Friday, February 12, 2016

Health Technologies & Elder Care

 GeroTechnology: An Introduction

As settings for long-term care become increasingly diversified, it is projected that there will be an increased reliance on family caregivers and technology within one’s home setting, especially during health status changes requiring extended care services.  A relatively new field, GeroTechnology (or GeronTechnology) engages technology companies, engineering and architectural firms, private entrepreneurial enterprises, research universities, governmental representatives, and members of the aging network – all working together to provide services that people need, when they need them, in the place they call HOME (Leading Age, 2016).   Rather than having to bear the expense of a nursing home, technology is being built into housing and products to improve person-environment congruence for older adults experiencing health status changes

As our senior population doubles over the next two decades, we face a daunting mission:  increasing the quality of care for a record number of elders while also striving to reduce the nation’s health care economic woes.  Many professionals argue that if we are to deliver quality care now and in the future, we must embrace the philosophy of a wellness revolution.  In other words, we will need to apply American innovation to wellness technologies that enable prevention, early detection, increased compliance, and new modes of remote caregiving and family support (Eldercare, 2015).

Home Care Technology and Aging-in-Place

By its very definition, home care helps people age-in-place.  In addition, home care technology provides essential tools to individuals on a widespread, cost-effective scale.   Telehealth or remote monitoring, an all-inclusive term, encompasses a range of high-tech applications that involve caring for patients remotely.  For example:

·               Monitoring an individual’s heart rate while that person is working out on a treadmill.

·               Transmitting a patient’s telemetry readings to a nurse via the Internet.

·               Virtually bringing a health care provider into a patient’s home via the digital use of a high-resolution camera.
(Hfaging, 2016).

As hospital stays have been shortened and more home care technology has become available, caregiving at home has come to take on many aspects of a mini intensive-care unit.  One interesting example is the MEDCOTTAGE – a mobile, modular medical home designed to be temporarily placed on a caregiver’s property for rehabilitation and extended care.  As noted on their Web page, the MEDCOTTAGE is a state-of-the-art hospital room with remote monitoring so caregivers can provide quality care and participate directly in their family member’s recovery (MedCottage, 2016).

Enabling Technologies and Chronic Care Management

A growing body of research indicates that care technologies can prevent premature institutionalization (and its related costs) while also giving older adults more control over their own health and living conditions.   The Center for Aging Services Technologies outlined several platforms that have demonstrated value for older Americans coping with chronic conditions.  Some of these include the following:

1.            Medication Optimization 

These platforms address medication non-adherence – a serious problem which is responsible for 33-69% of medication-related hospital admissions and 23% of all nursing home admissions. 

2.            Remembering to Take Medications

Many older adults have problems remembering to take their medications as well as remembering their timing and sequencing.  Medication reminder systems fall into several categories – passive organizers, commercial medication reminder services via phone or e-mail, and software for personal data assistance.

3.            Remote Patient Monitoring

These may include communication devices as well as weight scales, blood pressure monitors, assessment algorithms, and “clinician alerts” by remotely located health care professionals.  These are especially important in rural and medically underserved communities. 

4.            Assistive Technologies and Home Modifications

Videophone products, for example, offer family caregivers the advantage of being able to see and hear their relatives.  Observing an elder performing basic tasks, such as sitting down and getting into bed, can provide important information about strength and balance.  Additionally, if an individual has changed or stopped routine grooming and self-care habits, it will be more apparent via video.  

5.            Remote Training and Supervision

For family caregivers who have to learn how to perform long-term care tasks and who also feel isolated, remote training has become increasingly beneficial, e.g., online tutorials, coaching sessions, and family support groups.

6.            Cognitive Fitness: Training and Assessment

Designed for working with cognitively impaired older adults with chronic illness, some of the available tools include counseling support instruments, electronic health records, and point-of-care computers.

7.            Social Networking and Loneliness:  Social Connectedness

Although not typically categorized as an illness, loneliness is a problem faced by many older adults in poor health who may live alone.  As research indicates, they have a very different experience of aging than those with family and social supports.

In such cases, technology can help elders feel more connected to those outside their homes.  As just mentioned, videophones can be a tremendous asset.  In addition, computer networks, such as the Internet, offer many opportunities for communicating with others.  Some services are designed specifically for people aged 65+.  They may offer social activities as well as host a variety of online discussion and enrichment topics, such as book clubs and virtual travel excursions.

8.            Social Media

Most health experts agree that the future of medicine will incorporate social media – Internet-based tools used for sharing and discussing information.  Such social media might include social networking sites, news and bookmarking, blogs, video sharing, photo sharing, and virtual reality.

For example, according to nation-wide survey findings of The Pew Social Research Center,  once someone is online, living with a chronic disease is associated with a greater likelihood of accessing user-generated health content, such as blog posts, hospital and physician reviews, and podcasts.  In general, it seems that older adults believe that others with the same condition are more likely to understand, be supportive, and offer wise advice (Pew Research Center, 2010).

An aging population and a growing number of individuals living with chronic conditions mean, in turn, an increased reliance upon family caregivers to provide front-line health care. Recent national reports indicate that these caregivers are becoming health information specialists – thanks to the internet, used in researching health conditions and treatments.  (Pew Research Center, 2013). 

Health Technologies in Nursing Facility Settings
          While this discussion has primarily focused on home-based care, I also want to add a few    comments about those technologies that are being implemented within nursing home settings.

·               Advanced Total Quality Systems – integrate several basic components such as nurse calls, wandering management, fall prevention, resident tracking, resident assessment, and electronic medication administration.

·               Advanced Bedding Systems – have embedded sensors for monitoring vital signs and sleep quality.

·               Comprehensive, Interoperable Electronic Health Records (EHRs) – allow security in sharing health information across various settings. 

As noted by many nursing home administrators, resistance to change remains one of the biggest obstacles to technology integration within a facility’s environment.  Having a long history of being manual and paper-based, it will require a cultural shift to a technology base. Education and communication are essential in addressing this challenge (Eldercare, 2015).  

The Future of GeroTechnology

While it is clear that future cohorts of older adults will have more options in health care, much will depend upon their financial resources. It seems clear that consumers who do not have adequate income will have fewer choices in the type or quality of services received.  It must also be recognized that use of these technologies (low-tech and high-tech) assumes a level of health literacy, as well as a willingness to embrace the required new learning.  Others caution us to be mindful of potential negatives, such as patients’ privacy / confidentiality issues and dissemination/access to personal information. 

Most agree that those health technologies that connect elders (in a long-term care facility or home) and their respective families will continue to experience increased demand.   However, among the challenges we face will be the ability to make these innovations seamless, easy to use, respectful, and affordable. 
Health Technologies & Elder Care

  • Eldercare (2015). Assistive Technology, Eldercare: Connecting you to Community Services. 

  • Georgia Institute of Technology.  Human Factors & Aging Laboratory (2016).     

  • The American Elder Care Research Organization (2014). Technologies to reduce care costs and allow safe aging at home.  Paying for Senior Care.

Blog Author:  Dr. Donnelle Eargle

With a background in geriatric rehabilitation psychology, Dr. Eargle teaches gerontology-related courses at Saint Joseph’s College. Standish, Maine. 

Friday, January 29, 2016

Good Samaritan Laws

What do you think of when you hear about Good Samaritan Laws?  A duty to help those in need?  Protection when you provide CPR to a stranger?  Many people have heard of the law, but few are aware of how different the laws are from state to state.

Good Samaritan Laws are state statutes, which means that individual state governments have approved these laws in their states.  Some states choose to use the law to provide immunity to those who assist in emergency situations while other states actually require bystanders to help.  

Here is a relative breakdown:
  • Most of the 50 states provide immunity to those who administer care in emergency situations
  • 8 states provide no immunity to private individuals not meeting certain criteria
  • 24 states provide immunity for physicians rendering emergency care in a hospital
  • 6 states exclude rendering emergency care in a hospital from Good Samaritan coverage
  • 3 states require a duty to assist; if it is a reasonable emergency, physicians must assist
  •  (Source:
What does this mean for the average citizen who wishes to help out in emergency situations?  The answer is not clear, unfortunately.  A quick search will help you find the Good Samaritan Law in your state.  Most states will protect individuals who choose to assist injured people in emergency situations, as long as they use reasonable precautions and are of sound mind (i.e., have not been using drugs or alcohol).  The best advice is to offer help if you feel comfortable doing so at the time, but always be aware of your safety, as well.

Submitted by Valerie J Connor, MA CCC-SLP, Adjunct Faculty, Saint Joseph's College

Friday, January 15, 2016

Patient Safety and Harms that Impact Reimbursement

All healthcare administrators, physicians, nurses, ancillary staff, quality professionals, and most importantly patients and families, believe in providing the highest quality and safest delivery of care. 

For decades healthcare organizations have sought safe and high quality services for their patients. With a focus on decreasing harms to patients, organizations monitored falls, medication errors, medication near misses, hospital acquired infections, length of stay, radiology accuracy, and mortality to name a few. This was the key concept prior to pay for performance (P4P or Value Based Purchasing). The fact was that we did just that – we monitored, we reported and we monitored and we reported. The cycle went on for years. There were negotiable improvements gleaned from this process.

In 2001 the second of two books, was published by the Institute of Medicine; Crossing the Quality Chasm (2001). It was a result largely in response to the first book To Err is Human: Building a Safer Health System (1999) which focused on Patient Safety. A key phenomenon discovered was that nationwide in all healthcare systems, by all providers, there was great variability in patients’ outcomes. There was great variability in the care and treatments of patients. 

It was here that the path was set to design “A New Healthcare System for the 21st  Century” (To Err is Human 1998).

Over the next 10 years, organizations made some efforts to seek higher quality and patient safety improvements. Methodologies, based on evidence-based research, were put in place to not only identify the misses, the errors, the harms, and variances in outcome, but to add the research knowledge to the care and treatment guidelines.  

However there was a continued disappointment in how effective these initiatives were. Patients' outcomes still revealed a healthcare system that was harming patients and resultant low quality of care.

In 2002 the Joint Commission developed a set of evidence-based performance measures that hospitals reported. These clinical quality measures satisfied both regulatory (CMS) and accreditation requirements. 

The initial set of measures, often referred to as “Core Measures,” were:

  • Acute Myocardial Infarction (AMI) - 8 measures
  • Heart Failure (HF) – 4 measures
  • Pneumonia (PN)  -7 measures
  •  Surgical Infection Prevention (SIP or SCIP) – 2 measures

As an additional measure, patient satisfaction was brought into the set:
  • HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) – 1 measure

In 2011 the Centers for Medicare and Medicaid Services (CMS) released the final rule on Hospital Value Based Purchasing. This document, of 195 pages, outlined the Processes of Care and HCAHPS measures that hospitals must meet to maintain full reimbursement from CMS. 

Additionally private insurance companies began following this lead. Initially HCAHPS made up 30% of the measure and Process of Care made up 70%. 

The percentages have evolved over time. For fiscal year 2016 these percentages which directly impact reimbursement will be as follows:
·         HCAHPS – 25%
·         Outcomes – 40%
·         Process of Care - 10%
·         Efficiency – 25%

As we evolved to a more robust Pay for Performance (P4P) program, the emphasis is on not only improvement of quality and patient safety, but on optimal reimbursement for care. An overwhelming stimulus for P4P becomes the rate of growth in health care costs. Total spending for healthcare was estimated as 16 percent of the GDP (Gross National Product) in 2007 and predicted to rise to 25 percent of GDP in 2015 (National Conference of State Legislators, Publication for Nonpayment for Medial Errors; August 2008).  

Based on sentinel events and other research, CMS chose patient conditions that negatively affected the patient’s outcomes. Organizations named these “Never Events.”  Because the Never Events were hospital acquired and did not relate to the patient’s original diagnosis, Medicare would not reimburse the hospital for their care and treatment. These conditions were originally selected based in the facts that:  
a)the condition is associate with a high cost of treatment, 
b) if billed as a secondary diagnosis; the organization would reap a greater reimbursement, and 
c) most importantly the condition could be reasonably  prevented if the organization followed evidence based research and practices.  

If organizations did not adopt Patient Safety initiatives to prevent these conditions, reimbursements would be negatively affected. The Never Event conditions are:
  • ·         Object left in after surgery
  • ·         Air embolism
  • ·         Blood incompatibility
  • ·         Hospital acquired catheter associated urinary tract infections
  • ·         Hospital acquired decubitus ulcers
  • ·         Hospital acquired vascular catheter infections
  • ·         Surgical site infections
  • ·         Falls with injury
  • ·         Poor blood sugar control
  • ·         Deep vein thrombosis

Because these conditions are preventable, lengthen length of stay, increase costs and overall reduce the patient’s outcome, hospital organizations are under pressure to reduce and eventually eliminate patient harms completely. 

Hospitals have adopted organizational wide forums or committees  to review, analyze and recommend improvements across all departments. 

With a focus on reducing avoidable harms or Never Events, Quality leaders and Patient Safety Officers are leading these efforts with the collaboration with physicians and administration.  Data from safety organizations such as the National Quality Forum (NQF), Agency for Healthcare Research and Quality (AHRQ) and Center for Disease Control (CDC) are used by CMS to develop goals for avoidable harm reduction.

Today patient safety improvement efforts continue to be a focus of reducing patient harm. The stakes continue to rise as in 2010 the Patient Protection and Affordable Care Act resulted in increased penalties in reimbursement for low quality performance and poor patient safety results.

 Hospital Engagement Networks (HEN) have been developed. These are grant-funded collaborative  initiatives designed to determine best practices for harm reduction and also to educate organizations on the practice of the best practices with a goal of reducing Hospital Acquired Conditions. The caveat for an organization to be a HEN, or be a part of one, is the resultant optimal reimbursement from Medicare. 

As quality leaders and patient advocates, we realize the best result of decreased patient harms is the improved health of the entire population. 

In 2015, 17 HEN’s were awarded grant funds to continue this work for harm reducing thus improving patient safety (2015 Partnership for Patients/CMS).

Contributed by Rebecca Janssen, Adjunct Faculty SJC

Friday, December 18, 2015

Skilled Nursing Facilities and YOU!

At one time, if a person was admitted into a Nursing Home, the expectations would be that they would live out the remainder of their lives in that setting. While this may still be the case in many situations, the likely hood of someone who has been recently admitted into a Nursing Home for only a “Short Stay” has increased dramatically.

A person is now admitted to a Nursing Home with the expectation of going back to their home after only a short period of time. This period of time could be anything from one week to twenty days. The actual length of any one person’s stay will vary depending on their condition and their source of payment. Many Private Health Insurances will seek to have a resident discharged within a two week window. If the payment source is Medicare, they will pay 100% of the services for only the first twenty days.

Many of the short term admissions could be due to the need for some form of Rehabilitation services such as Physical Therapy, Occupational Therapy or some other Medical Service that is required to strengthen the person before going back to their home.

Long Term Care (Skilled Nursing Facility) provides a range of services that supports the personal care of each individual person. This model differs from the “Medical Model” in that various surgeries and other such services are generally not performed in a Nursing Home Setting.

How do you know if a loved one might require Long Term Care?
In general, someone is admitted to a Nursing Home if they are in need in areas termed “Activities of Daily Living” (ADL’s). The Activities of Daily Living are basic self-care tasks that include the following:
Selecting Proper Attire
Maintaining Continence
Putting on clothes
Transferring (could be from bed to wheelchair etc.)

These activities of daily living are routines that most take for granted each day and are generally learned in early childhood.

Slightly more complex skills that should also be addressed when evaluating if a person is capable of living on their own are:
Managing Finances
Handling Transportation (driving or using public transit)
Preparing meals
Using the telephone and other communication devices
Managing Medications
Housework and basic home maintenance

Who assesses these ADL’s?

Nurses in the Hospital
Rehabilitation specialists
Geriatric Social Workers  

Each of the above may perform these functional assessments.

Unless a person admitted to a Skilled Nursing Facility will pay privately, someone must perform some or all of the above tasks if the Nursing Home expects payment. If someone will be under Medicare services, they must have the proper approval and assessment from a doctor. Currently, Medicare requires an admission of 3 days in a hospital before they will approve payment to a Nursing Home. Many HMO’s and other potential payers have waived the 3 day hospital stay. Even if a person has private insurance that will pay for the services, the Nursing Home must receive the proper authorization from the insurance company before they can expect payment. While Medicaid generally pays for Nursing Home Care for those who financially qualify for the state services, an individual must “prove” that there is also a Medical need and thus be assessed from someone in the above group. In general, the person conducting the assessment will either be a physician or a Geriatric Social Worker that is not affiliated with any one Nursing Home.

Assessing a seniors functional abilities helps the family and medical professionals determine that person’s plan of care.  Over time, periodic assessments can be equally valuable by showing patterns, predicting future needs and measuring either progress or decline.
Whether the senior is able to perform all of the activities of daily living independently, needs help in a few areas only or needs help with most if not all of them, the assessment will help tailor the care plan to meet these needs.

What is the best Healthcare Setting to receive care?

Of course, if you are a Nursing Home Administrator, the best care can be given “at your Nursing Home”!! Depending on the level of care required, a nursing home setting may very well be the ideal location for a person to receive care. However, there are many alternatives to Nursing Home care including home care services. Home care and assisted living has taken a sizable chunk out of the business in recent years. There are many positives and negatives to each situation and there might be many variables that must be taken into account before deciding which locale is best for you and your loved one. The decision as to what setting is the best for any one person is beyond the scope of this presentation. There are many web-sites available that provide assistance in helping decide the best situation for you and your loved one. As always, a conversation should be held with your physician before making a decision.

How is Long Term Care funded?

In a sense, we all do since the vast majority of NH Residents are either on Medicare or Medicaid. As such, these services are generated through the Federal Government (even though Medicaid is a State program, they are funded mainly from the Federal Government).
Many of the “Medicare Supplement” Insurance programs are still funded through Federal Government programs.
Medicare is a Federal Program that will pay for a Residents stay in a Skilled Nursing Home for up to 100 days for any one spell of illness.
Speaking in very general terms, what a Private Insurance Company will pay for skilled services depends on the specific policy in place. Most will follow the “Medicare” guidelines to some extent and only pay for skilled services.
Most any Nursing Home will gladly accept a Resident who is willing to pay privately.
Taking the premise that most Residents who require long term care will not be paying privately for an extended length of time, the main source of funding for a nursing home who accepts long term residents is then Medicaid.
Some insurances will pay for long term care but again, one needs to know the exact circumstances that payment will be made and exactly how long and what amounts.

Finding the right setting that meets your needs

A conversation with your Physician is always a great start. Your Physician should be able to provide some valuable insight into exactly what services and in what setting might be best.
Most Hospitals will employ either a Nurse or a Social Worker who will act in the capacity of a Discharge Planner. When a resident is being prepared for placement beyond the Hospital, the Discharge Planner is available to assist in this process by reaching out to area Health Facilities that might best match the resident’s needs.    
There are many web sites that will also list the various health care settings in your immediate area.
These web sites not only provide a list of names, but also present a summary that compares each Home to each other. This summary can include how the facility has performed in their annual State Survey.

Some of helpful web sites are:

The four web sites above was helpful in compiling the information used in this article. 
This article was provided by Charles Carrozza, Adjunct Faculty member at Saint Joseph's College.

Thursday, December 03, 2015

It Matters!

Dr. Michael Mileski is an adjunct faculty member in the health administration programs at Saint Joseph's College.  He is an expert in long-term care services and other areas.  He has recently published an article that we want to share with you!  Please see the link below:

Wednesday, November 25, 2015

The Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs): Delivery System Reform, Medicare Payment Reform, & the MACRA

This MACRA system makes three important change to how Medicare pays those providers who give care to Medicare beneficiaries. The areas that have changed are as follows:

  • 1.      This new system ends the Sustainable Growth Rate (SGR) formula that was crucial in determining the reimbursement/payment to healthcare providers for services delivered to their Medicare beneficiaries.
  • 2.      Establishing a new framework to establish a reward system for healthcare providers that deliver better or higher quality care, not just more care over more dates of service (DOS).
  • 3.      Eliminating the fragmented quality reporting program and establishing a single system for the reporting of quality results.

The new MACRA reform works in a way that will enhance and expedite the change of the payment structure from billing for services, without the weight of quality figured in, to a system that reimburses based on value and quality of care delivered to the patient. In addition, the MACRA system streamlines and simplifies the process in which a provider can successfully take part in Medicare’s quality programs by initiating:

  • 1.      A Merit-Based Incentive Payment System (MIPS)
  • 2.      Alternative Payment Models (APM)

These two new systems will be go into effect through the upcoming years from 2015-2021 and beyond.

MIPS is a program that combines parts of the existing Physician Quality Reporting System (PQRS), the Value Modifier (VM) or otherwise known as Value-based Payment Modifier, and Medicare Electronic Health Record (EHR) incentive program into one single system that is based on:
  • ·         Quality
  • ·         Resource use
  • ·         Clinical practice improvement
  • ·         Meaningful Use for EHR

The APM model is designed to give providers new ways to get paid for the care that they give Medicare Beneficiaries. This includes lump-sum incentive payment, increased transparency for physician-focused payment models, and offering higher annual payments.

The timeline for MIPS and APM starts in 2015 and will go through 2016, and later. The payments will include for MIPS incentives of quality, resource use, clinical improvements, and meaningful use from 4% through 9% in 2016. APMs will have a 5% incentive payment and is excluded from MIPS.
For more information on MACRA you can go to:

For more information on the Medicare Access and CHIP Reauthorization Act you can to to:

Submitted by Kevin Harrington, Full Time Faculty, Health Administration, 
Saint Joseph's College.   Contact Kevin at if you would like to discuss this further.

Friday, November 13, 2015

Moving from Information to Knowledge in Challenging Times!

“The species that survives is the one most able to change.”
          Charles Darwin

The healthcare sector is a dynamic and rapidly evolving business model that has new market forces being imposed on it from a variety of directions.  Moving from the historical “fee-for-service”  (FFS)payment scheme to “bundled payments” for a defined period of time after discharge,  is intended to put providers at risk, for both the outcomes of care and the cost of the services provided.   
                In the middle of summer, the Centers for Medicare and Medicaid Innovation (CMMI) announced a mandatory bundled payment requirement for two (2) Medicare orthopedic DRG’s, or the so-called CCJR model.  This payment system is being applied in seventy-five (75) metropolitan locations across the country and is supposed to start on January 1, 2016.

                Currently, CMMI has about forty (40) demonstration projects around the country that are experimenting with numerous systems to reduce costs and enhance outcomes.   Accountable Care Organ1zations (ACO’s) in the form of “Pioneer ACO’s”, original ACO’s and Next Generation ACO’s, are all part of this evolving payment direction.  Even non-acute care organizations are moving into risk-based payment systems.  The CMMI Bundled Payment Care Initiative (BPCI) Model 3 demonstrations that saw almost 1,000 non-acute care providers (skilled nursing facilities, home care providers, and hospice organizations) accept contracts to provide services under a fixed bundle amount.

While some providers and payers have used similar models for non-governmental payers, moving the Medicare FFS to this new model will require move information about the care, costs, and outcomes to the patient by providers.  That will translate into the need for health information systems that creates a value to the organization to provide the ability to move to a knowledge-based decision process.

Darwin’s quote should certainly be considered by healthcare providers as the evolution of the care delivery system moves into the sector.  Those providers that understand the information that will be needed to thrive in this new knowledge environment will most likely be one of the survivors.  Those organizations that fail to see how information is translated into knowledge and make decisions based on the data will have difficulty competing.

Contributed by Steve Chies, MHA, Adjunct Faculty Saint Joseph's College

Friday, October 30, 2015

National Radiologic Technology Week

We celebrate the National Radiologic Technology Week 
November 8 through 14, 2015!

                In celebration of National Radiologic Technology Week, Saint Joseph’s College would like to publicly recognize all Registered Radiologic Technologists for the important work that each of you perform. The week of November 8th is set aside to thank and applaud all Radiologic Technologists for the role that you play in providing not only safe, quality exams, but also great patient care. Congratulations on behalf of Saint Joseph’s College.

                The American Society of Radiologic Technologists' (ASRT) theme this year is “Discovering the Inside Story.” 

This is two-fold: 
  • initial discovery and 
  • personal contribution.
Our founding father, Wilhelm Conrad Roentgen, discovered x-rays on November 8, 1895. This discovery allowed for the first glimpse into the human body. Since then, significant medical advances have greatly improved the way that we visualize internal organs and structures, such as bones, muscles, blood vessels, heart arteries, etc. The most recent advances in Computed Tomography (CT) Angiography, PET/CT Scans for Cancer, Digital Mammography, and Imaging Tests instead of exploratory surgery have all contributed to less invasive procedures and have enhanced the patient’s experience. These advancements have done away with surgical approaches, ultimately making it less costly, less painful, and allows for shorter hospital stays.

                There are over 324,000 Radiologic Technologists in the United States who are making a difference in the lives of their patients! This week long celebration allows each of you to stop and ponder your own personal inside story. What drew you to this profession and why do you do what you do? What contribution to the profession do you hope to make? In an attempt to keep up with the rapid pace of medical advances, what personal career goals do you aspire to? Saint Joseph’s College can help you reach your goal. Please check out the online degree programs that are available and the fast track options.

Happy Radiologic Technology Week!

Contributed by Brenda M. Rice, MHA, BSHA, RTR                                                                                
Program Manager, Radiologic Science Administration Degree, SJC

Wednesday, October 14, 2015

National Healthcare Quality Improvement Week

National Healthcare Quality Week is October 18-24, 2015.  

Any of us who are involved with healthcare should take a moment to celebrate some of the measurable achievements in healthcare quality on improved patient care outcomes. 

Each of us make a difference - Administrators, Nurses, Therapists, Social Workers, Nursing Assistants and all who contribute to a patient's healthcare experience.

I have been a health care professional and leader for the past 30 years.  In my 30 years of practice as a Nursing Home Administrator, Registered Nurse, Public Health Professional, Home Health Provider and now as an Acute Care Compliance Officer, I have never seem a time more dynamic than the past five years. "Syzergy" is a term in astrology  that means alignment of planets/celestial bodies.  I believe that we are in a time of healthcare syzergy, one where there is alignment of political, financial and consumer forces working to change the landscape of healthcare and demanding improvements in both the value and quality of U.S. healthcare.

Health Care Quality Improvement , like leadership, is part science and part art .  I believe that the Affordable Care Act (ACA) and other policy initiatives have had a significant impact on quality of care.  The increased focus on public reporting, transparency, and quality measures have sparked interest in quality outcomes and provided the catalyst for remarkable quality improvement gains in several long-term care clinical quality measures over the past several years.
On March 2, 2015 CMS released the 2015 Impact Assessment of Quality Measures Report

Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer, stated "the 2015 Impact Report demonstrates that the nation has made clear progress in improving the healthcare delivery system to achieve the three aims of better care, smarter spending, and healthier people."

The key findings include: 
·         Quality measurement results demonstrate significant improvement. 95 percent of 119 publicly reported performance rates across seven quality reporting programs showed improvement during the study period (2006–2012). In addition, approximately 35 percent of the 119 measures were classified as high performing, meaning that performance rates exceeding 90 percent were achieved in each of the most recent three years for which data were available. 
·         Race and ethnicity disparities present in 2006 were less evident in 2012. Measure rates for Hispanics, Blacks and Asians showed the most improvement, and American Indian/Native Alaskans and Native Hawaiian/Pacific Islanders the least improvement. Transparency and monitoring of measures rates by race and ethnicity for all publicly reported measures and ensuring that disparities across programs, setting and demographic groups are eliminated, remain top priorities consistent with our CMS Quality Strategy. 
·         Provider performance on CMS measures related to heart and surgical care saved lives and averted infections. From 2006 to 2012, 7,000 to 10,000 lives were saved through improved performance on inpatient hospital heart failure process measures, and 4,000 to 7,000 infections were averted through improved performance on inpatient hospital surgical process measures. (A number of the measures are also included in the previously released patient safety results demonstrating from 2010 to 2013 a 17 percent reduction in patient harm, representing 1.3 million adverse events and infections avoided, approximately 50,000 lives saved, and an estimated $12 billion in cost savings.) 
·         CMS quality measures impact patients beyond the Medicare population. Over 40 percent of the measures used in CMS quality reporting programs include individuals whose healthcare is supported by Medicaid, and over 30 percent include individuals whose healthcare is supported by other payer sources. This demonstrates the public-private collaboration that CMS facilitates and hopes to expand. 
·         CMS quality measures support the aims of the National Quality Strategy (NQS) and CMS Quality Strategy. CMS quality measures reach a large majority of the top 20 high-impact Medicare conditions experienced by beneficiaries, with more measures directed at the six measure domains related to the NQS priorities, and better balance among those domains. Much of our data resulted from process measures; however, there is an increase in measures related to patient outcomes, patient experience of care, and cost and efficiency. CMS is moving increasingly toward these outcome measures across programs. 

The 2015 report can be found at:

I am personally very heartened by these findings and feel them in my everyday work.  This past week I attended a system collaborative meeting where the top leaders in my acute care system came together to discuss "Just Culture," national safety initiatives, strategies for involving staff in changing practices around near miss events and staff satisfaction survey results that will impact the future of quality and safety work in our organization.  This work is amazing to me and the outcomes are improving with a lot of hard work by many dedicated people. 

In closing I would like to share a quote from my healthcare quality hero, Dr. Avedis Donabedian.  In an interview with Health Affairs one month before his death he said:

"Systems awareness and systems design are important for health professionals, but they are not enough. They are enabling mechanisms only. It is the ethical dimensions of individuals that are essential to a system’s success. Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession, you have to love your God. If you have love, you can then work backward to monitor and improve the system."

 Contributed by 

 Tammy Rolfe, Adjunct Professor, St. Josephs College

Monday, September 21, 2015

Predictive Modeling, a thing of the future….or is it here now?

Did you know that the Centers for Medicare and Medicaid Services (CMS) uses predictive analytics to analyze all Medicare fee-for-service (FFS) claims? This is done in part to detect claims that may be considered fraudulent.

The predictive analytics system utilizes algorithms and models that will examine claims submitted to Medicare so as to determine if the claims should be flagged for suspicious billing. Moreover, this is done in a “real time” environment. This process is being incorporated by CMS into the claims processing part of the equation.

This idea came about through the Section 4241 of the Small Business Jobs Act of 2010 (SBJS) as it mandated that CMS implement a predictive analytics system to analyze Medicare claims for areas at high risk of fraud. This is a similar process to one credit card companies are currently doing in the pre-payment arena.

As of June 30, 2011 CMS has been running all Medicare FFS claims through this predictive modeling system. This process builds profiles on providers, networks, billing patterns, and beneficiary utilization. The outcome of this process is that CMS can now create risk scores to determine the likelihood or fraud in the billing process. In addition, they can flag potentially fraudulent claims and/or billing patterns.

The risk scores will clearly and quickly identify any billing activity that is unusual and group them by providers, beneficiaries, and networks with the highest risk scores. This system, a very high-tech system, is not designed to replace the expertise or experienced analysts as the analysts still review prioritized cases and history along with identifying any innocuous billing and they will record this activity directly into the predictive analytics program and the payment is released as usual. If an analyst finds any activity that is fraudulent they will alert the CMS Center for Program Integrity, MACs, or Zone Program Integrity Contractors to enact targeted payment denials. When the alert involves egregious fraud, the billing privileges of the provider will be revoked.

The risk scores alone to not initiate any administrative action and the providers will not be able to appeal these risk scores. Currently, CMS is not denying any claims based solely on the alerts generated by this system. The predictive model is still being refined and they are developing more advanced algorithms that line up more closely to the complexities of medical treatment and billing.
With all of this said, CMS is dedicated to ensuring prompt payment to the providers as this is a statutory requirement, but in urgent circumstances CMS will leverage its authority to waive the prompt payment process and conduct a more detailed review on the provider.

Overall, by enacting a predictive modeling system, CMS is staying up with the times and doing its best to combat improper billing practices and to protect the Medicare Trust Fund.

Submitted by Kevin (Michael) Harrington, Full-Time Faculty at SJC