 *Free of Medica on Error Rate sof 5% or MoreF760 *Residents Are Free of Significant Med ErrorsF761 Label/Store Drugs & Biologicals

483.50  Laboratory, Radiology, and Other Diagnostic SeF770 Laboratory ServicesF771 Blood Blank and Transfusion ServicesF772 Lab Services Not Provided On ‐SiteF773 Lab Svs Physician Order/No fy of ResultsF774 Assist with Transport Arrangements to Lab SvcsF775 Lab Reports in Record ‐LabName/AddressF776 Radiology/Other Diagnostic ServicesF777 Radiology/Diag. Svcs Ordered/No fy ResultsF778 Assist with Transport Arrangements to RadiologyF779 X ‐Ray/Diagnos c Report in Record‐Sign/Dated

483.55  Dental ServicesF790 Rou ne/Emergency Dental Services in SNFsF791 Rou ne/Emergency Dental Services in NFs

483.60  Food and Nutrition ServicesF800 Provided Diet Meets Needs of Each ResidentF801 Qualified Dietary StaffF802 Sufficient Dietary Support PersonnelF803 Menus Meet Res Needs/Prep in Advance/FollowedF804 Nutri ve Value/Appear ,Palatable/Prefer TempF805 Food in Form to Meet Individual Needs

F806 Resident Allergies, Preferences and Subs tutesF807 Drinks Avail to Meet Needs/Preferences/ Hydra onF808 Therapeu c Diet Prescribed by PhysicianF809 Frequency of Meals/Snacks at Bed meF810 Assistive Devices  ‐ Ea ng Equipment/UtensilsF811 Feeding Asst  ‐Training/Supervision/ResidentF812 Food Procurement, Store/Prepare/Serve ‐ SanitaryF813 Personal Food PolicyF814 Dispose Garbage & Refuse Properly

483.65  Specialized Rehabilitative ServicesF825 Provide/Obtain Specialized Rehab ServicesF826 Rehab Services ‐ Physician Order/Qualified Person

483.70  AdministrationF835 AdministrationF836 License/Comply w/Fed/State/Local Law/Prof StdF837 Governing BodyF838 Facility AssessmentF839 Staff QualificationsF840 Use of Outside ResourcesF841 Responsibili es of Medical DirectorF842 Resident Records ‐ Identifiable InformationF843 Transfer Agreement F844 Disclosure of Ownership RequirementsF845 Facility closure‐AdministratorF846 Facility closureF849 Hospice ServicesF850 *Qualifications of Social Worker >120 BedsF851 Payroll Based Journal

483.75  Quality Assurance and Performance ImprovemF865 QAPI Program/Plan, Disclosure/Good Faith AttemptF866 {PHASE‐3} QAPI/QAA Data Collec on and MonitoringF867 QAPI/QAA Improvement Ac vi esF868 QAA Committee

483.80  Infection ControlF880 Infection Prevention & ControlF881 Antibiotic Stewardship ProgramF882 {PHASE‐3} Infec on Preven onist Qualifica ons/RoleF883 *Influenza and Pneumococcal Immuniza ons

483.85 {PHASE‐3} Compliance and Ethics ProgramF895 {PHASE-3} Compliance and Ethics Program

483.90  Physical Environment

F907 Space and EquipmentF908 Essen al Equipment, Safe  Opera ng Condi onF909 Resident BedF910 Resident RoomF911 Bedroom Number of ResidentsF912 Bedrooms Measure at Least 80  Square Ft/ResidentF913 Bedrooms Have Direct Access to Exit CorridorF914 Bedrooms Assure Full Visual PrivacyF915 Resident Room WindowF916 Resident Room Floor Above GradeF917 Resident Room Bed/Furniture/ClosetF918 Bedrooms Equipped/Near Lavatory/ToiletF919 Resident Call SystemF920 Requirements for Dining and Activity RoomsF921 Safe/Func onal/Sanitary/ Comfortable EnvironmentF922 Procedures to Ensure Water AvailabilityF923 VentilationF924 Corridors Have Firmly Secured HandrailsF925 Maintains Effec ve Pest Control ProgramF926 Smoking Policies

483.95  Training RequirementsF940 {PHASE‐3} Training Requirements ‐ GeneralF941 {PHASE‐3} Communication TrainingF942 {PHASE-3} Resident’s Rights TrainingF943 Abuse, Neglect, and Exploitation TrainingF944 {PHASE‐3} QAPI TrainingF945 {PHASE‐3} Infection Control TrainingF946 {PHASE-3} Compliance and Ethics TrainingF947 Required In‐Service Training for Nurse AidesF948 Training for Feeding AssistantsF949 {PHASE-3} Behavioral Health Training

Friday, July 14, 2017Page 2 of 2Report‐30: LTC‐Rule Job Aid

F906 Emergency Electrical Power System

Page 13: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

CMS Training Resources

Nursing Homes (Google: CMS Nursing Home LTCSP)

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html

This website has links to several resources including:

• Appendix PP

• Revised list of the new Ftags

• LTC Survey Pathways (41 pathways)

• Entrance Conference Form – Matrix with instructions

• And more…

The Medicare Learning Network (Google: CMS Medicare Learning Network)

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html

This website has links to:

• Medicare Learning Network (MLN) Newsletter

• Electronic Mailing Lists

• MLN Calls & Webcast training (upcoming and past)

MLN Calls & Webcast Training Example: Nursing Home Facility Assessment Tool

To locate training follow the steps below:

1. Click on Events & Training/Calls & Webcasts link

2. Type the topic of interest in the search field next to Filter On (see screen shot below, in this example

the search is for Facility Assessment Tool)

3. Click the date of the program for a link to the training information. (See screen shot above.)

Page 14: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

Integrated Surveyor Training Website (Google: CMS ISTW)

https://surveyortraining.cms.hhs.gov/pubs/ProviderWelcome.aspx

This website offers 24/7 training on Federal regulations and survey process for both providers and

surveyors.

To access the training follow the steps below:

1. Click the link I AM A PROVIDER (see the screen shot below)

2. Click Course Catalog

3. Select the course you would like to view. You may use the Filter By: Type or Search Courses. See search

examples below.

Page 15: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES

ENTRANCE CONFERENCE WORKSHEET

1/2018 1

INFORMATION NEEDED FROM THE FACILITY IMMEDIATELY UPON ENTRANCE

1. Census number 2. Complete matrix for new admissions in the last 30 days who are still residing in the facility. 3. An alphabetical list of all residents (note any resident out of the facility). 4. A list of residents who smoke, designated smoking times, and locations.

ENTRANCE CONFERENCE 5. Conduct a brief Entrance Conference with the Administrator. 6. Information regarding full time DON coverage (verbal confirmation is acceptable). 7. Information about the facility’s emergency water source (verbal confirmation is acceptable). 8. Signs announcing the survey that are posted in high-visibility areas. 9. A copy of an updated facility floor plan, if changes have been made. 10. Name of Resident Council President. 11. Provide the facility with a copy of the CASPER 3.

INFORMATION NEEDED FROM FACILITY WITHIN ONE HOUR OF ENTRANCE

12. Schedule of meal times, locations of dining rooms, copies of all current menus including therapeutic menus that will be served for the duration of the survey and the policy for food brought in from visitors.

13. Schedule of Medication Administration times. 14. Number and location of med storage rooms and med carts. 15. The actual working schedules for licensed and registered nursing staff for the survey time period. 16. List of key personnel, location, and phone numbers. Note contract staff (e.g., rehab services). 17. If the facility employs paid feeding assistants, provide the following information:

a) Whether the paid feeding assistant training was provided through a State-approved training program by qualified professionals as defined by State law, with a minimum of 8 hours of training;

b) The names of staff (including agency staff) who have successfully completed training for paid feeding assistants, and who are currently assisting selected residents with eating meals and/or snacks;

c) A list of residents who are eligible for assistance and who are currently receiving assistance from paid feeding assistants.

INFORMATION NEEDED FROM FACILITY WITHIN FOUR HOURS OF ENTRANCE

18. Complete the matrix for all other residents. The TC confirms the matrix was completed accurately. 19. Admission packet. 20. Dialysis Contract(s), Agreement(s), Arrangement(s), and Policy and Procedures, if applicable. 21. List of qualified staff providing hemodialysis or assistance for peritoneal dialysis treatments, if

applicable. 22. Agreement(s) or Policies and Procedures for transport to and from dialysis treatments, if applicable. 23. Does the facility have an onsite separately certified ESRD unit? 24. Hospice Agreement, and Policies and Procedures for each hospice used (name of facility designee(s)

who coordinate(s) services with hospice providers).

Page 16: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES

ENTRANCE CONFERENCE WORKSHEET

1/2018 2

25. Infection Prevention and Control Program Standards, Policies and Procedures, and Antibiotic Stewardship Program.

26. Influenza / Pneumococcal Immunization Policy & Procedures. 27. QAA committee information (name of contact, names of members and frequency of meetings). 28. QAPI Plan. 29. Abuse Prohibition Policy and Procedures. 30. Description of any experimental research occurring in the facility. 31. Facility assessment. 32. Nurse staffing waivers. 33. List of rooms meeting any one of the following conditions that require a variance:

• Less than the required square footage • More than four residents

INFORMATION NEEDED BY THE END OF THE FIRST DAY OF SURVEY

34. Provide each surveyor with access to all resident electronic health records – do not exclude any information that should be a part of the resident’s medical record. Provide specific information on how surveyors can access the EHRs outside of the conference room. Please complete the attached form on page 4 which is titled “Electronic Health Record Information.”

INFORMATION NEEDED FROM FACILITY WITHIN 24 HOURS OF ENTRANCE

35. Completed Medicare/Medicaid Application (CMS-671). 36. Completed Census and Condition Information (CMS-672). 37. Please complete the attached form on page 3 which is titled “Beneficiary Notice - Residents

Discharged Within the Last Six Months”.

Page 17: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES

ENTRANCE CONFERENCE WORKSHEET

1/2018 3

Beneficiary Notice - Residents Discharged Within the Last Six Months

Please complete and return this worksheet to the survey team within 24 hours. Please provide a list of residents who were discharged from a Medicare covered Part A stay with benefit days remaining in the past 6 months. Please indicate if the resident was discharged home or remained in the facility. (Note: Exclude beneficiaries who received Medicare Part B benefits only, were covered under Medicare Advantage insurance, expired, or were transferred to an acute care facility or another SNF during the sample date range).

Resident Name Discharge Date

Discharged to: Home/Lesser Care Remained in facility

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Page 18: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES

ENTRANCE CONFERENCE WORKSHEET

1/2018 4

ELECTRONIC HEALTH RECORD (EHR) INFORMATIONPlease provide the following information to the survey team before the end of the first day of survey.

Provide specific instructions on where and how surveyors can access the following information in the EHR (or in the hard copy if using split EHR and hard copy system) for the initial pool record review process. Surveyors require the same access staff members have to residents’ EHRs in a read-only format.

Example: Medications EHR: Orders – Reports – Administration Record – eMAR – Confirm date range – Run Report

Example: Hospitalization EHR: Census (will show in/out of facility)

MDS (will show discharge MDS)

Prog Note – View All - Custom – Created Date Range - Enter time period leading up to hospitalization – Save (will show where and why resident was sent)

1. Pressure ulcers

2. Dialysis

3. Infections

4. Nutrition

5. Falls

6. ADL status

7. Bowel and bladder

8. Hospitalization

9. Elopement

10. Change of condition

11. Medications

12. Diagnoses

13. PASARR

14. Advance directives

15. Hospice

Please provide name and contact information for IT and back-up IT for questions: IT Name and Contact Info: ______________________________________________________________

Back-up IT Name and Contact Info: _______________________________________________________

Page 19: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

______________________________________________________________________________

MATRIX INSTRUCTIONS FOR PROVIDERS _____________________________________________________________________________

1/2018

The Matrix is used to identify pertinent care categories for: 1) newly admitted residents in the last 30 days

who are still residing in the facility, and 2) all other residents.

The facility completes the resident name, resident room number and columns 1-20, which are described in

detail below. Blank columns are for Surveyor Use Only.

All information entered into the form should be verified by a staff member knowledgeable about

the resident population. Information must be reflective of all residents as of the day of survey.

Unless stated otherwise, for each resident mark an X for all columns that are pertinent.

1. Residents Admitted within the Past 30 days: Resident(s) who were admitted to the facility

within the past 30 days and currently residing in the facility.

2. Alzheimer’s/Dementia: Resident(s) who have a

diagnosis of Alzheimer’s disease or dementia of

any type.

3. MD, ID or RC & No PASARR Level II: Resident(s) who have a serious mental disorder,

intellectual disability or a related condition but does not have a PASARR level II evaluation and

determination.

4. Medications: Resident(s) receiving any of the

following medications: (I) = Insulin, (AC) =

Anticoagulant (e.g. Direct thrombin inhibitors

and low weight molecular weight heparin [e.g.,

Pradaxa, Xarelto, Coumadin, Fragmin]. Do not

include Aspirin or Plavix), (ABX) = Antibiotic,

(D) = Diuretic, (O) = Opioid, (H) = Hypnotic,

(AA) = Antianxiety, (AP) = Antipsychotic, (AD) = Antidepressant, (RESP) = Respiratory (e.g.,

inhaler, nebulizer).

NOTE: Record meds according to a drug’s

pharmacological classification, not how it is

used.

5. Facility Acquired Pressure Ulcer(s) (any stage): Resident(s) who have a pressure ulcer at any

stage, including suspected deep tissue injury

(mark I, II, III, IV, U for unstageable, S for

sDTI)

6. Worsened Pressure Ulcer(s) at any stage: Resident(s) with a pressure ulcer at any stage

that have worsened.

7. Excessive Weight Loss without Prescribed

Weight Loss program: Resident(s) with an

unintended (not on a prescribed weight loss

program) weight loss > 5% within the past 30

days or >10% within the past 180 days. Exclude

residents receiving hospice services.

8. Tube Feeding: Resident(s) who receive enteral

(E) or parenteral feedings (P).

9. Dehydration: Resident(s) identified with actual

hydration concerns takes in less than the

recommended 1,500 ml of fluids daily (water or

liquids in beverages and water in foods with high

fluid content, such as gelatin and soups).

10. Physical Restraints: Resident(s) who have a

physical restraint in use. A restraint is defined as

the use of any manual method, physical or

mechanical device, material or equipment

attached or adjacent to the resident’s body that

the individual cannot remove easily which

restricts freedom of movement or normal access

to one’s body (e.g., bed rail, trunk restraint, limb restraint, chair prevents rising, mitts on hands,

confined to room, etc.). Do not code wander

guards as a restraint.

11. Fall(s), Fall(s) with Injury, Fall(s) with Major

Injury: Resident(s) who have fallen in the

facility in the past 90 days or since admission

and have incurred an injury or not. A major

injury includes bone fractures, joint dislocation,

closed head injury with altered consciousness,

subdural hematoma.

Use (F) to identify residents with a fall(s), (FI)

to identify a resident who has sustained an injury

excluding major injury, and (FMI) to identify a

resident who has sustained a fall(s) with Major

Injury.

12. Indwelling Urinary Catheter: Resident(s) with

an indwelling catheter (including suprapubic

catheter and nephrostomy tube).

Page 20: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

______________________________________________________________________________

MATRIX INSTRUCTIONS FOR PROVIDERS _____________________________________________________________________________

1/2018

13. Dialysis: Resident(s) who are receiving (H)

hemodialysis or (P) peritoneal dialysis either

within the facility (F) or offsite (O).

14. Hospice: Resident(s) who have elected or are currently receiving hospice services.

15. End of Life/Comfort Care/Palliative Care:

Resident(s) who are receiving end of life or

palliative care (not including Hospice).

16. Tracheostomy: Resident(s) who have a

tracheostomy.

17. Ventilator: Resident(s) who are receiving

invasive mechanical ventilation.

18. Transmission-Based Precautions: Resident(s)

who are currently on Transmission-based

Precautions.

19. Intravenous therapy: Resident(s) who are

receiving intravenous therapy through a central line, peripherally inserted central catheter, or

other intravenous catheter.

20. Infections: Residents(s) who has a

communicable disease/contagious infection. For

example, (M) MDRO, (P) pneumonia, (TB)

tuberculosis, (VH) viral hepatitis, or (C) c-diff

OR has a healthcare-associated infection (e.g.,

(WI) wound infection or (UTI) Urinary Tract Infection).

Page 21: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

Resident Name Res

iden

t Roo

m N

umbe

r

1

Dat

e of

Adm

issi

on if

Adm

itted

with

in th

e Pa

st 3

0 D

ays

2

Alz

heim

er’s

/ D

emen

tia

3

MD

, ID

or

RC

& N

o PA

SAR

R L

evel

II

4 M

edic

atio

ns: I

nsul

in (I

), A

ntic

oagu

lant

(AC

), A

ntib

iotic

(A

BX

), D

iure

tic (D

), O

pioi

d (O

), H

ypno

tic (H

), A

ntia

nxie

ty

(AA

), A

ntip

sych

otic

(AP)

, Ant

idep

ress

ant (

AD

), R

espi

rato

ry

(RE

SP)

5

Faci

lity

Acq

uire

d Pr

essu

re U

lcer

(s) (

any

stag

e)

6

Wor

sene

d Pr

essu

re U

lcer

(s) (

any

stag

e)

7

Exc

essi

ve W

eigh

t Los

s w

/out

Pre

scri

bed

Wei

ght L

oss P

rogr

am

8

Tub

e Fe

edin

g

9

Deh

ydra

tion

10

Phys

ical

Res

trai

nts

11

Fall

(F),

Fall

with

Inj

ury

(FI)

, or

Fall

w/M

ajor

Inju

ry (F

MI)

12

Indw

ellin

g C

athe

ter

13

Dia

lysi

s: P

erito

neal

(P),

Hem

o (H

), in

faci

lity

(F) o

r of

fsite

(O)

14

Hos

pice

15

End

of L

ife C

are

/Com

fort

Car

e/Pa

lliat

ive

Car

e

16

Tra

cheo

stom

y

17

Ven

tilat

or

18

Tra

nsm

issi

on-B

ased

Pre

caut

ions

19

Intr

aven

ous t

hera

py

20

Infe

ctio

ns (M

,WI,

P, T

B, V

H, C

, UT

I)

21

Oth

er

MATRIX FOR PROVIDERS

1/2018

Page 22: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

1

National Partnership to Improve Dementia Care in Nursing Homes

National Partnership to Improve Dementia Care in Nursing Homes

� CMS launched the Partnership to Improve Dementia Care in Nursing Homes on May 30, 2012.

� An initiative to ensure appropriate care and use of antipsychotic medications for nursing home residents.

� The government partnered with national organizations, providers, caregivers, and advocacy groups.

National Partnership to Improve Dementia Care in Nursing Homes

� The partnership was to promote comprehensive dementia care and therapeutic interventions for nursing home residents with dementia related behaviors.

� The goals were to improve person centered care and reduce the use of unnecessary antipsychotic medications.

Page 23: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

2

National Partnership to Improve Dementia Care in Nursing Homes

� The partnership is committed to improving the quality of care for individuals with dementia living in nursing homes.

� The partnership has a mission to deliver health care that is person centered with a focus on protecting residents from being prescribed antipsychotic medications unless there is a valid, clinical indication and a systematic process to evaluate each individual’s needs.

Why Antipsychotic Medications

� Antipsychotic drugs, when administered to residents with dementia, can cause:

� over-sedation,

� make the residents more prone to falls,

� compromise overall well-being, and

� increase the risk of death.

Why Antipsychotic Medications

� Both first and second generation antipsychotic medications have serious side effects and can be especially dangerous for elderly residents. When used without an adequate rationale, or for the purpose of limiting or controlling expressions or indications of distress without first identifying a cause, there is little chance that they will be effective, and they commonly cause complications such as movement disorders, falls with injury, cerebrovascular adverse events (CVA’s and TIA’s) and increased risk of death.

� The FDA Boxed Warning which accompanies second generation antipsychotic medications states, “Elderly patients with dementia-related psychosis treated with atypical anti-psychotic drugs are at an increased risk of death.” There are similar boxed warnings for first generation anti-psychotic medications.

Page 24: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

3

National Partnership to Improve Dementia Care in Nursing Homes

� The official measure is the percentage of long - stay residents who are receiving an antipsychotic medication.

� This excludes residents diagnosed with Schizophrenia, Huntington’s Disease, or Tourette’s Syndrome.

National Data

� Baseline data, obtained from 2011 Quarter 4, documented 23.9% of long-stay nursing home residents were receiving an antipsychotic medication.

� CMS challenged states to reduce unnecessary antipsychotic medications in nursing home residents by 15% before June 2013.

Oklahoma Data

� Oklahoma started with 27.3% of our long-stay nursing home residents receiving an antipsychotic medication.

� 5,100 of 19,300 residents in nursing homes were being administered antipsychotic medications.

� Oklahoma was ranked 48th highest in use of antipsychotic medications.

� More than 100 Oklahoma homes had over 30% of residents on antipsychotic medications.

Page 25: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

4

Oklahoma Partnership to Improve Dementia Care in Nursing Homes

� In June and July 2012, Oklahoma Partners and Stakeholders reached a consensus regarding dynamic activities to educate prescribing physicians, pharmacists and nurse managers regarding antipsychotic medications.

� The partnership’s improvement theory was that equipped with best practice standards, nursing facility leaders (administrators, nurses, pharmacists, and physicians) could reduce unnecessary antipsychotic medications for long- stay residents with dementia.

� Our goal was to reduce the prevalence of unnecessary antipsychotic medications used to treat behaviors for residents with dementia by 15% by June 2013.

Oklahoma Partnership to Improve Dementia Care in Nursing Homes

� The Oklahoma State Department of Health

� The Oklahoma Foundation for Medical Quality

� The Alzheimer’s Association, Oklahoma Chapter

� The Oklahoma Culture Change Coalition

� The University of Oklahoma College of Pharmacy

� The OUHSC Department of Geriatric Medicine

� Leading Age Oklahoma

� The Oklahoma Association of Health Care Providers

� Representatives From Oklahoma Nursing Homes

� Many Others

Oklahoma Partnership to Improve Dementia Care in Nursing Homes

� Throughout the next year the Oklahoma Partnership provided many educational opportunities through seminars, one on one visits with facility staff, on line training, workshops, webinars, guest speakers and you tube trainings.

� Results were better than the targeted 15% reduction.

� Actual improvement was 18% by June 2013.

� This was one of the top ten results in the U.S.

� Oklahoma’s ranking on antipsychotic drug use improved from 48th to 39th.

Page 26: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

5

Cost Savings

� Cost savings were estimated at $4.8 million annually based on reduced use of medications.

� There were 944 fewer residents receiving antipsychotic medications.

Continued Progress

� The Partnership continued it’s efforts through July 2014, when Oklahoma reached a 24% reduction in antipsychotic drug use.

� Affecting 1059 residents

� With Drug cost savings estimated at $8 million annually.

All Time Low Prevalence of Use

� Oklahoma reached a low of 19.4% prevalence of antipsychotic use in September of 2015, down from a high of 27.5% in December 2011.

Page 27: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

6

STAR- OKLTC Network

� To ensure continued improvement in quality of care for individuals living with dementia, Long Term Care Stakeholders reconvened in 2017. The group has agreed to reinvigorate efforts to improve dementia care, with an emphasis on sustainability of the antipsychotic drug reductions achieved through the Partnership.

Current Data

� The most current data for the prevalence of antipsychotic medication use for Long-Stay residents is from September 2017.

� There has been a decrease of 36.6% to a national prevalence of 15.1%.

� Oklahoma has a 19.5% prevalence of antipsychotic medication use in long-stay residents.

� This represented a 28.5% decrease in the use of antipsychotic medications for long-stay residents from 2011Q4 to 2017Q4 in Oklahoma.

Oklahoma Ranking

�Oklahoma ranks 51st highest in the use of antipsychotic medications in the nation!

�19.5% is the highest prevalence of antipsychotic use in the nation!

Page 28: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

7

New Goals

� The National Partnership to Improve Dementia Care recently announced a new goal:

� Nursing Homes with low rates of antipsychotic medication use are encouraged to continue their efforts and maintain their success.

� Late Adopters, facilities with high rates of antipsychotic medication use, are to work to decrease antipsychotic medication use by 15% by the end of 2019.

LATE ADOPTERS

� These Nursing Homes have made little to no progress in decreasing their antipsychotic medication use or have actually increased their use of antipsychotic medications since the start of the National Partnership.

Criteria Used to Determine Homes Deemed as Late Adopters

� Facilities were included that were in both of the following categories:

� Nursing Homes in the lowest 25% of the long-stay antipsychotic medication quality measure in 2017Q1 (a value > 20.29%)

� Nursing Homes in the lowest 25% of change in the long-stay antipsychotic medication QM from 2011Q4 to 2017Q1 (with an increase in value or a decrease of less than 6.7%)

Page 29: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

8

Criteria Used to Determine Homes Deemed as Late Adopters

� Of the prior list, they included only facilities that also had a long-stay antipsychotic medication QM > the national average in 2017Q1 ( a value > 15.73%)

� Additionally, they disregarded facilities that were in the top 10% of Schizophrenia prevalence in 2017Q1 (a prevalence > 18.29%)

Late Adopters

� Initially 50 homes were designated as Late Adopters in Oklahoma.

� Per request of CMS, the OSDH and TMF Health Quality Institute, the CMS designated Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Oklahoma, have reached out to 36 of these nursing homes, deemed Late Adopters in Oklahoma, to make them aware of their status and to offer assistance and a referral for a quality improvement program.

LATE ADOPTERS

� OSDH is also providing information to facilities who are Late Adopters at their recertification surveys.

Page 30: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

9

Information

� The National Partnership Resource Repository -– for information regarding The National Partnership to Improve Dementia Care.

� Https://www.nhqualitycampaign.org/dementiaCare.aspx.

Regulatory References

� F758 – Unnecessary Psychotropic Medications

� F744 – Residents with Dementia Receive Appropriate Treatment & Services to Reach Their Highest Practicable Well-Being

HELP

� CMP Funded Programs can help your facility decrease the use of antipsychotic medications and promote person centered care for residents with dementia.

� TMF Health Quality Institute, the CMS designated Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Oklahoma, will provide free consultation services to assist you.

Page 31: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

10

WE CAN DO THIS

� Let’s NOT be #51

� We Focused on the Issue in 2012 – 2014 and significantly lowered our numbers.

� OKLAHOMA was recognized by the State and Nationally for the progress we made.

� Our Residents Deserve to have the best life they can with person centered care to promote their highest practicable well-being.

� If you need help or guidance it is available.

� We Can Do This

Thank you

Paula Terrel, R.N.

Preventive Medical Consultant

Oklahoma State Department of Health

Page 32: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/05/2018

1

Quality Improvement Assistance for Nursing Homes

Julie Myers, DrPH, CPHQ

Objectives• Describe the history and purpose of the CMP

Fund Program• Define eligibility of participation• Delineate current projects and services

available to eligible nursing homes

Page 33: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/05/2018

2

History• Revolving Fund was established in 2013 per state

statute §63-1-107.4• In 2014, OSDH released the first RFP to fund

improvement grants• In 2015 the Program itself was funded followed

by expansion in 2016 to include education for nursing homes, needs assessment, data analysis, and quality assurance of projects

Eligibility for Assistance• Skilled nursing facilities• Nursing homes • Certified as a provider by the federal

government (Medicaid or Medicare)

Page 34: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/05/2018

3

LTC Composite Score• Baseline: December 31, 2014 = 10.3

(highest – worst score on record)

• Remeasurement: April 30, 2018 = 8.7• 2.5 points in the right direction• 15.5% Relative Improvement from baseline!

CMP Fund Program Goals• Help Oklahoma become the leader of

nursing home quality in the region • Stretching toward the goal of a 6.0 or better

composite score

Page 35: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/05/2018

4

VisionServe as a catalyst for

improving quality of life and quality of care in nursing homes

StrategyProvide assistance in quality improvement by

funding effective projects based on the needs of the

nursing homes in Oklahoma

Page 36: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/05/2018

5

Tactics• Fund three to five projects that address focus areas annually• Fund provider and surveyor educational series• Visit up to twenty long-term care communities annually to

qualitatively assess needs, successes, and barriers• Host two to three funding information sessions annually• Facilitate four to six contractor network calls annually• Develop a network of CMP Programs across the nation

Funding Focus: Clinical Quality–Antipsychotic Use

/Dementia Care–Catheter Use–Depression–Falls/Mobility

–Medications–Pain–Pressure Ulcers–UTI–Underweight

Page 37: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/05/2018

6

Funding Focus: Other• Consistent Assignment• Hospitalizations• Person-Centered Care• Staff Stability

• ADL Increased Need• Incontinence• Physical Restraints• Vaccines: Flu /Pneu

Current CMP Fund Projects• QAPI Support• Medication

Optimization • Oral Care

• Dementia Care In-Service

• Fall Prevention• New Projects Soon!

Page 38: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/05/2018

7

Pop Quiz• Who is eligible?

• What is funded?

• Do we provide in-service trainings at no cost to you?

• What do you do when you come up with an idea to fund quality improvement?

Questions?

CMP Fund ProgramJulie Myers, DrPH, CPHQ

[email protected]

http://CMP.Health.ok.gov

Page 39: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

1

Improving Care for Oklahoma Seniors

TMF Quality Innovation Network Quality Improvement

Organization (QIN-QIO) for Oklahoma

Sandra Terry, MBA, BSN, RN

TMF QIN-QIO State Program Director for Oklahoma

Imagine If You Will…

2

Why I Do What I Do

What is your story?

3

Page 40: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

2

TMF QIN-QIO Regional PartnersTMF has subcontracted with strong, experienced quality

improvement partners to provide expert technical assistance and

quality improvement support for participating providers across

the region.

� Arkansas Foundation for Medical Care

� Primaris (Missouri)

� QIPRO and Ponce Medical School Foundation (Puerto Rico)

� TMF Health Quality Institute (Texas and Oklahoma)

4

Nursing Home Quality

Improvement Project

Goals for this five-year project

ending in 2019 include:� Achieve a score of six or less on the National Nursing

Home Quality Composite Measure Score

� Decrease antipsychotic medication use

� Decrease health care-associated infections and other

health care-acquired conditions

� Decrease potentially avoidable hospitalizations

� Track and prevent Clostridium difficile

6

Page 41: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

3

How can the TMF QIN-QIO help

you?� Assist with interpretation of data reports

and development and implementation of a

quality improvement plan.

� Provide education and resources on clinical

quality topics, with an emphasis on

reducing inappropriate antipsychotics, as

well as infection prevention and antibiotic

stewardship.

� Assist with reporting of Clostridium difficile

infection rates to the Centers for Disease

Control and Prevention’s National

Healthcare Safety Network database.

[email protected] 7

Your Nursing Home Quality

Improvement Team

8

Susan PurcellDirector

Frank Barber Quality

Improvement Consultant

Cayce BrewsterHealth Services

Consultant

Your Nursing Home Quality

Improvement Team

9

Melody Malone Quality Improvement

Consultant

Debi MajoQuality Improvement

Consultant

Tiffany LanghamQuality

Improvement Consultant

Page 42: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

4

Your Nursing Home Quality

Improvement Team

10

Cheri LipscombQuality Improvement

Consultant

Monika MaxwellQuality Improvement

Consultant

Carla SmithQuality Improvement

Consultant

Care Coordination Project:

A Community-Based Approach

Project Goals:� Reduce hospital readmission rates in the Medicare

program by 20 percent

� Reduce hospital admission rates in the Medicare

program by 20 percent

� Increase community tenure by increasing the

number of days spent at home by Medicare Fee-

for-Service (FFS) beneficiaries by 10 percent

� Reduce the prevalence of adverse drug events,

emergency department visits and observation

stays or readmissions occurring as a result of the

care transitions process

12

Page 43: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

5

Source: Medicare FFS Claims. Time Period: 08/01/2017 – 10/31/2017

Oklahoma: Discharge Disposition After Inpatient

Hospitalization and 30-Day Readmission Rates

13

Setting

Number of

Discharges

% of All

Discharges

30-day

Readmits

Rate of

30-day

Readmits

Home Health Agency 7,372 19.6% 1,241 16.8%

Home 20,725 55.2% 3,546 17.1%

Hospice 1,617 4.3% 53 3.3%

Inpatient Rehabilitation

Facility 1,620 4.3% 274 16.9%

Long-Term Acute Care 853 2.3% 119 14.0%

Nursing Home 5,386 14.3% 1,176 21.8%

All 37,573 100.0% 6,409 17.1%

Drivers for Readmissions� Lack of transfer of information between providers

and/or patients at the time of transition

� Low patient activation, which impacts a patient

and/or caregiver to self-manage their condition

� Lack of standard processes to effectively manage the

transition of the patient between settings

14

Communities for Care Coordination

Partners:

Hospitals, skilled nursing facilities, home health agencies,

physicians, patients, caregivers, payers and stakeholders

Communities:

� SE: Durant

� NW: Elk City/Weatherford area

� SW: Lawton

� NE: Miami

� Central: Norman

� Oklahoma City 15

Page 44: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

6

Medication Safety Project

� GOAL: Reduce adverse drug events by 35 percent

per 1,000 Medicare FFS beneficiaries

� Why: Older adults are seven times more likely to

be hospitalized due to an adverse drug event

� How: Monitor rates for anticoagulants, diabetic

agents and opioids by care setting, state and

region

16

Filled by long-term care (LTC) pharmacies

• 4,894 prescriptions for opioids were filled

• 6,960 unique beneficiaries residing in LTC facilities

• 70 percent of beneficiaries in a LTC facility had a prescription opioid filled.

17

Filled by community pharmacies

• 78,347 prescriptions for opioids were filled

• 123,243 unique beneficiaries not residing in LTC facilities

• 64 percent of beneficiaries had a prescription opioid filled

Opioid Prescriptions in OklahomaMedicare Fee-for-Service Beneficiaries April 1, 2016 – March 31, 2017

Percentage of Medicare Fee For Service Beneficiaries with Prescriptions for

Opioids

18

48%

64%

58%

64%

12%

NCC data 4/1/2016 through 3/31/2017 General population, non-LTC

Page 45: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

7

Percentage of Medicare Fee For Service Beneficiaries with Prescriptions for

Opioids - LTC

19

51%

70%

83%

63%

N/A

NCC data 4/1/2016 through 3/31/2017 prescriptions filled by pharmacies servicing long term care facilities

Benefits to Participating Providers

� Partner with multiple community organizations, such as

beneficiaries, practitioners and stakeholders, to address

problems across the continuum of care in communities

� Develop a project plan, with a timeline, to implement

evidence-based interventions

� Establish online data portal accounts for providers to track

and monitor readmissions data and download provider and

community-level 30-day readmission reports

� Participate in live, web-based educational forums to learn and

share best practices with other network members

20

Your Readmissions Quality

Improvement ConsultantJenny Kellbach

[email protected]

Phone: (405) 578-4491

21

Page 46: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

8

Oklahoma Nursing Home

Oral Care Project

Under contract with the Oklahoma State

Department of Health through the

Civil Money Penalty Funds Award

How can TMF help you?

Oral Health Care Project Participants Receive:

� Three onsite oral education trainings

› Importance of Daily Oral Care for the Elderly

› Daily Oral Care Strategies and Care Planning

› Residents Requiring Special Care and the Resistant

Resident

� Free educational toolkit that will provide staff with

resources so they feel more confident to provide oral

care and perform oral assessments on their nursing

home residents

23

Take 60 seconds each day to perform

an oral health assessment.

Oral cancer in the elderly

� Seven times more likely to be diagnosed with

oral cancer than those under age 65

� When in doubt, refer out 24

Page 47: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

9

Breathing in germs from a dirty mouth is a

significant risk factor for pneumonia

� Germs from this plaque can get into the lungs

and cause pneumonia

25Study by Quagliarello V et al. Modifiable risk factors for nursing home acquired pneumonia. Clin Infect Dis 2005;40:1-6

Your Quality Improvement Consultant

for the Oral Health Project

Shelley Mitchell, CDA, RDH, MEd

[email protected]

26

Join the TMF QIN-QIO Website

https://www.TMFQIN.org

� Provides targeted technical assistance and will engage

providers and stakeholders in improvement initiatives

through numerous Learning and Action Networks (LANs)

� The networks serve as information hubs to monitor data,

engage relevant organizations, facilitate learning and

sharing of best practices, reduce disparities and elevate

the voice of the patient.

27

Page 48: Provider Training Long Term Care Agenda LTC Provider Training Handouts.pdf1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays 2:00 p.m. – 2:20 p.m. QM/Composite

06/19/2018

10

All Are Welcome

� Visit the Networks tab for more information.

� As you complete registration, follow the

prompts to choose the network(s) you would

like to join.

28

Questions?

Together we can make a better world for our

seniors. Won’t you join us?

29

Contact Me

Sandra Terry, MBA, BSN, RN

State Program Director for Oklahoma

TMF Quality Innovation Network

[email protected]

405-919-6490

www.TMFQIN.org

30

This material was prepared by TMF Health Quality Institute, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers

for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 11SOW-

QINQIO-C3-18-29