Audrey Sunderraj, Director of Survey & Certification with the Kansas Department on Aging recently met with KHCA staff and others to discuss deficient practice issues and survey trends. Click here for a link to the 3rd quarter report.
Other issues that were discussed included consistency in survey regions. Questions about black box warnings and how they should be care planned were asked. Director Sunderraj provided the following:

"Here is the guidance on drugs that need to be care planned.

The care plan must cover those medications with a potential for significant impact upon the resident and those that require ongoing monitoring of their use. A facility may focus the care plan on those medications that, based on a comprehensive assessment, have the potential for a clinically significant impact upon the resident or have side effects for which the resident is at particular risk. When a medication (for example, amiodarone, digoxin, or warfarin) is known to present a clinically significant risk, the facility would have to justify not including it in the care plan. The facility should be able to tell or show a surveyor the goal and objectives for medications being used and how they are monitoring the resident for efficacy and adverse consequences.
The facility is not required to list each and every medication, but the care plan must have sufficient information to assure that the care is provided as needed and the medication use is monitored as necessary and that the location of the information regarding dose and duration is on the clinical record, such as in the physician’s orders."

The question of when must all providers use electronic health records was discussed. The CMS S&C letter that addressed this and other issues on Electronic health records is 09-53 and can be accessed by clicking here.

Regional Round tables

To date,  roundtables with Audrey Sunderraj and the regional survey managers have been held in Lawrence, Salina and Hays. Excellent information has been shared on a variety of topics including top 10 deficiencies, consistency in guidance to and from surveyors, and the IDR process. Meetings are scheduled for November 14 in Wichita and November 21 in Chanute. Click here for more information.

What is Gero Prep? 
An important new member benefit is available to nurses for the challenging road ahead.
As we anticipate member needs, advocate on your behalf and help you elevate quality in long-term care we've found a program that ticks all the boxes. It also fits the quality and workforce initiatives of our association.

This program is the AHCA/NCAL Gerontological Nurse Certification Prep Course.

We’ve teamed with a nationally accredited provider of continuing nursing education so that you can provide advanced gerontological training to your key RN staff.

Applicants may apply for Joan Hamel Nursing Scholarship monies to off-set the cost of this training! Contact KHCA/kcal for application information.

 AHCA/NCAL Gerontological Nurse Certification Prep Course expertly equips RNs to pass the national Gerontological Certification exam:

•Created expressly to expand the knowledge, skills, competencies, personal and professional growth of registered nurses (RNs) in long-term care facilities.
•Prepares RNs for attainment of national certification as Gerontological Nurses (credential RN-BC: Registered Nurse—Board Certified) through rigorous testing by the American Nurses Credential Center (ANCC).
•National certification is a badge of quality. It signifies the highest standard of clinical and leadership excellence. And it assures employers, residents and families of quality nursing care.
•In facilities employing certified RNs, key quality indicators — including patient outcomes, patient satisfaction and RN satisfaction — have shown marked improvement.
•To date, RNs who’ve taken this Gero Prep Course have a 96% exam pass rate.

For more information, click here.

The follow KHCA/kcal members were named as receiving no deficiencies by the Kansas State Fire Marshal's Office in 2011:

GOLDEN LIVING CENTER  FREDONIA 
GOLDEN LIVING CENTER  NEODESHA
MEDICALODGES KINSLEY  
FAMILY HEALTH AND REHABILITATION
MEDICALODGES ARKANSAS CITY
MORAN MANOR
GOLDEN HEIGHTS LIVING CENTER 
THE CENTENNIAL HOMESTEAD
MEDICALODGES POST ACUTE CARE CENTER
GOLDEN LIVING CENTER CHASE COUNTY 
LAKEPOINT NURSING AND REHAB CTR EL DOR
MEDICALODGES COFFEYVILLE
LAKEPOINT NURSING CENTER

Inside a bustling ER ward one August afternoon, 
a fragile-minded , antique woman hummed an aimless tune.
I slightly pulled the curtain back then as I stepped inside the humming stopped. 
Her blue eyes shined. Her smile was sweet and wide.
"When did you get here?" she asked. Her face brimmed with relief. 

"I wasn't sure you'd find me. I've been traveling for a week." 
"We're on our way to Zanesville. I've got two young kids in tow. 
I lost my precious husband, Bob, about two months ago."
"I think I had some kind of spell, though I don't feel too bad. 
My family must be worried. Will you call my mom and dad?" 
With gentle reassurance that I'd do just what she asked,
I left her with a friendly nurse and went about my task.
     
I called back to the office. I knew they'd be concerned. 
I shared her situation, and the rest that I had learned. 
Returning quickly to her room I fused my face with cheer, and as the curtain parted, 
she said," When did you get here?'
"I'm so glad that you found me for I have no way to pay.
My mom's back in Ohio. Will you be my mom today?"
"You're like her in so many ways. I'm safe when I 'm with you.
And when I get into a jam you know just what to do."
     
She leaned against her pillow as she slowly closed her eyes.
She fiddled with her wedding ring. Shallow breaths gave way to sighs.
The doctor brought her test results then ordered her admission 
into a special unit where folks went with her condition.
She transferred to a wheel chair and began her lengthy ride 
through several locked and coded doors. Then finally- we arrived.
Too quickly it became the time to say our last good-byes. 
I stepped around the wheel chair and her face streamed with surprise.
I knelt to hug her one more time and my eyes welled up with tears,
As she whispered in her soft, sweet voice, “When did you get here?"

Join AHCA/NCAL for its annual symposium on quality performance in long term care.  The AHCA/NCAL Quality Symposium: Inspiring Excellence in Long Term Care conference, will take place February 23-24, 2012 at the Westin Galleria hotel in Houston, TX.

Returning for its fourth year, the symposium continues to offer comprehensive programming led by experts in the field on implementing and sustaining quality initiatives in the long term care setting.  Education sessions have been designed to strengthen quality processes across all areas of the Malcolm Baldrige National Quality Award framework. Attendees can also earn more value for their training dollars by participating in pre-symposium workshops, which offer deeper exploration of the key areas of quality in long term care. The symposium’s Poster Session Gallery will allow peers from across the country to share their quality success stories.

The AHCA/NCAL Fourth Annual Quality Symposium  is not to be missed. For more information, click here. The Registration Deadline is January 31, 2012. 

It's almost time - on November 1, 2011 AHCA/NCAL will begin accepting online "intent to apply" documents and payment.

The AHCA/NCAL National Quality Award Program provides a pathway for providers of long term care services to journey towards performance excellence. The program is based on the core values and criteria of the Baldrige Performance Excellence Program. Click here for full details.

The Quality Award program has three progressive step levels. Applications are judged by trained Examiners who provide feedback on opportunities for improvement to support continuous learning. Facilities must achieve an award at each level to progress to the next level.

Bronze – Commitment to Quality applicants begin their quality journey by developing an organizational profile including vision and mission statements, an awareness of their environment and customers’ expectations, and a demonstration of their ability to improve a process.

Silver – Achievement in Quality applicants demonstrate a level of achievement in their quality journey through good performance outcomes that have evolved from how they embrace the core values and concepts of visionary leadership, focus on the future, resident-focused excellence, management by innovation, and focus on results and creating value.

Gold – Excellence in Quality applicants must show superior performance over time that is based on their systematic approaches to leadership; strategic planning, focus on customers, measurement, analysis and knowledge management, workforce focus, process management and results. Gold applicants address the complete Baldrige Criteria for Performance Excellence in Health Care.
 

On Thursday, November 3, 2011 from 12:30-2pm CT, CMS will host a National Provider Call on "Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Minimum Data Set (MDS) 3.0 and Resource Utilization Group-Version 4 (RUG-IV) Policies and Clarifications.”  CMS subject matter experts will provide a brief overview of the policies, along with clarifications on the SNF PPS FY2012 policies related to the MDS 3.0.  A question and answer session will follow the presentations.

Target Audience:  SNF providers, facility Resident Assessment Instrument (RAI) coordinators, state RAI coordinators, rehabilitation therapists, Recovery Audit Contractors, and Medicare Administrative Contractors
 
Agenda:
* Allocation of group therapy
* Changes to the MDS Assessment Schedule
* End of Therapy (EOT) Other Medicare Required Assessment (OMRA) Clarifications
* End Of Therapy with Resumption (EOT-R)
* Change of Therapy (COT) OMRA

Registration Information:
In order to receive the call-in information, you must register for the call.  Registration will close at 11m CT on Thursday, November 3rd or when available space has been filled. No exceptions will be made. Please register early.  For more details, including instructions on registering for the call, please click here.

Skilled Nursing Facility Claims Hold

The Centers for Medicare & Medicaid Services (CMS) has identified a claim processing problem impacting Skilled Nursing Facility (SNF) type of bills 18x and 21x containing Healthcare Common Procedure Coding System (HCPCS) code AAAxx and Revenue Code 0022.  We are holding these claims.  As soon as a system fix is in place and successfully tested, these claims will be released for processing. We appreciate your patience and apologize for any inconvenience this may cause.  

New Skilled Nursing Facility (SNF) Health Insurance Prospective Payment System (HIPPS) Codes CMS recently developed a new Change of Therapy (COT) Other Medicare Required Assessment (OMRA) for the SNF PPS and developed a mechanism to allow providers to report a Resumption of Therapy on an End of Therapy (EOT) OMRA.  In addition, several new Assessment Indicators (AIs) were created to identify that a COT OMRA was completed.  Also, to distinguish between cases where an EOT OMRA is performed with the resumption items completed and cases where an EOT OMRA is completed without the resumption items completed.  The new AIs were introduced in Chapter 6, Section 6.4, of the new Minimum Data Set (MDS) manual located here. 

As a result of these new AIs, CMS must add approximately 1,500 new HIPPS codes to the Fiscal Intermediary Shared System (FISS).   The HIPPS master list here will be updated within the next 2 weeks with these new codes.

SNF and Swing Bed providers should continue to use the HIPPS codes assigned by grouper on their claims.

CMS anticipates the effective date of the revised guidance for F322 – Feeding Tubes- to be sometime during the first six months of 2012.

As you recall,  CMS issued new Interpretive Guidance at F 322 (Feeding Tubes) in September which was to be effective in November.  This guidance has now been retracted until CMS has included information for the Quality Indicator Survey.  Additional information regarding expected release date will be provided when we receive from CMS.

The Office of Inspector General's ( OlG ) Work Plan sets forth various projects to be addressed during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General. The Work Plan includes projects planned in each of the Department's major entities: the Centers for Medicare & Medicaid Services; the public health agencies; the Administrations for Children & Families; and Administration on Aging. Information is also provided on projects related to issues that cut across departmental programs, including State and local government use of Federal funds, as well as the functional areas of the Office of the Secretary of Health & Human Services (HHS). Some of the projects described in the Work Plan are statutorily required, such as the audit of the Department's financial statements, which is mandated by the Government Management Reform Act.

OIG does not provide additional details on jobs to be undertaken or information on the status of jobs contained in its Work Plan. For example, although estimated issue dates are provided in the Work Plan, we would not provide revised estimates or current status.

The areas involving nursing homes include:

Nursing Homes

Medicare Requirements for Quality of Care in Skilled Nursing Facilities

Safety and Quality of Post-Acute Care for Medicare Beneficiaries (New)

Nursing Home Compliance Plans (New)

Oversight of Poorly Performing Nursing Homes

Nursing Home Emergency Preparedness and Evacuations During Selected Natural Disasters

Medicare Part A Payments to Skilled Nursing Facilities

Hospitalizations and Rehospitalizations of Nursing Home Residents

Questionable Billing Patterns During Non-Part A Nursing Home Stays (New)

For detailed information click here.
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