The Heart of Health Care: The Many Roles of Nursing Leaders in Post-Acute Care
In today’s vastly changing health care environment, the role of nursing leadership is one thing that remains consistent. It is and always will be the heart of health care.
My role as an operational leader was to set the strategic direction of the organization while working side-by-side with my nursing leader. I found organizational success unattainable without the contributions of my nursing leader and her team.
Nursing leaders focus on setting standards, setting policy, dealing with compliance, and overseeing quality measures and clinical outcomes. They spearhead innovation and transformation within their teams and the organization as a whole.
As I reflect on my career, and the dynamic nurse leaders that I have had the opportunity to work with, I note the following are the cornerstones of successful nursing leaders:
Nursing leaders provide direction for their department while holding staff accountable. Nursing leaders oversee many responsibilities, including:
- resident care delivery
- customer and staff satisfaction
- clinical processes
- financial outcomes
Nursing leaders continually expand their knowledge and understanding of industry changes. Their main goal is caring for our residents. Staying on top of the changes that affect the organization can challenge nursing leaders. It is important that nursing leaders continue accessing education, tools and outside resources. Education provides a level of support for their organizations’ priorities, as well as expected outcomes.
Translating the information and knowledge into organizational best practice is another responsibility. Aligning industry changes with facility and department goals helps to relieve some of the pressure felt by nursing leaders. Implementing best practices allow nursing leaders to focus on targeted, high-level priorities and clinical processes for successful outcomes.
Align Talent and Clinical Success
Nursing leaders continue to work with their team at all levels. They identify the knowledge, skills and abilities of their team. Then, they align those talents with the clinical priorities of their organization. This allows for ongoing mentorship and development of future nursing leaders. Successful nursing leaders help build upon their success by surrounding themselves with an amazing team. Team building is essential to leading a diverse group of people with distinct personalities and skills. Fostering an environment of collaboration and professional growth is a key strategy for successful nursing leaders.
Motivate and Innovate
Given all the changes faced by nursing leaders, they possess a unique ability to motivate staff, especially in times of challenge. They know when to talk and when to listen. They are often confident and optimistic while inspiring enthusiasm in those around them. Today’s nursing leaders also spark and support innovation, knowing change is necessary to succeed in the new health care environment.
Being a leader is an amazing journey. It continues to provide opportunities for innovation, as well as personal and professional growth. Working next to dynamic nursing leaders in post-acute care is an honor and a privilege. Thank you for being at the center of our organizations, and for being the heart of health care.
Happy Valentine’s Day!
Chief Strategy and Marketing Officer
Contact Pathway Health for more information on how we can expand the education and expertise of your long term care staff.
Pathway Health Leaders at Vertical Summit 2019
Pathway Health’s Lisa Thomson and Dan Billings will be attending the annual Health & Human Service Vertical Summit for Marsh & McLennan in Atlanta, GA on February 8. The event will host leaders from across the health care industry for productive meetings and networking opportunities. Thomson will also be presenting an industry overview keynote for this annual event.
- 10:00-11:15 a.m. – Lisa Thomson – State of the State Keynote
Pathway Health leaders are traveling to many events in February for insights into the future of health care, in 2019 and beyond. Stay informed of their progress through social media and our blog.
What If… 2019 Conference with LeadingAge Minnesota
Pathway Health leadership will exhibit and present during the LeadingAge Minnesota Institute & Expo on February 6-8, 2019. The event centers on the theme of “What If…” pushing the boundaries of health care and challenging attendees to think bigger. What if we could start from scratch? What if we could dream without limits? What if we were more inclusive?
These answers and more may be found during one of the many presentations provided by Pathway Health professionals during the conference. Mark your planners for the following events:
- 3:00-4:00 p.m. – Lisa Thomson – Building Nurse Competencies
- 3:00-4:00 p.m. – Leah Killian-Smith – PDPM – ICD10 Coding – Turning Words into Numbers for Payment
- 4:15-5:15 p.m. – Karolee Alexander – PDPM – Double the Data: More MDS Data Under Section GG
- 8:30-9:30 a.m. – Leah Killian-Smith – Purposeful Preparation for Phase 3 ROPs
- 10:30-11:30 a.m. – Leah Killian-Smith – Trauma Informed Care: Preparation for Phase III Requirements of ROPs
- 10:15 a.m.-12:30 p.m. – Karolee Alexander – Data = Quality: How to Use Data to Achieve Quality Outcomes
Stay informed of all Pathway Health events and educational sessions on our social media and blog.
What Do You Really Need to Do Now to Prepare for PDPM?
When the Medicare payment model changes for nursing homes on October 1, 2019, the drivers of reimbursement will be dramatically changed. Under the current payment model, the amount of therapy provided to the resident in a seven-day period is the major determinant of the amount of daily payment the nursing home will receive from Medicare. Additionally, the resident’s level of dependence in activities of daily living (ADL) impacts the final payment category and amount. The higher the level of ADL dependence, the higher the payment rate. The nursing assistant staff documents the supporting charting of each resident’s ADL dependence level.
The new payment model, Patient-Driven Payment Model (PDPM), uses the resident’s clinical conditions as the main determinant of payment. The resident’s ADL dependence score is derived from an area of the Minimum Data Set (MDS) that is assessed and documented by the professional staff. There is no impact on the payment rate from the amount of therapy services provided. Payment is higher in the Physical Therapy (PT) and Occupational Therapy (OT) components of PDPM for residents who require some ADL help but are not totally dependent. These residents are more likely to be able to participate in and benefit from therapy services.
The PDPM system is comprised of six components:
- Non-Case-Mix Base Rate
- Physical Therapy
- Occupational Therapy
- Speech therapy
- Skilled Nursing
- Non-therapy Ancillary
Each component is scored separately and has federally established rates for each Case-Mix category in the component. The Case-Mix rates for each component are summed to establish the overall daily payment rate for the resident’s skilled stay under Medicare Part A.
There will be no transition period to PDPM. On September 30, 2019, Medicare payment will be from the RUG-IV classification system. On October 1, 2019, Medicare payment will be determined by a new MDS that established the PDPM payment rate. Because there will be no transition, nursing facilities need to perfect their systems that impact PDPM now.
The triad of systems, or M-I-P, that support PDPM are highlighted below:
- MDS coding accuracy, especially in Section GG, functional performance and Section I, diagnoses
- ICD-10 diagnosis coding accuracy and management
- Pre-bill claim check review
MDS Coding –
Section GG of the MDS was added in October 2017. Confusion remains about the best process for obtaining an accurate assessment of the resident’s USUAL performance in the first three days and last three days of their Medicare stay. The most effective approach is to have the nursing and therapy staff collaborate on coding Section GG. If the resident only performs the activity in therapy, that is the resident’s usual performance. If the resident performs the activity multiple times per day with nursing staff and only once with therapy, the resident’s performance with nursing staff best represents their usual performance.
ICD-10 Diagnosis Coding –
Section I of the MDS is dependent upon accurate ICD-10 diagnosis coding and management so that the MDS and the Medicare claim contain the same information in the same order. There are few resources for staff education for ICD-10 coding for nursing homes. Most nursing facilities do not have a professionally certified medical coder on staff. Ensure that the staff responsible for coding understands the Official Coding Guidelines as published by the CMS and NCHS.
Most clinical software used in nursing homes automatically enters the diagnosis codes onto the bill. There must be processes in place to ensure that the admitting and primary diagnoses are entered in the correct location on the bill and the coded conditions entered on the bill provide the clinical “story” that supports the amount being billed.
Pre-bill Claim Review –
Pre-bill Claim Review involves an interdisciplinary team process that starts with the draft bill or claim and validates the information on the bill as well as the supporting documentation in the resident’s medical record. When this process is conducted effectively, the facility submits a “clean claim” that is a much lower risk for audit or medical review, thus is paid quickly and accurately.
PDPM Solutions to Start Preparing Now
Pathway Health PDPM experts can assess your facility’s M-I-P systems and provide a detailed action plan for enhancing or improving these processes. Our PDPM consulting services and tools can support your busy leaders and staff to effect a smooth transition to the PDPM system. Pathway Health also offers expert PDPM training – classroom, onsite and web-based. Contact us to learn more.
New! Complimentary PDPM Resource
The Non-Therapy Ancillary (NTA) component of PDPM presents an opportunity to capture reimbursement for resident comorbidities and special treatments. This one-page tool is a quick reference to those items that qualify in the NTA component of PDPM. Download now>
Ready to start preparing for PDPM? Contact us.
Director of Reimbursement and Clinical Consulting,
Fighting the Flu is Nothing to Sneeze At!
The influenza season is hitting hard across the U.S.
In fact, the Weekly Influenza Surveillance Report indicates that influenza-like illness (ILI) shows an elevated activity of Influenza A (H1N1)pdm09, Influenza A (H3N2), and Influenza B viruses as they continue to co-circulate. (Source: CDC)
Check out the ILI activity as listed on the CDC Weekly U.S. Influenza Surveillance Report for the week ending January 5, 2019.
Vital indicators include:
- Viral Surveillance: Influenza A(H1N1)pdm09 viruses have predominated in most areas of the country.However, Influenza A(H3) viruses have predominated in the southeastern United States (HHS Region 4).
- Geographic Spread of Influenza: The geographic spread of influenza in 30 states was reported as widespread; Puerto Rico and 17 states reported regional activity; two states reported local activity; the District of Columbia, the U.S. Virgin Islands and one state reported sporadic activity; Guam did not report.
- Influenza-associated Hospitalizations: A cumulative rate of 9.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. The highest hospitalization rate is among adults 65 years and older (22.9 hospitalizations per 100,000 population).
Did you know?
- 1 to 3 million serious infections occur every year in SNFs.
- Infections include urinary tract infection, diarrheal diseases, antibiotic-resistant staph infections and many others.
- Infections are a major cause of hospitalization and death; as many as 380,000 people die of these infections each year.
Having a well-written and effective infection prevention and control plan is key to success. Preventing influenza and treating it promptly may reduce the risk of influenza-associated complications, including hospitalization and death.
It is estimated that 90 percent of seasonal influenza-related deaths and more than 60 percent of seasonal influenza-related hospitalizations in the United States each year occur in people 65 years and older. Hospitalizations also are often sentinel events in this population group, precipitating disability and potentially resulting in loss of the ability to live independently.
Preventing transmission of influenza viruses and other infectious agents requires a multi-faceted approach that includes developing a system with policies and procedures for the following:
- Infection Control
- Antiviral Treatment
- Antiviral Chemoprophylaxis
Preventing influenza and treating it promptly may reduce the risk of influenza-associated complications, including hospitalization and death. Consider the following:
- Policies: ensure staff members are performing appropriate hand hygiene and that appropriate infection control measures are being utilized facility-wide.
- Procedures: prepare the staff for what to do in case of an outbreak and what steps can be taken to minimize the number of Influenza cases as the season moves forward.
- Resources: Pathway Health has many resources to assist related to infection control and outbreak management, as well as online resources through the PathwayLearningNetwork.com.
For more information on preventing seasonal influenza and the 2018-2019 influenza Season, check out the CDC Resources available to health care organizations.
- Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities
- Prevention Strategies for Seasonal Influenza in Healthcare Settings
- Healthcare-associated infections and long-term care settings
Need assistance with infection control processes, systems and training? Pathway Health’s team of experts and trainers are ready to assist. Contact us today.
Director of Education
Best Practices for Staff Competencies
Care Providers of Minnesota will host an online workshop titled, “Staff Competencies,” to present leadership and staff of care facilities with the requirements for nursing competencies. Pathway Health’s Karolee Alexander will work with webinar participants to accumulate many competency tools they can adapt for their own benefit going forward.
- Review the regulations requiring nursing competencies
- Describe the elements of competency
- Identify the core nursing competencies
5 Elements of QAPI Interactive Workshop
Take part in simulated QAPI projects and explore methods to involve all departments in the QAPI process. Pathway Health’s Lisa Thomson presents at this 1-day interactive workshop providing resources and education healthcare professionals need to move their Quality Assurance and Performance standards forward.
Objectives for this event include:
- Describe all five elements of Quality Assurance and Performance Improvement
- Understand how to implement QAPI by participating in case studies
- Demonstrate the skills to educate and include all departments in a QAPI project
- Identify creative QAPI topics that would be meaningful for each participants organization
The event will take place January 10 from 9 a.m. – 4 p.m. Learn more and register to participate here.
Insight Opportunities from LeadingAge Kansas
Be sure to attend the webinar presented by Pathway Health’s Leah Killian-Smith on culturally competent actions and procedures within nursing facilities. The event, titled “Comprehensive Care Plans That Are Culturally Competent and Trauma Informed,” is part of a series by LeadingAge Kansas that breaks down new regulations in order to prepare nursing facilities for changes that go into effect November 28, 2019.
Tune in from 2:00 p.m. – 3:00 p.m., and gain the following insight:
- Identifying existing holes in the facilities pre-existing resident care plan as it is related to cultural competence and trauma
- Building a resident care plan with culturally competent goals, and approaches
- Including trauma-informed approaches and objectives for the nursing facilities care plans going forward
Ho! Ho! Ho!…Oh No! Readmissions are Not Merry and Bright for Most.
In light of the recent readmission outcomes due to SNF Value-Based Purchasing (SNFVBP), our industry is challenged with some significant readmission penalties.
As you know, The Centers for Medicare and Medicaid Services (CMS) implemented measures to reduce avoidable hospital readmissions by lowering a year’s worth of payments to nearly 11,000 SNF providers. The financial incentives were determined by each facility’s readmission rates.
*The above chart indicates the number of SNFs with SNFVBP Impact: Green-Bonus; Yellow-No Change; Red-Penalty.
Make your Readmission Measure List and Check it Twice…
Consider the following to positively impact your quality processes:
- Implement INTERACT® – INTERACT® (Interventions to Reduce Acute Care Transfers) is an evidenced-based, internationally recognized quality improvement program specifically designed for post-acute care providers. Identify and implement a comprehensive program for the identification of a change of condition to reduce care transfers. As indicated in the State Operations Manual/Interpretive Guidance, all skilled facilities must have a process in place encompassing all staff to assist in the indemnification and notification of a potential change of condition.
- Review Your Current Hospitalization Rate – Hospitals, health systems, physicians and insurers continue to review the impact of high readmissions on their Medicare payment rates and will use this information to determine which SNF providers they will choose to as a preferred provider, affecting referrals into SNF organizations.
- Implement Tracking – SNF providers need to track their overall hospitalization rate on a real-time, ongoing basis for performance improvement and better outcomes. Tracking real-time hospitalization data will provide a benchmark for quality improvement and provide information highlighting your organization’s hospitalization quality improvement efforts as a preferred provider.
- Understand Your Current Skilled Nursing Facility Readmission Measure (SNFRM) – This is the current measure used by CMS to determine whether you will receive a quality incentive add on to your Medicare rate or a potential penalty, which reduces your Medicare rate for an entire fiscal year.
It is important to focus on readmissions now!
- Reducing unplanned hospitalizations, including 30-day hospital readmissions and emergency department (ED) visits, are a significant concern for SNFs, as well as acute care hospitals. SNFs are increasingly under pressure by hospitals, health systems and insurers to reduce 30-day readmissions because of the overall impact to the patients and their families, quality outcomes and financial penalties in place for hospitals and SNFs.
- Tracking, trending and benchmarking specific quality measures, such as an organization’s hospitalization rate, are fundamental to any quality improvement program.
- Unless clearly and consistently defined measures are used, it is not possible to benchmark or compare your measures with other facilities, or with marketplace, state, regional or national data.
- CMS is monitoring readmission and ED rates through various quality measurement initiatives, including the SNFVBP and the Nursing Home Compare Five Star short-stay quality measures. These quality measures utilize data sources such as the Minimum Data Set (MDS) and claims data to calculate readmission rates. There will always be a delay to retrieve necessary information from national data sources, which is unavoidable for national programs.
SNFVBP is here to stay! ‘Tis the season to continue to focus on readmission measures for quality and financial success in 2019.
- Evaluation of Nursing Facility Resident Safety During Implementation of the INTERACT® Quality Improvement Program – JAMDA 2018
- Degree of Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program Associated with Number of Hospitalizations – JAGS 2018
- Kaiser Health News: Look-Up: Medicare’s Bonuses and Penalties for Nursing Homes Near You.
- Medicare.gov – SNFVBP Facility-Level Dataset
Pathway Health provides the insight, expertise and knowledge to keep your organization on the right path. Visit pathwayhealth.com or 877-777-5463.
Chief Strategy and Marketing Officer
Appreciation + Inquiry = Innovation
- Define – Clarifying your project’s purpose, content, and what needs to be achieved.
- Discover – Appreciating the best of ‘what works’ to rediscover what are your organization’s successes, strengths and periods of excellence.
- Dream – Envisioning ‘what could be’ by using past achievements and successes identified in the discovery phase to imagine new possibilities and guide your future.
- Design – Co-Constructing ‘what should be’ by bringing the ‘best of what is’ together with ‘what might be’, to create ‘what should be – the ideal’.
- Destiny – Innovating ‘what will be’ identifies how the design is delivered, and how it’s implemented.