Medicalodges Kinsley, a 42 bed skilled home and 6 bed residential care home in the south central part of the state, has earned four deficiency free surveys in a row on the nursing home side and two in a row on the residential care home side. How do they do that?

29 year veteran administrator Mike Velder says they put their pants on everyday just like everybody else. He credits their success to a team effort – from the Medicalodges Home Office in Coffeyville and his regional director Marla Nispel to his core group of staff, many of whom have worked there for 20+ years. Velder says the Home Office supplies very good resources for policy and procedures and his team in the home takes care of the rest.

Velder describes Kinsley as a close knit community. In his two years there, he has worked hard to continue to earn the trust and support of the people in the town. He calls his work a ministry and says, “If you take care of the residents, take care of the staff and take care of the families, everything else will fall into place.” Not only do the state surveyors agree, the community does too, as his census has increased by 30%.

Velder reports having a good working relationship with the regional survey team and feels this helps to set the tone for the survey.

What happens next? Well no good deed goes unpunished. Velder reports looking up from his desk this week and seeing "four ladies with laptops that I did not recognize” coming through the doors. Indeed, Medicalodges Kinsley is currently under a federal walk-behind survey. “They are very congenial and very meticulous,” says Velder of the federal team. "They are going through every piece of paper in the building. I don’t think I’ll get out of this one without a tag but that will still leave us four out five with zero deficiency surveys. Not bad,” says Velder.

Not bad indeed. 

KHCA/kcal welcomes Miranda Metcalf as the new Association Assistant. Since graduating from Washburn, Miranda has spent her time working with the state legislature and state agencies. She will be handling much of KHCA’s website and communications as well as education registrations. “I’m very excited to join the KHCA team and look forward to meeting all of our members and helping them however I can.” Feel free to contact  her with any of your questions at 785-267-6003 or mmetcalf@khca.org.

Don’t miss this special Dementia Care Training!

Register today for the KHCA/Kcal presentation by Teepa Snow, nationally renowned dementia practioner and educator, on July 11 at the Holidome in Topeka, 605 SW Fairlawn Road. Registration starts at 8 a.m. and the presentation ends at 4:15 p.m. Click HERE for the brochure and registration. July 11 is especially for Assisted Living/Residential Health Care (earlier stages of dementia), while July 12 is intended for Nursing Facility staff. Home Plus members should attend whichever session matches their resident population best. The program is approved for six Continuing Education contact hours for both Administrators and nurses. A special free event for family members will be presented the night of July 11, 2011 at the Topeka Shawnee County Public Library and is sponsored by KHCA/kcal and the Heart of America Chapter of the Alzheimer's Association.

NFPA will be providing a series of FREE online trainings on Code Changes to Sprinkler Systems using Antifreeze.  This is important information for homes that have sprinkler systems with antifreeze. Please contact Amanda Yorkey with questions. Click here for details on the training.

Amanda Yorkey
Kansas State Fire Marshal
785-296-0659

KHCA/kcal Sales Associate Member Lancaster Pollard recently  shared information about helping a management company with a refinancing project. The interesting issues involved in HUD’s Sec. 232/223(f) mortgage insurance program are listed below.

Case Study:  Tennessee Health Management, Inc.

Facility type: Thirteen skilled nursing facilities

Location: Various sites throughout Tennessee and Alabama (THM headquarters in Parsons, TN)

Project objective: Refinancing/refunding

Financing amount: $69,375,000

Source of funding: Fixed-rate notes insured by the FHA Sec. 232/223(f) program via LEAN processing

Background and Challenges
Tennessee Health Management, Inc. (THM) is an employee-owned organization that manages over 30 skilled nursing facilities throughout Tennessee and Alabama. THM was seeking a permanent fixed-rate funding structure for several of its facilities.

THM had existing pooled debt in excess of $100 million, which was cross-collateralized by a number of facilities, including the 13 it was seeking to refinance. THM utilized its offshore captive to provide liability insurance on the facilities.

Financial Solution
Lancaster Pollard worked with THM to refinance 13 properties using HUD’s Section 232/223(f) mortgage insurance program. The firm was able to allocate portions of the pooled debt to each facility. That flexibility allowed debt to be allocated in a manner that best served THM’s fiscal future.

THM’s non-rated offshore insurance captive structure was not compliant with HUD’s guidelines. Lancaster Pollard worked with both HUD and THM to institute a Fronting Paper structure that was agreeable to both parties.

The firm also helped make HUD comfortable with the size of the portfolio, which is just below the mid-size threshold and thus not subject to a corporate review, yet large enough to require acute underwriting attention. Lancaster Pollard worked with HUD and THM to guide all parties through the transaction and keep all 13 closings moving on schedule.

Outcome
THM was able to obtain fixed-rate, long-term financing for 13 of its facilities. This reduced its annual debt service and provided a structure without any ongoing financial covenants.

In addition, THM was able to use some of the proceeds to fund its replacement reserves accounts for these facilities and perform some capital improvements in conjunction with the refinance.

For more information, contact:

Tyler Howard
Marketing Communications Specialist
Lancaster Pollard & Co.
65 East State Street, 16th Floor
Columbus, OH 43215
(614) 224-8800

The leader of the nation's largest nursing home association has suggested the federal government cut Medicare reimbursement rates by 3% in fiscal 2012, not the threatened 11.3%. Such a move, along with more possible phased-in cuts, could take more than 100,000 caregiving jobs out of harm's way.

Gov. Mark Parkinson, president and CEO of the American Health Care Association, responded Monday to the Centers for Medicare & Medicaid Services' proposed rule, which could cut certain Medicare reimbursements to skilled nursing facility operators by more than one-tenth. In a letter to CMS Administrator Donald Berwick, Parkinson said the rule would amount to a $4.47 billion cut to skilled nursing facilities. Parkinson also said such a reduction could put more than 100,000 jobs at risk, “reduce wage and salaries by about $5 billion, cut state and federal tax revenues by $1.6 billion, and decrease Gross Domestic Product (GDP) by about $12.5 billion.”

“A reduction of $4.47 billion, coupled with additional Resource Utilization Group (RUG) system changes estimated in the billions and increased costs in the hundreds of millions of dollars, are of great concern,” Parkinson wrote. “Implementing these adjustments all at once could threaten the financial stability and viability of the SNF sector, and therefore, its ability to continue to provide quality care.”

Parkinson also acknowledged in the letter that skilled nursing facilities “were likely overpaid in FY 2011 due to the implementation of MDS 3.0 and RUG reforms [in October 2010].” A solution, he said, would be for CMS to reduce reimbursement rates by 3%, “plus the market basket update [2.7%].” Then, in fiscal 2013 and subsequent years, CMS could further reduce rates by up to 3%, plus the market basket update, until budget neutrality would be reached, he said.

“We accept that we cannot calculate an exact amount of the over payment,” Parkinson wrote to Berwick. “To prevent an over correction, AHCA proposes a measured response to protect the sector, our residents and the economy.”

In addition, on Tuesday AHCA disclosed a letter that was sent by 152 members of Congress to Berwick, asking for a delay in Medicare reimbursement cuts to long-term care providers in order to get more accurate data on which to make decisions. “CMS has based this option on data obtained from only one fiscal quarter, which we believe is unprecedented,” the lawmakers wrote on Friday. “Given the limited timeframe, we are concerned that the agency's proposed option is not based upon accurate data.”

Article originally printed in McKnight's.

A Message from AHCA:
Thank you to our advocates! Your tireless efforts have helped us gather a remarkable 152 signatures on the Congressional sign-on letter regarding the SNF PPS proposed rule. This letter was truly a bipartisan effort with 79 Democrats and 73 Republicans. This level of success would not have been possible without your contributions and determination which amounted to over 15,000 letters to Members of Congress.

Our work is not yet over! Please stay tuned as we continue the steady drum beat on this very important issue. To stay informed on our grassroots action it is important that you are registered as an advocate in our system. Click here to do so. 
 

A few key concepts come to mind when I think about data management systems for health care staff on the frontlines. For example, “a stitch in time saves nine.” One of my favorites is “You will never find time for anything; if you want time you must make it.” I always wondered about how to “make time.” Then I saw the LTC Trend Tracker do it.

Here is my recipe for successfully making time: add a dash of “efficiency,” a pinch of “effectiveness” and the unbelievably simple-to-use LTC Trend Tracker. Then all you need to do is log onto the LTC Trend TrackerSM web-tool to get your facility’s specific data.

This leading edge data management tool focuses you on getting the maximum output, while using minimum resources to reach your end goal. To me that translates to “less work, better results.”

Why is LTC Trend Tracker so good? LTC Trend Tracker is an online tool that securely and seamlessly puts “at your fingertips” a host of facility performance reports so you can TRACK, ORGANIZE, IDENTIFY, BENCHMARK, EXAMINE AND COMPARE almost anything you can imagine about your facility’s clinical and operational performance over time.

LTC Trend Tracker is Administrator- and DON-tested with over 3,500 facilities now using the system. I’ve highlighted here three uses that I think demonstrate the agility of the LTC Trend Tracker tool in preparing reports you probably dreaded getting ready in the past.

Quality Assurance Meetings:
Prepare efficiently for the quarterly QA meeting. LTC Trend Tracker can make your QA process preparation amazingly smooth. With a few clicks of the mouse you get multiple CASPER reports -- Staffing, Survey History and Resident Characteristic Reports; NH Quality Measure, Five Star Staffing Report, Cost Report and Medicare Utilization Report. You will “make time” for actually thinking about the meeting rather than struggling with data chaos.

Budgeting:
Need historical information on your seasonal Medicare Utilization as compared to your peers? Need insight into your staffing patterns? No problem with LTC Trend Tracker. You get theses reports seamlessly: Cost Report, Medicare Utilization Report and CASPER Staffing Characteristic Report. 

Survey Preparedness:
You have your State Survey Entrance Notebook ready, but do you know the top 15 tags in your state for Health and Life Safety Code Inspections? Ask LTC Trend Tracker for the CASPER Survey Citation Reports to prepare your team for survey.

These are “typical” uses but there are many, many more. I just can’t include them all in one short article. However, there are two common questions I want to preemptively answer concern the “pool” that LTC Trend Tracker draws from and the “uploading” of data.
1. LTC Trend Tracker provides benchmarking based on ALL Medicare certified nursing homes, not just those registered for LTC Trend Tracker. Therefore, you use the universe of facilities.
2. AHCA “uploads” data, not you. Uploading is the transfer of a file or program from one computer to another. What that means is that when you log onto the LTC Trend Tracker secure server, your data is already there based on a predetermined schedule of availability. Bottom line translation: LTC Trend Tracker will prevent more work for you later.

Oh, did I forget to mention the cost? For members of the Kansas Health Care Association the system is free, and there are no subscriptions or hidden fees. It is truly a value added benefit of membership, provided in partnership with the American Health Care Association, your state’s national representative in Washington D.C.

To learn more, contact me at pconnorton@ahca.org or 202-898-2833. Better yet, visit me at the LTC Trend Tracker Booth at the Kansas Health Care Association Convention in October. To log on or register, visit www.ltctrendtracker.com. LTC Trend TrackerSM is one of the five Performance Tools selected for the Quality First, Keeping the Promise initiative.

________________

Peggy Connorton, who joined AHCA in 2010, spent over a decade as administrator of nursing homes and assisted living residences. Her commitment to AHCA and its Affiliated Organizations is as a change agent to bring about a culture of success through better health care management. Ms. Connorton can be reached at pconnorton@ahca.org. Digital photo available upon request.

The Center for Nursing Excellence in LTC at Sigma Theta Tau is offering an Entitled Diabetes Care of the Older Adult course. This course is being offered free to the first 200 registrants.  Click here for full details.

CMS released a memo to State Survey Directors last week with rules for implementing the new “Reporting Reasonable Suspicion of a Crime in a Long-Term Care Facility” requirement of the Elder Justice Act.  View the full CMS memo here or here.

The new requirement states that any employee or contractor of a long-term care facility must report to local law enforcement and the state survey agency “any reasonable suspicion of a crime” committed against a resident of the facility.  A failure to report may result in civil penalties against the employee and/or the facility, as well as exclusion from participation in a federal health care program.

In response, AHCA has created templates to help with this process. Please note the disclaimer that these are templates, not endorsed by CMS or any other state or federal agency, including law enforcement, and developed to assist nursing facilities respond to this new mandate. Each individual nursing home will need to modify the policy and reporting form given their own current policy and procedures and state and local laws about reporting. Since facilities are required to have a policy and procedure, AHCA thought this might be a helpful place to start.
 
We are sure that a number of situations, questions and unique circumstances will come up as a result of this new law. Many of these will have to be addressed at the local level but we also want to hear about these so that we can address them with CMS when appropriate. Also, if there are additional templates that we can develop, please let us know. 

The next CMS Skilled Nursing Facility (SNF)/Long-Term Care (LTC) Open Door Forum is scheduled for: Thursday, August 11, 2011
Date: Thursday, August 11, 2011;
Start Time: 1:00 PM Central Time (CT);
Please dial in at least 15 minutes prior to call start time.
Conference Leaders: Sheila Lambowitz, Gregory Price.

Open Door Forum Participation Instructions:
This call is Conference Call Only.
1. To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID#: 68644999.
Persons participating by phone are not required to RSVP.
TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Encore: 1-800-642-1687; Conference ID#: 68644999.
Encore is an audio recording of this call that can be accessed by dialing 1-800-642-1687 and entering the Conference ID. Encores for ODFs held on Thursdays can be access the following Monday or business day. The recording is available for 3 business days.
For ODF schedule updates, E-Mailing List registration and Frequently Asked Questions, visit our website at http://www.cms.gov/opendoorforums .
Thank you.