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Category Archives: Leadership Insights

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INTERACT Leadership Insights

 

INTERACT has a strong foothold in the new landscape of value-based care and quality assurance performance improvement.

Read one of my top picks, 10 Years of INTERACT: The Push for Better SNF Care published in the June/July issue of Caring for the Ages, a publication of AMDA/The Society for Post-Acute and Long-Term Care Medicine, to learn more about the impact INTERACT is making in the delivery of care throughout the post-acute continuum.

Read the complete article>

 

Joseph Ouslander, M.D. Sr. Medical Advisor Project Director for INTERACT®

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Tick, Tock…PDPM is Fast Approaching!

The Medicare payment classification system change to Patient Driven Payment Model (PDPM) for SNFs is October 1, 2019. Medicare payments will be based on the PDPM classification system instead of the RUGS IV classification system.

There will be no transition period to PDPM. Nursing facilities need to perfect their systems that impact PDPM now. Help your team prepare with the following 90-day plan:

Click to download tool>


July 2019: Educate and Review

  • Complete staff education about the PDPM classification system and ICD10 CM Official Coding Guidelines for admissions staff, billing staff, MDS staff, social workers, nurse leaders, HIM staff, Case management staff and Administrative staff.
  • Review Medicare technical and clinical coverage criteria, as they have not changed.
  • List changes to make to standard clinical document:
    • Update the pre-admission intake forms to collect primary diagnosis and other co-morbidities.
    • Identify a PDPM estimator for use with pre-admission reviews.
    • Update discipline-specific Admission assessments to refer to the clinical conditions used in the PDPM classification system.
    • Update daily skilled nursing charting format to refer to the clinical conditions used in the PDPM classification system.
    • Revise the Medicare meeting agenda to review the skilled residents’ progress toward goals related to their clinical conditions.

August 2019: Identify and Revise

  • Determine changes needed to the E.H.R. care plan library to capture the monitoring and treatment provided for residents’ clinical conditions.
  • Review Medicare Advantage contracts to validate payment structures and confirm the internal processes for calculating RUG categories, if relevant for Medicare Advantage plan billing.
  • Identify the mechanisms to monitor and decide about completing an Interim Payment Assessment.
  • Write and revise policies and procedures for managing the PDPM system:
    • Interim Payment Assessment criteria and process
    • Use of the Other State Assessment item set
  • Review and revise as needed, the assignments of MDS section completion (e.g., Section I, Section K, and Section O).
  • Review diagnosis codes and sequencing for Medicare Part A stays.

September 2019: Monitor and Implement

  • Begin to estimate PDPM payments for new Medicare Part A admissions.
  • Monitor the number of Medicare Part A admissions to plan for transition IPA scheduling.
  • On September 25, identify the residents expected to still be in the facility on October 1, 2019. Review their diagnosis codes and sequencing. Review Section GG coding and each resident’s current status.
  • On September 28, schedule Interim IPA assessments with ARD between October 1 and October 8.

Click here to download and print the complimentary tool.


PDPM Insight, Expertise and Knowledge.

Pathway Health PDPM experts can assess your organization’s readiness 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.

 

Karolee Alexander
Director of Reimbursement and Clinical Consulting

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Celebrating Leaders in Clinical Excellence

National Nurses Week is a time for everyone – individuals, employers, other health care professionals, community leaders, and nurses – to recognize the vast contributions and positive impact of America’s 4 million registered nurses. Each year, the celebration ends on May 12, Florence Nightingale’s birthday.

As health care becomes more specialized with different types of provider types, higher acuity in various settings, increased technology, primary care physicians and specialists and interdisciplinary team members – one profession provides the continuity across the continuum – Nursing!

Nurses continue to play a pivotal role in quality patient care and outcomes. Nurses are the patient advocate, working with the patient, family and all health care professionals for smooth transitions of care.

The role of nursing is rapidly evolving as nursing professionals are tasked with an even wider range of responsibilities in the new health care environment. Nursing has become more complex in ways that couldn’t have been imagined a generation ago. Nurses are not only caregivers, but they are teachers, advocates and great innovators – utilizing their expertise and critical thinking abilities to assess and resolve complex situations. Nurses are innovators, influencing change in healthcare. With the change to a value-based approach to care, challenging organizations related to reimbursement and efficiencies, nursing leaders are reshaping care by enhancing clinical processes and competencies with their teams, fostering better outcomes. Empowering the capabilities of their teams unleashes a “gold mine” of talent, skills, and innovation amongst all nurses within an organization!

Every day, nurses continue to promote health and cater to the unique needs of individuals by providing safe and quality care. Many times in our complex health care world, we are wrapped up in day to day operations and complicated regulations and lose sight of the glue of our organization – our professional nurses. They are the heart of health care!

To all of the nurses across the nation, we thank you! Thank you for embracing the new health care environment and all of the changes it brings, reminding us every day why we do what we do – provide excellent care and services to those in need.

Happy Nurses Week!

Donna L. Webb, RN – Chief Operating Officer

 

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An Effective QAPI Program with the Beacon Institute

Get hands-on learning to address your QAPI responsibilities that approach with the upcoming Phase 3 changes later this year. Pathway Health’s Jeanne Carlson presents at the upcoming event, “Implementing An Effective QAPI Program Applying Root Cause Analysis,” hosted by the Beacon Institute.

The event takes place on May 9 from 9 a.m. – 4 p.m. and breaks down how the QAPI process works in the “real world,” defining the essential elements of a data-driven QAPI program. The event will include group cooperation as attendees face actual QAPI projects head-on.

Check out more educational opportunities from Pathway Health »

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Phase 3 Preparedness at MN-DONA/LTC Annual Meeting

Pathway Health will be attending the 2019 MN-DONA/LTC Spring Connection and Annual Meeting hosted by Minnesota Director of Nursing Administration in St. Paul, MN, on May 2. This annual spring meeting offers the opportunity to learn and grow with your team and other nurse leaders during a single-day event. Participants gain access to networks, mentorship possibilities, health care leaders and more.

In addition to our attendance, we are also proud to announce our sponsorship of the event and Social Networking Reception to help support the efforts of the MN-DONA and fellow attendees to learn and grow in the world of nursing and long-term care.

Attendees can connect with Pathway Health leaders during these following events:

May 1:

  • 6 – 8 p.m.– Social Networking Reception at the Radisson Hotel

May 2:

  • 9:45 – 10:45 a.m.– Karolee Alexander – Purposeful Preparation for Phase 3
  • 12:45 – 1:30 p.m.– MN-DONA/LTC Annual Meeting

Schedule an appointment to connect with a Pathway Health expert.

Pathway Health leaders are traveling to many events in May for insights into the future of health care, in 2019 and beyond. Stay informed of their progress through social media and our blog.

 

Blog

Meet us at WHCA/WiCAL in Green Bay

Pathway Health’s Stacy Jones and Leah Killian-Smith will be attending the 57th Annual Spring Conference & Exposition hosted by Wisconsin Health Care Association and the Wisconsin Center for Assisted Living in Green Bay, WI, from April 10 – 12. This annual conference focuses on four major challenges facing the health care community in 2019 and beyond: workforce issues, resident issues, regulations, and reimbursement. Participants gain access to networks, mentorship possibilities, health care leaders and more.

Attendees can connect with both of our team members at the Pathway Health booth during these times:

April 10:

  • 5 – 8 p.m.– MVPs of LTC Reception Located in the Atrium of the Hyatt

April 11:

  • 10:30 – 11:30 a.m.– Leah Killian-Smith – Purposeful Preparation for Phase 3
  • 11 a.m. – 1:30 p.m.– Expo/Lunch in Expo Hall
  • 4:30 – 7:30 p.m. – Social Hour and Networking Event Dueling Pianos

Schedule an appointment to connect with a Pathway Health expert.

Pathway Health leaders are traveling to many events in April for insights into the future of health care, in 2019 and beyond. Stay informed of their progress through social media and our blog.

 

Blog

Envisioning the Future with AANAC and AADNS in Orlando

Pathway Health’s Susan LaGrange, Karolee Alexander, Colleen Toebe, Cindy Perrault, Louann Lawson, and Leah Killian-Smith will be exhibiting at the 2019 AANAC and AADNS Annual Conference hosted by the American Association of Nurse Assessment Coordination in Orlando, FL, from April 3 – 5. Susan LaGrange will also present at the event.

This will be the second conference in April for our team members as they travel to meet with potential clients. We look forward to open discussions on PDPM perspectives, the expanding role of nurse leaders, industry insights from the presentations, and networking opportunities on the floor.

Meet with our representatives directly at any of the following times:

April 3:

  • 7 – 9 p.m.– Opening Reception in the Exhibit Hall 

April 4:

  • Morning – 1:30 p.m.– Exhibit booth #202

April 5:

  • 8:15 – 9:15 a.m. – Susan LaGrange – Restorative Care (Breakout Session)

Be sure to catch them at booth #202 when they aren’t presenting! Our exhibit will be open until 1:30 p.m. on April 4.

Schedule an appointment to connect with a Pathway Health expert.

Pathway Health leaders are traveling to many events in April for insights into the future of health care, in 2019 and beyond. Stay informed of their progress through social media and our blog.

Blog

Reconnect 2019 Annual Meeting with LeadingAge Illinois

Pathway Health’s Cheryl Studzinski and Jane Burch will be attending, and Kim Stenzel presenting at, the 2019 Connect Annual Meeting & Expo hosted by LeadingAge Illinois in Schaumburg, IL, from April 2 – 4.

This will be the first conference in April for our team members as they travel to meet with potential clients. We look forward to open discussions on nursing leaders in long-term care facilities, industry insights from the presentations, and networking opportunities on the floor.

Meet with our representatives directly at any of the following times:

April 2:

  • 11 a.m. – 2:30 p.m.– Expo booth #711

April 3:

  • 11 a.m. – 2:30 p.m.– Expo booth #711

April 4:

  • 8 – 9:30 a.m.– Kim Stenzel – Revitalize Restorative Nursing Program for Success!
  • 9:45 – 10:45 a.m.– Kim Stenzel – Overview of Behavioral Health Services
  • 11 a.m. – 12 p.m.– Kim Stenzel – Creating Effective Teams

Be sure to catch them at booth #711 when they aren’t presenting! Exhibits are open at 11 a.m. from April 2 – 3.

Schedule an appointment to connect with a Pathway Health expert.

Pathway Health leaders are traveling to many events in April for insights into the future of health care, in 2019 and beyond. Stay informed of their progress through social media and our blog.

Blog

New CMS Memos – Leadership “Need to Know”

We all know change is an inevitable, new reality in post-acute care. Our industry continues to transform utilizing data (organizational and public) as a determining factor for consumers, strategic partners, and regulators. In the past few weeks, the Centers for Medicare & Medicaid Services (CMS) has published three new QSOs that directly impact providers.

After reviewing the memorandums, I developed a few tools for leaders to help gain a better understanding of the changes, as well as key steps to help prepare your team and your organization.

Below is a brief summary of the CMS announced changes. Click Here for Detailed Description.

April 2019 Improvements to Nursing Home Compare

In summary:

  • Star Ratings – The freeze on Health Inspection Star Ratings will be lifted effective April 2019 impacting your organization’s overall star rating.
  • Quality Measure Domains – New Quality Measure Domains and changes impacting your Five Star rating will go into effect.
  • Staffing Domain Improvement – Thresholds for staff ratings will be adjusted. It’s important to note the threshold for the, “number of days without a registered nurse (RN) onsite,” that triggers an automatic downgrade to one star, “will be reduced from seven to four days.”
  • CMPs – It’s also important to note that the moratorium on CMPs will be lifted as of April 1 in alignment of the Health Inspection Star Rating lift as indicated above.

Revision to Appendix Q – Immediate Jeopardy (Core Appendix Q)

Clarification on how surveyors issue Immediate Jeopardy (IJ) citations has been released by CMS. There is updated interpretive guidance related to noncompliance as well as specific differentiators that are important for leaders to understand:

  • Likelihood vs. potential
  • Noncompliance vs. culpability
  • Psychosocial harm
  • Key components of Immediate Jeopardy

Download the Leader’s Guide: Core Appendix Q Overview, which will assist you and your team in understanding the changes impacting providers.

Leaders should review the online basic Core Appendix Q training on the Integrated Surveyor Training Site which provides a comprehensive review and understanding of the changes.

Enhanced Oversight and Enforcement of Non-Improving Late Adopters

CMS has identified approximately 1,500 facilities that have not improved their antipsychotic medication utilization rates. CMS has heightened its regulatory focus on those organizations, and they will be subjected to enforcement remedies for noncompliance.

While these memorandums are not a surprise to us, there are key tactics you can take to prepare your team for the impending changes. Download this QuickTip Guide for a comprehensive look at the upcoming changes.

Learn more from Pathway Health with our educational classes and training sessions. Contact us today!

Lisa Thomson
Chief Strategy and Marketing Officer

Blog

It all Starts from the Top: Get Proactive with Talent

In this day and age of labor challenges, talent management is even more critical than it has ever been for senior care organizations. Many organizations are stressed with finding enough of the right staff and have doubts about anything getting better in the future. If one looks to the adage that, “It all starts at the top,” it would be interesting to see that many people are viewing talent development as the new CEO skill requirement. It doesn’t take more than a quick Google search to see that this connection and perspective is widely held across a variety of work settings.

People are the most valuable asset in senior care, and leaders need to take a proactive view of their capacity and needs.

For administrators, first and foremost, they need to have a strong management team. The ‘second lieutenants’ are one of the key pieces towards driving success. A high performing, stable management group helps move the bar on solving, or at least mitigating, the labor challenges faced today. An organization cannot afford missteps or lack of synergy with this team, especially when it comes to fostering a strong work climate.

Leadership Considerations

Developing your management team is a primary responsibility of leadership and a strategic choice. Proactive leaders are using a variety of time-tested approaches exemplified by the following:

  1. Have the right people on the team. Jim Collins expands upon this concept in his book, Good to Great.
  2. Ensure everybody is headed in the same direction with the same overall goals. Alignment is a key to success and one of the fundamental, necessary foundations advanced by the Baldrige Performance Excellence Program.
  3. Explore how the team competencies and required development will support the future organizational goals (Bishop in Forbes, 2018).

As leaders, we have an opportunity to make a difference every day in the field of senior care and services. Ultimately, our leadership performance impacts the daily life of a multitude of individual residents and clients, and our staff.

So, if you believe that talent management does start at the top, then it is everyone’s responsibility to make sure that we stay hopeful about tomorrow. One of the ways to solidify that optimism is by taking the steps to ensure we have a cohesive, proactive, and strong management team to lead the way.

Douglas M. Olson, Ph.D., MBA, NHA, FACHCA
Senior Advisor

Director, Center for Health Administration and Aging Services Excellence 
Professor, Health Care Administration Program
University of Wisconsin – Eau Claire