Monday, March 05, 2018

Aging and Dehydration

What is dehydration? Simply put “Dehydration occurs when more water and fluids leave the body than enter it” (Crosta, 2017).  Studies show that even mild dehydration (1-3% of body weight) can impair many aspects of brain function (Leech, 2017).

Research has also shown that between 6-30% of people over age 65 are hospitalized for some form of dehydration.  The major cause is the lack of fluid intake.  This is often attributed to patients not having the sensation of “thirst”, and not recognizing the signs/symptoms of dehydration such as a sense of dizziness, dry mouth, headache, or a feeling of tiredness.  Another reason noted by patients is their desire to avoid frequent, inconvenient trips to the bathroom, and lastly a fear associated with spontaneous incontinence or loss of bladder control.  (Konings, F., Mathijssen, J., Schellingerhout, J., Kroesbergen, I., Goede de, J., & Goor de, I. (2015).

The benefits of proper hydration aid the body in getting rid of waste - through urination, perspiration and bowel movements.  Proper hydration also keeps body temperature normal, lubricates and cushions joints, and assists in protecting sensitive tissues.

How much fluid should adults drink per day? About 15.5 cups (3.7 liters) of fluids for men and about 11.5 cups (2.7 liters) of fluids a day for women (Mayo Clinic Staff,1998-2018).   Tips to encourage/increase hydration are as follows:  make it a game/encourage the use of colored drinking glasses, incorporate more fluids into other foods such as soups and less sugary beverages like vegetable juices and non-caffeinated beverages such as herbal teas and fruit juices, and making fluids easily accessible.

Crosta, P (2017, December 20). What you should know about dehydration. Retrieved from
Konings, F., Mathijssen, J., Schellingerhout, J., Kroesbergen, I., Goede de, J., & Goorde, I. (2015).  Prevention of dehydration in independently living elderly people    at risk: A study protocol of a randomized controlled trial. International Journal    of Preventive Medicine6103. doi:10.4103/2008-7802.167617
Leech, J. (2017, June 4). 7 Science-based health benefits of drinking enough water.  Retrieved from  
Mayo Clinic Staff. (2018). Water: How much should you drink per day? Retrieved from

The author, Patricia M. Cuddy, is a student currently enrolled in the Master of Health Administration program at St. Joseph’s College.  Ms. Cuddy has worked in healthcare for 24 years as a registered, licensed Radiology Technologist, Clinical Manager of Radiology, and is currently working in Human Resources.

Monday, February 26, 2018

Morbidities Experienced by Geriatric Combat Veterans

One disease of the circulatory system that is associated with geriatric combat veterans is ischemic heart disease. Ischemic heart disease (also known as coronary artery disease) has been linked to exposure to Agent Orange during the Vietnam War (Veterans' Diseases Associated with Agent Orange, 2015). Coronary artery disease is common even among non-combat veterans. It is the number one cause of death in the United States (Coronary artery disease, 2017). While this morbidity is comparable to civilian counterparts, for geriatric combat veterans of the Vietnam War exposure to Agent Orange has become an uncontrollable risk factor.
            When compared to non-veteran populations, some respiratory morbidities are higher among veterans. One study revealed adjusted ratios of mesothelioma to be higher among veteran populations than among New York state or Los Angeles County totals (Spirtas, et al., 1994). While asbestos was once common in the United States in carpentry related taskings, it was also common in Naval shipyards. This translates to an increased risk of mesothelioma for Navy Veterans especially during and before the 1980s.
            Because of one of the more recent conflicts, veterans of the Gulf War have experienced chronic digestive symptoms (Weng, Guo, & Yang, 2015). These morbidities range from heartburn to irritable bowel syndrome. Many gastrointestinal symptoms experienced by these Gulf War veterans began while they were in country. Many veterans did not report this especially if there was minimal interference with day-to-day life.
            Another by-product of Agent Orange is early onset peripheral neuropathy. Some combat veterans of the Vietnam War began suffering from peripheral neuropathy within only one year after their time in country ended (Veterans' Diseases Associated with Agent Orange, 2015). Thus, many veterans have been suffering weakness, numbness, and pain in their extremities for a very long time (Peripheral neuropathy, n.d.). Most people do not develop peripheral neuropathy until they are over the age of 55 (Understanding peripheral neuropathy, n.d.).
            A morbidity of the endocrine system that is experienced by geriatric combat veterans is Hodgkin’s lymphoma. Hodgkin’s lymphoma is another morbidity that is secondary to Agent Orange exposure during the Vietnam War (Veterans' Diseases Associated with Agent Orange, 2015). Also known as Hodgkin’s disease, this is a cancer of the lymphatic system (Hodgkin's lymphoma (Hodgkin's disease), n.d.). Research has shown a positive association between Agent Orange and the development of Hodgkin’s lymphoma (Hodgkin's disease and Agent Orange, 2016).
            Immune system disorders are dangerous because they reduce a person’s natural ability to fight diseases. While some studies have suggested a statistical difference in the immune systems of Vietnam veterans exposed to Agent Orange, follow-up studies do not support these findings (Veterans and Agent Orange, 2010). While Immune disorders in combat veterans may not be related to combat exposure, there is a link between autoimmune disease and prevalence in their descendants. Adult children of Vietnam veterans who were exposed to Agent Orange seem to have a higher prevalence of autoimmune disorders (Ornstein, Fresques, & Hixenbaugh, 2016).
            One disease of the skin that occurs more often in Vietnam War veterans is chloracne. Chloracne, for many Veterans, began soon after exposure to Agent Orange during their time in country (Veterans' Diseases Associated with Agent Orange, 2015). Chloracne is a rare skin condition that includes blackheads, cysts, and nodules (Chloracne or Acneform Disease and Agent Orange, 2017). Studies have shown a direct link with this skin condition and chemicals used in Agent Orange (Institute of Medicine, 1994).
            Amputation has been a historically unavoidable byproduct of combat. While amputations accounted for 5% of combat wounded during World War II, they rose to 19% during the Vietnam War (Burkhalter, 1994, p. 131).  Most of these service members had more than one limb amputated due to use of field-expedient tourniquets. Advancement in prosthetics has improved the day-to-day lives of many of these veterans.
            One of the greatest problems experienced by geriatric combat veterans is mental health ailments such as post-traumatic stress disorder (PTSD). There is a demonstrated long-term pattern of healthcare utilization by geriatric veterans with serious and chronic mental illnesses (Sajatovic, Popli, & Semple, 1996). Chronic mental health issues have led to an increase in suicides in Veterans. The rate of suicide among veterans reached 22 per day in 2010 (Lazar, 2014, p. 459).
Conclusions and Final Thoughts
While there are several morbidities that seem to be consistent among civilian populations, there are several that are exacerbated by conditions experienced during combat. There seems to be a lack of foresight with use of chemicals such as Agent Orange. The military is learning from the mistakes of the past. All soldiers heading to combat are now assigned gas masks and chemical suites called JSLIST (Joint service lightweight integrated suit technology) and MOPP gear (mission oriented protective posture) for short.
Tricare and the VA have both made grand strides in delivery of mental healthcare as of late. Last year, the new Secretary of the VA, Dr. David Shulkin, opened access for mental healthcare to those with other than honorable discharges. This was important because many of these discharges came about because in the past, services didn’t recognize the need for mental healthcare and it was seen as a weakness by not only seniors but peers and subordinates. This is a stigma that we are still getting past, but we are heading in the right direction.
About the Author
Josh Johnson is a former combat medic in the U.S. Army with three combat tours, Joshua Johnson currently works as an Administrative Officer at the Robert J. Dole VA Medical Center in Wichita, Kansas. In addition, he is completing his M.H.A. degree at Saint Joseph’s College of Maine.

Burkhalter, W. F. (Ed.). (1994). Orthopedic surgery in Vietnam. Washington, D.C.: Medical Department, United States Army.
Chloracne or Acneform Disease and Agent Orange. (2017). Retrieved from U.S. Department of Veterans Affairs:
Coronary artery disease. (2017). Retrieved from Medline Plus:
Hodgkin's disease and Agent Orange. (2016). Retrieved from U.S. Department of Veterans Affairs:
Hodgkin's lymphoma (Hodgkin's disease). (n.d.). Retrieved from Mayo Clinic:
Institute of Medicine. (1994). Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam. Washington, D.C.: The National Academies Press.
Lazar, S. (2014). The mental health needs of military service members and veterans. Psychodyn Pschiatry, 459-478.
Ornstein, C., Fresques, H., & Hixenbaugh, M. (2016). The children of Agent Orange. Retrieved from Pro Publica:
Peripheral neuropathy. (n.d.). Retrieved from Mayo Clinic:
Sajatovic, M., Popli, A., & Semple, W. (1996). Ten-year use of hospital-based services by geriatric veterans with schizophrenia and bipolar disorder. Pschiatric Services, 961-965.
Spirtas, R., Heineman, E. F., Bernstein, L., Beebe, G. W., Keehn, R. J., Stark, A., . . . Benichou, J. (1994). Malignant mesothelioma: attributable risk of asbestos exposure. Occupational and Environmental Medicine, 804-811.
Understanding peripheral neuropathy. (n.d.). Retrieved from American Academy of Neurology:
Veterans and Agent Orange. (2010). Washington D.C.: National Academies Press. Retrieved from
Veterans' Diseases Associated with Agent Orange. (2015). Retrieved from U.S. Department of Veterans Affairs:
Weng, W., Guo, X., & Yang, Y. (2015). Gastrointestinal problems in modern wars: clinical features and possible mechanisms. Military Medical Research, 1-8.

Thursday, February 15, 2018

What an Emergency Room Nurse Thought Management Was

               Management is about trading in your scrubs, sneakers, and nursing station for a corner office on the 5th floor. It’s about buying a new wardrobe filled with skirt and pant suits and walking down the hallway with a new pair of Christian Louboutins. Management gives me the opportunity to work Monday through Friday with holidays off, and a guarantee extended vacation. I am in charge of budgets, timelines, meetings, hiring new employees, and addressing issues on the unit to the best of my ability. Executives say they respect what I do and honor all my hard work. However, my ideas are often pushed to the side and ignored. Some of my staff look up to me as their leader, and some talk about how I don’t do anything right. Management does not allow me to be creative and implement new strategies or ideas. It does not allow me to fight for my staff and get them and the patients that they need. I am unable to push my employees to reach their full potential. When my employees make mistakes, I must discipline them according to policy without empathy or compassion to what is going on. I am a manager.
            Over the last 11 weeks, Leadership in Healthcare Administration has taught me about being a leader. Prior to taking this class I was a firm believer that managers managed and were not considered leaders. From previous employments, mangers did their rounds and I never felt supported or heard. However, with the start of my new job I started to see a difference in management and what I learned in this course supported those observations. To manage effectively one must be a leader. A manager needs to lead along with handling budgets, staffing, schedules and meetings. Throughout this class, I have learned the roles and skills of a true leader and the influence they have to inspire the team.
            Leadership effectiveness in healthcare is an important role.  It merges the work of clinical staff and administrators in the success of the organization. Leaders have a large effect on inspiring the team, managing, reaching goals and changing the atmosphere of the facility. They are able to do this by tapping into many of the topics discussed throughout this semester. Leaders must shift between roles daily for each encounter they face. These roles include being an innovator/broker which focuses on creativity and communication, a monitor/coordinator focusing on project management and supervising. Leaders need to be a director/producer in order to achieve goals and facilitate and mentor which supports their managerial role. Along with switching between roles, groundbreakers need to be skilled in motivating, vision-setting, analyzing, and task managing. It is important to utilize these roles and apply their skills while dealing with the constant tensions within the organization. Tensions are required to balance each other out. Polarity maps help visualize the need for these tensions. Freedom and hold responsible is a good example a tension that complements each other. As a leader, we must give others the chance to grow and perfect their skills. By doing someone else’s work we are not holding them responsible and not allowing them to flourish. What surprised me most in leadership was the need for creativity and empathy. As I stated before, management at my current employment has confirmed the benefits of empathy and creativity in effective leadership. Leaders working among the staff have the power to voice their needs and implement new strategies. Open minded managers can take imperfections in the system and innovate creative alternatives to those problems. With flaws in the system, leaders must empathize with staff, patients and family. Staff who feel disconnected and not cared about tend to be distant and their work is less effective. Patients and family who feel uncared for, unheard and not a priority will not come back to the facility. Empathy is needed in leaders to connect with staff and patients and make them feel like they are important. Empathy will keep staff happy and patients and family coming back to the organization.
            Mangers are not the only leaders in a team. Staff who apply leadership qualities and values are leaders themselves. Anyone can be a leader. Throughout this course I have learned that management is more than pant suits and red bottom heals. Leaders who manage effectively are still wearing their scrubs and sneaks, working among staff and listening to patient needs. They may have a corner office on the 5th level, but their real office is on the clinical floor. Healthcare is in need of leadership, and with the understanding and implementation of what I have been taught in this class, I know I will be a pronounced leader in healthcare.
Belasen, A.T., Eisenberg B., Huppertz, J. (2016) Mastering   Leadership A vital Resource for Health Care Organizations.   Burlington MA: Jones and Bartlett Learning 978-1-284-04323-5

Patel, N. (2014, May 19). 8 must-have ingredients of a successful blog post. Entrepreneur. Retrieved from
Contributed by Brianna Colleran, MHA Student, Saint Joseph's College

Thursday, February 01, 2018

Making a Positive Disruption in Healthcare before it is too late

We are fast approaching a healthcare bubble that will eventually pop if healthcare leaders do not start to “think outside the box” in making a positive disruption in the healthcare industry. What will the future state of healthcare look like and how will it impact you and your family? We have all seen healthcare expenses continue to rise at an alarming rate, premiums continue to increase, quality of care is not consistent, and the future state of healthcare is truly unknown. Who will be responsible for helping resolve these issues before it is too late? Now is the time for healthcare leaders to step up to the plate and find creative ways to change healthcare instead of waiting around for someone else to make these changes, which are not occurring fast enough. Now is the time for Healthcare leaders to make a positive disruption in the Healthcare sector before it is too late!

How can this be done? Well, it cannot be done by following the same processes repeatedly yet expecting different results. Leaders cannot afford to wait for someone else to make innovative changes. Instead, each leader must personally create an environment which fosters creativity so that innovation can occur within their departments/facilities. Today more than ever, maximizing overall efficiency while still providing a high level of service is a focus for most hospitals, yet creativity in improving and/or creating new and improved processes are not occurring fast enough. Why? As our class HA511 noted and in speaking to my colleagues throughout the country, most leaders have become unbalanced in their leadership approach focusing more time as transactional leaders and are not focusing enough time on being a transformational leader due to today’s fast-paced environment. However, we do see some hospitals/leaders looking at best practices across their industry in utilizing proven methods that have been shown to work. While this is a great starting point to improve processes/outcomes in healthcare, more innovative solutions must be created from front line healthcare leaders and their staff for our healthcare system to take steps towards creating a much-needed positive disruption in the industry before it’s too late.

Now is the time for leaders to take time and make time in helping their staff meet as a team in discussing creative solutions focused around improving processes/workflow/patient outcomes. I truly believe that future leaders and healthcare organizations need to devote time in forming highly engaged and functional teams within their organization in setting up “think tanks” to help create a new positive disruption in how they will deliver more efficient care in the future. While leaders can and should utilize technology and technological advances to improve healthcare, they must never forget the importance of personal connection and creativity amongst their team as that is the true key to unlock creativity and is how we will save the future state of healthcare.

How can future leaders create innovative solutions focused around making a positive disruption in changing healthcare as we know it? This is a very tough question to answer, especially since the fasted paced environment that we are living in has programmed most leaders to become transactional, more than transformational. Understanding yourself is the first step needed to be innovative and impact change which I feel a lot of leaders unintentionally lack in today’s fast paced environment. A leader taking EQ tests can help them recognize their current mindset and manage those identified tendencies. By understanding your strengths and weaknesses as a leader, you will have a better chance of navigating through your emotional tendencies and work on creating a more balanced leadership approach. I feel for this to happen, leaders must humble themselves and keep an open mind. The next step is to understand the Competing Value Framework (CVF) model to help leaders view, then balance their leadership tendencies. This theory consists of four quadrants which are further broken down into eight competing roles to include; mentor, facilitator, innovator, broker, monitor, coordinator, director and producer. These eight competing roles are then broken down to transformational leadership and transactional leadership.

As I have discussed, leaders need to focus more time on the transformational leadership approach in helping their team “think outside the box” in solving problems and in improving healthcare as we know it before it’s too late. Once employees are engaged, appropriately trained and tap into their creative processes, they will be able to help come up with creative solutions to problems within their department/facility that were previously never thought of. If done correctly, this will in turn create a more efficient and effective system for the employee’s as well as their patients in creating a positive disruption.

Regulations and legislation are also stressing the current healthcare system, because hospitals now get reimbursed according to Key Performance Indicators (KPI) results that are set by organizations such as Medicare, Medicaid, Affordable Care Act and HCAPS. I have personally seen hospitals trying to prepare for these KPI’s in a silo, at the executive level only, which to me is not a smart approach. Instead, why wouldn’t they take a more collaborative approach across hospital divisions to see what suggestions each area has? Is it a lack of time? Well, one thing is for certain, if you do not make time to think of creative solutions to problems as a team, eventually you will be left behind as other organizations may already be focusing on fostering creativity throughout their entire organization.

 As one of my favorite quotes by Kenneth Blanchard goes, “None of us are as smart as all of us.” Therefore, it is so important for you as a leader to not constantly work in silos as that will greatly limit the possible creative solutions that your staff are able to come up with in addressing a specific barrier/topic at hand. We cannot tap into our staff’s creative process without making time to meet and discuss creative solutions to the problems at hand. I challenge each of you as leaders and/or future leaders to keep this in mind as you manage you teams/organizations into the future. Don’t wait around for change to occur on its own, instead create an environment for your team which fosters creative solutions in making a positive disruption within the healthcare sector before it’s too late. 
Contributed by Aaron Kawa, MHA Student

Monday, January 22, 2018

Providing Safe, Quality Care. How Are We Doing?

Providing quality patient care continues to be the underpinning of all patient experiences from hospital and long term care, to physician offices and community clinics. Quality, safe patient care impacts patient satisfaction, employee retention, and reimbursement. Have we made any progress since the 2002 publication Across the Quality Chasm? This Institute of Medicine’s (IOM) publication, written in response to the seminal treaty on patient harm titled To Err Is Human: Building a Better Healthcare System, still informs and guides quality initiatives today. The Institute of Medicine continued to bring focus to the patient safety movement with seven more publications highlighting rural health care, healthcare provider competency, communication and interdisciplinary teamwork.

Since 1970, the IOM’s goal, under the US National Academy of Sciences, has been to focus on utilizing evidence based research to make recommendations and provide guidance for the health of the general public as well as advising science policy. Beginning in 1996, the IOM began a healthcare quality initiative that involved three phases. To Err Is Human was published within the end of phase one (1999), bringing to light the challenges for providing quality care, and the devastating impact medical error has on individuals, communities and health care organizations. Across the Quality Chasm, published in 2002, laid the foundation and vision to promote safe quality care through the work of health care policy, and health system involvement. The IOM’s Six Aims of Quality continues to be the template in the ongoing phase three. Quality care should be Safe, Effective, Patient-Centered, Timely, Efficient and Equitable.

So how do we measure up, 17 years after the publication of To Err Is Human? Do we see less medical error and stronger, safer health care models for patient care? A recent report by researchers at Johns Hopkins University states that after an eight year review of data, more than 250,000 deaths in the US per year are due to medical error, and is the third leading cause of death. This increase in deaths is possibly due to the underreporting of medical error.

Great strides continue to be made in areas such as standardization of care and procedures, advancements in technology, and stronger leadership commitment to high reliability organizations.

Hospitals maintain  focus on several crucial areas to reduce error. First, involve the patient in their care by empowering and encouraging them to question, engage and partner with all health care providers in health care decisions. Next, monitor vulnerable populations and strive to eliminate disparities in healthcare. Third, make communication between all members of the health care team essential in all patient interactions. Finally, health care leaders must encourage a culture of safety, allowing all members of the health care team to not only safely report error, but be involved in ongoing safety plans and initiatives. All of these areas assist in becoming high reliability organizations. A highly reliable organization views safety as an ongoing, ever changing strategy to monitoring, reviewing and adjusting safety plans at every level of the organization.

Agency for Healthcare Research and Quality. High Reliability. (2017). Retrieved from:

Harvard Business Review. (2016). The Next Wave of Hospital Innovation to Make Patients Safer. Retrieved from:

Institute of Medicine. (2001). Crossing the Quality Chasm: A new Health System for the 21st Century. Retrieved from:

Johns Hopkins Medicine. (2016). Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. Retrieved from:

Managed Healthcare Executive. (2017). Four ways to reduce dangerous medical errors at your hospital. Retrieved from:,1


Written by Katie Cross, MSN, RNC-OB, Part-Time Faculty, Saint Joseph's College

Friday, January 05, 2018

Leading Trustees

Working with trustees or boards of directors is a critical skill essential for healthcare administrators. 

Our own Steve Chies, Program Manager of Long-Term Care Administration, has considerable experience in this area and has recently taught a webinar about this important topic.  Check it out here!

Monday, December 11, 2017

Homecare: Automatic Denials

With the increasing trend of patient care being delivered it the home, and many health care organizations looking at vertical integration into home care, this topic of Home Care can be of assistance to healthcare administrators.

Centers for Medicare & Medicaid Services (CMS) directed Medicare Administrative Contractors (MACs) to start the process of doing an automatic denial of Home Health Prospective Payment System (HHPPS) claims. This process will be automatic when there are some conditions for payment that are not met in the claims submission process, specifically if the patient assessment data is not met.

If the claim is submitted without OASIS Assessment information the claim will be denied.

This information must be submitted within 30 days of completion. For the most part, this window of 30 days will have elapsed by the time the 60 day Plan of Care/Episode for HHPPS is completed. Now when the claim is submitted, for dates of service after April 1, 2017. Medicare claims processing will now look for the corresponding OASIS assessment is present in the Quality Information and Evaluation System (QIES).

If the criteria of the assessment is not found and the date of the claim is more than 30 days after the assessment completion date that is reported on the claim, Medicare will deny the claim. With that said, in the beginning however, Medicare will allow for 40 days.

In the information that Medicare sends back to the agency the following codes:
  • Group Code of CO
  • Claim Adjustment Reason Code 272

The home health agency can do some things to avoid unnecessary denials. Before submitting the claim the home health agency should check to see if the OASIS assessment has been completed and accepted in the QIES National Database. The home health agency can also verify by reviewing their OASIS Agency Final Validation Report to OASIS.

Basically, the home health agency should ensure prior to the submission of the OASIS assessment and the claim and that the following is correct:
  • Home Health CMS Certification Number (OASIS item M0010)
  • Beneficiary Medicare Number (OASIS item M0063)
  • Assessment Completion Date (OASIS item M0090)
  • Reason for Assessment (OASIS Item M0100) equal to 01, 03, or 04

Most importantly, accuracy of home health agency claims information is essential to prevent claim denials.

For more information on various Home Health Prospective Payment initiatives at:

Kevin Harrington, MATS, MSHA, RHIA, CHP  Full-Time Faculty at Saint Joseph's College

Monday, November 27, 2017

ACHCA Announces Bill McGinley, CNHA, CALA, CAS, FACHCA as New President and CEO

We are excited that our very own Bill McGinley is the new President and CEO of ACHCA!

Bill is a member of the Assisted Living Administration Advisory Committee for Saint Joseph’s College of Maine!.  

The American College of Health Care Administrators (ACHCA) has selected Bill McGinley, CNHA, CALA, CAS, FACHCA as its new President and CEO effective December 4, 2017. Mr. McGinley has been in the field of long-term care administration since 1980. His leadership skills and knowledge will greater strengthen ACHCA’s future. He has been a Nursing Home Administrator for 35 years. He began his career with the Greenery Rehabilitation Group, Inc. a nationally known leader in the field of head-injury rehabilitation and sub-acute care. The majority of Bill's career was with SALMON Health and Retirement, a Massachusetts family owned company managing a SNF, ALR, Adult Day Health Center, and a child care center. Most recently he was the executive director of New Pond Village, a CCRC in Walpole, MA.

Bill holds an MBA from Boston University with a concentration in Health Care Management. He is a Fellow of the America College of Health Care Administrators (FACHCA). He is also a Certified Nursing Home Administrator (CNHA), Certified Administrator of Sub-Acute Care (CAS), and a Certified Assisted Living Administrator (CALA). He is certified as an assisted living director (CDAL) by the Senior Living Certification Commission. Bill recently became only the third person in the country to achieve the Health Services Executive (HSE) credential from the National Association of Long Term Care Administrator Boards (NAB).

In May of 2010 he was named Outstanding Member of the American College of Health Care Administrators (ACHCA). In 2017 ACHCA named him as the recipient of the Distinguished Assisted Living Administrator Award.

Bill is the past President of the Massachusetts Chapter of the American College of Health Care Administrators. He was the chair of the 2009 Convocation in Providence, RI. He was the chair of the ACHCA Professional Certification Committee and served as an item writer for the certification exams. He was a founding trustee of the MetroWest Health Care Foundation and served as chair of the MetroWest Healthcare Foundation Commission on Healthy Aging. 

Monday, November 13, 2017

Next Generation Accountable Care Organization (NGACOs)

The NGACO Model offers Accountable Care Organizations (ACOs) the option to participate in a payment model called All-Inclusive Population Based Payment (AIPBP) where the ACO will take the responsibility for entering into payment arrangement with their providers and paying claims instead of Medicare paying it through the Fee-for-Service (FFS) program.

The goal here is to establish a monthly cash flow for the AIPBP participating ACOs through a mechanism called the Next Generation Participants and Preferred Providers. The plan is that the AIPBP builds on population based payments in the NGACO Model but actually allows for more flexibility in establishing payment relationships between the ACO and their providers.

So to establish a monthly cash flow, under the AIPBP a participating ACO can receive a monthly lump-sum payment for those providers that have entered into a written agreement for AIPBP Payment Arrangements. The monthly payment will be based on an estimation of the care that the provider will deliver to the beneficiary in the performance year by AIPBP participating providers. These lump-sum payments will be reconciled after the performance year so they can balance out the monthly payments against what AIPBP participating providers would have received under the Fee-for-Services program.

Providers will continue to submit Fee-for-Service claims to Medicare, but payments will not be made on these submissions to providers that signed-up to participate AIPBP (outside of add-on payments for inpatient hospitals (outlier, disproportionate share, IME, new technology and Islet isolation cell transplantation payments). If a provider does not have an AIPBP Payment Arrangement in place with an ACO, they will continue to receive Fee-for-Service payments for all of the patients/beneficiaries they treat.

Providers will continue to submit all Fee-for-Service claims to CMS and CMS will make coverage and liability determinations and assess beneficiary liability. Beneficiary liabilities will be calculated based on what Medicare would have paid the provider if they were not involved with an AIPBP. Medicare Summary Notices (MSN) should reflect the amount that would have potentially been paid. Providers in the AIPBP will continue to receive MSNs.

For more information on this topic, feel free to visit

Provided by Kevin Harrington, MATS, MSHA, RHIA, CHP  Faculty, Saint Joseph's College

Friday, October 27, 2017

Communication in Healthcare

Medical errors are the third leading cause of death in the United States.  While patient safety efforts have gained momentum over the years, we still have a long way to go. One important area of patient safety for healthcare administrators to consider is effective communication.

Where should communication efforts focus?  Patient safety improves when we improve both staff communication and patient/healthcare professional communication.  Some barriers to affective communication include:

1.  Competition for time – healthcare professionals are pressed for time in many ways.  Productivity requirements, multi-tasking, and emergencies can create stressful environments that reduce effective communication.
2.  Competition for attention – we live in a fast-paced world where technology often competes for personal attention.  Managing the use of technology can impact the ability to be an effective listener.
3.  Managerial philosophy – administrators  set the tone for proper communication in the healthcare environment.

1.  Socioeconomic background – various backgrounds can result in communication breakdowns.  Healthcare professionals and patients do not always come from the same background, which creates a rift in contextual knowledge.
2.  Previous experiences – patients with negative previous experiences in healthcare settings might have difficulty with trust, which can result in a lack of proper communication
3.  Cultural background – healthcare providers in diverse communities face cultural differences that can cause communication breakdowns.
4.  Language Differences – lack of trained interpreters can result in communication difficulties.
5.  Sensory Issues – vision difficulties and hearing loss impact the ability to communicate properly with patients.

What can we do to improve overall communication in the healthcare setting?  Consider the above list of barriers and choose one or two that is a critical issue in your healthcare setting.  Brainstorm ways to improve communication efforts and implement one or two new policies at a time.  Be sure to keep the new initiative as simple as possible.  After a set amount of time, evaluate the new policy to see if it had an adverse or positive impact on overall communication efforts.  Eliciting feedback from both staff and patients is the best indicator of overall improvements.

For more information, please see:

Contributed by Valerie Connor, MA CCC-SLP; MS CHES, Faculty at Saint Joseph's College