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:

Feeding

Toileting

Selecting Proper Attire

Grooming

Maintaining Continence

Putting on clothes

Bathing

Walking

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)

Shopping

Preparing meals

Using the telephone and other communication devices

Managing Medications

Housework and basic home maintenance

Who assesses these ADL’s?

Doctors

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:

www.longtermcare.gov

www.cms.gov

www.nhqualitycampaign.org

www.medicare.gov/nursinghomecompare

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.

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:

http://www.4cnas.com/Post-TraumaticStressDisorderandtheRoleoftheCertifiedNursingAssistant.html

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:

http://healthaffairs.org/blog/2015/09/28/macra-new-opportunities-for-medicare-providers-through-innovative-payment-systems-3/

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

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf

Submitted by Kevin Harrington, Full Time Faculty, Health Administration, 

Saint Joseph's College.   Contact Kevin at michaelharrington@sjcme.edu if you would like to discuss this further.

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

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 8^th 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

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:

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/National-Impact-Assessment-of-the-Centers-for-Medicare-and-Medicaid-Services-CMS-Quality-Measures-Reports.html

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

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.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1133.pdf

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

Happy National Assisted Living Week!

The week of September 13-19 will celebrate America’s Assisted Living communities with the theme “Nourishing Life: Mind, Body, and Spirit.” 

This theme emphasizes that in Assisted Living, the aim is to nourish the entire person, not just the body.  The philosophy of assisted living care encompasses mind, body, and spirit in order to maximize each person’s quality of life.  This goal is accomplished through spiritual care, creative outlets, enjoyable events both within and outside the community, involvement in meaningful, enriching activities, and relationships with residents, friends, family, and staff. 

Additionally, assisted living staff members find their lives enriched by interactions with residents and families.  Their lives are nourished by caring for residents, seeing them flourish, developing friendships, and putting smiles on their faces. 

Some communities will profile some of their residents who will share inspiring life stories.  Many residents have made remarkable contributions to their families, communities, and nation.  They deserve to be honored and appreciated.  Likewise, staff members often provide care and support in difficult situations; they also deserve honor and support. 

Thank you to Assisted Living staff members across the country for your dedicated service.  Thank you to Assisted Living residents for allowing us the privilege of knowing you and sharing in your lives.  Enjoy this week that is dedicated to you!

(For more information, see http://www.ahcancal.org/ncal/events/nalw/Pages/default.aspx/.)

Contributed by Philip C. DuBois, CNHA, FACHCA, Program Manager, Long Term Care Administration, Saint Joseph's College

The Patient Experience

Why is it important to provide patients with the best experience we can?

The most obvious and noblest of reasons is because it is the right thing to do. We should be treating our patients, caring for them in a manner that we would want for ourselves, our families and our friends. As Michael Dowling, President and CEO of the North Shore-Long Island Jewish Health System often reminds staff, many of our patients are us, our relatives and friends. We should be treating all patients as such (Author’s attendance at Mr. Dowling’s presentations.).

A second reason focuses on the theme of choice as related to how our patients view the quality of care we provide. Deming tells us that quality is meeting or exceeding our customer’s needs and expectations. Deming also tells us that loyalty is achieved when we exceed those expectations (Aguyao, 1990; Deming, 1982). Changing how health providers view their patients as customers continues to have its detractors, but few would argue, that increasingly patients have choices, and all in health care now have multiple competitors. If our organizations are to become and continue to be facilities of choice, there is a need to be distinguished from our competitors.

            Pyzdek (2001) in his description of the Kano Model of Customer Expectations explained that meeting basic levels of quality is something that is taken for granted. Meeting them does not result in satisfaction, but not meeting them is a source of dissatisfaction. There are expectations that customers believe are important and the more they are met the more satisfied the customer. The provision of providing exciting quality occurs when the customer receives more than what was expected and this level of quality becomes increasingly important as competitive pressures for nurses present internal customer problems with dissatisfaction with peers or supervisors. Similarly, Bertel (2003) referred to events and practices that dissatisfy customers as the must-haves, which if unfilled would serve as sources of dissatisfaction. Bertel used the term delighters which would not cause dissatisfaction if not present, but when they are present serve to truly satisfy or delight the customer.

A third reason and most recent interest in the patient experience came from HCAHPS, a CMS-developed patient satisfaction questionnaire. In October 2012, HCAHPS’ (Hospital Consumer Assessment of Healthcare Providers and Systems) patient satisfaction scores were utilized by CMS in the calculation of reimbursement for patient stays HCAHPS is not only an instrument that affects reimbursement, its results are publicly reported, permitting comparisons by the public (CMS, 2015).

Creating and Managing Expectations

            Creating expectations initially derives from the informed consent process. This process should have included communication regarding diagnosis, agreed upon course of treatment following an explanation of alternatives, with risks and benefit (Bord, 2014). Patients must have an opportunity to pose questions and to have those questions answered in a manner they can understand. The process must also include an awareness that the patient understands what has been conveyed and an agreement by the patient for a course of care. The process occurs between the physician and the patient.

Once hospitalized, patients are obviously “managed” much more by other hospital staff who have a responsibility to make patients aware of what to expect during their stay. With their experience, other hospital staff have greater expertise regarding what is likely to happen to and for patients, and in what sequence, than patients could possibly have. Initial expectations also derive from past experiences with the facility, discussions with others, experiences with other facilities, and information derived from the media, “report cards,” various web sources etc.

Likewise, mindful that effective communication must be a two-way process, staff have a responsibility to seek out questions and comments from patients regarding their needs and expectations (similar to a consent process), and to appropriately respond to these, both in terms of words and actions to best meet those needs and expectations. The voice of the patient-customer regarding their expression of needs and expectations is often critical to how quality is perceived by the patient (Stroud, n.d.). Bertel, (2003) described the centrality of meeting customer needs in the Six Sigma model with: “Failure to listen to and understand the Voice of the Customer can be fatal” (p. 171). Further, Solomon (2015) stated: “If you want to stem patient dissatisfaction, stop giving off cues of indifference and uncaring.”

             Managing expectations, requires transparency of information between staff and patients on an ongoing basis. Treatment plans may have to be altered due to either patient condition, physician direction or hospital “circumstances.” Solomon (2015) provides the following additional items regarding how to improve the patient experience (Bullets rather than numbers have been utilized here):

 Get every employee thinking about purpose, not just functions… To create successful medical outcomes and hospitable human experiences for our patients’ is a purpose. 

‘Sorry’ may be the hardest word, but it’s a word that everyone on your team needs to learn.  Resolving patient issues means knowing how to apologize for service lapses…It means getting rid of the defensiveness …when confronted by a patient upset with what she perceives to be a service gaffe. Instead, take your patient’s side in these situations, immediately and with empathy, regardless of what you think the “rational” allocation of “blame” should be. And spread this approach throughout your staff through role-playing and other training devices, so it will serve you fully every time a patient hits the fan.

Teach your employees – every single one – how to handle a patient or family member’s complaint or concern.  

 If you want to improve, strive to create a blame-free environment. 

Understand that improving patient satisfaction is about systems just as much as it is about smiles.

Cultural Change toward a Customer Approach

Increasingly patients don’t want to be considered as patients; they want to be considered customers. They want to know and agree to how they will be treated, what should happen, what are the outcomes, what to expect when they leave the hospital, what to expect about their health. We cannot effectively respond to these expectations with a departmental/silo mentality. We must break down these silos, learn to work as interdepartmental, inter-professional teams, although past models of professional education did not foster this approach, and change in these educational models is needed (National Center for Healthcare Leadership, 2011).

 Contributed by Dr. Walter Markowitz, Adjunct Faculty 

References

Aguayo, R. (1990). Dr. Deming: The American who taught the Japanese about quality.

            New York: Simon and Schuster.

Bertel, T. (Ed.). (2003). Rath and Strong’s Six Sigma leadership handbook. Hoboken, NJ: John Wiley and Sons, Inc.

Bord, J. (2014). Informed consent. Retrieved from https://depts.washington.edu/bioethx/topics/consent.html

CMS. (2015). HCAHPS factsheet. Retrieved from http://www.hcahpsonline.org/Files/HCAHPS_Fact_Sheet_June_2015.pdf

Deming, W. E. (1982). Out of the crisis. Cambridge, MA: MIT Press.

National Center for Healthcare Leadership. (2011). Michael Dowling accepts 2011 Gail L. Warden Leadership Excellence Award. Retrieved from https://www.youtube.com/watch?v=ZHCOzlYMyxQ

Pyzdek, T. (2001). The Six Sigma handbook: A complete guide for greenbelts, blackbelts, & managers at all levels. New York: McGraw-Hill.

Solomon, M. (January 11, 2015). 8 ways to improve patient satisfaction, patient experience and (by the way) HCAHPS scores. Retrieved from http://www.forbes.com/sites/micahsolomon/2015/01/11/8-ways-to-improve-patient-satisfaction-and-patient-experience-and-by-the-way-improve-hcahps-scores/

Stroud, L. (n.d.). Defining CTQ outputs: A key step in the design process. http://www.isixsigma.com/methodology/voc-customer-focus/defining-ctq-outputs-key-step-design-process/

(Note: Dr. Markowitz was the Director, Strategic Planning, North Shore-Long Island Jewish Health System.)

Healthcare and Schools

In the July/August issue of Health Progress magazine, an article written by Rochelle Davis, Jeffrey Levi, Ph.D. and Alexandra Mays, MHS, discusses the unique opportunity health and education systems have for partnership to serve the health challenges of elementary and secondary students.

As health care administrators, we sometimes are not aware of the important role schools have for health education programs, emergency health care services, nutrition and other health-related issues
The article titled “Ten Principles for Collaboration” outlines the opportunity hospitals have for developing and implementing programs with schools that will ultimately serve not only those in need but also invests in the future through our children.

The ten principles include:

• Needs assessment and implementation strategy
• Data exchange mechanisms
• Project scope or targets
• Sustainability
• Community engagement
• As well as several others

The full version of this article can be located at www.chausa.org under the publications and then the Health Progress tab.

Contributed by Becky Urbanski, Ed.D., SJC instructor, Catholic Health Care Leadership and Mission Integration graduate courses

Thinking about the end…

According to his book cover biography, Atul Gawande is the author of three best-selling books, including Complications, Better, and The Checklist Manifesto.  I have read all three and was quite excited to read his most current publication, Being Mortal.  Mr. Gawande is a surgeon, professor, and writer.  His books cover complicated and controversial topics in a calm and uncomplicated manner.  He introduces us to real people, with real medical issues while adding a human view to the sometimes sterile medical world.

In Being Mortal, Mr. Gawande tackles end-of-life issues.  He provides a historical perspective of end-of-life care, as well as current issues facing our society.  For example, he asserts that our medical community is still confused on the best methods for providing care for patients with long-term illnesses.  He states:

               “People with serious illness have priorities besides simple prolonging their lives.  Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete.  Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars.”

Mr. Gawande considers how “we can build a health care system that will actually help people achieve what’s most important to them at the end of their lives”.  He states, “People die only once.  They have no experience to draw on.  We need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come – and escape a warehouse oblivion that few really want.”

Overall, Mr. Gawande uses real-life stories to teach his readers the importance of compassion and facing reality.  He asserts that encouraging patients to think about and plan for the end of their life is just as important as preventative care.  In fact, some studies have shown that simply having a conversation about advanced directives (e.g., living wills) can reduce depression and confusion at the end-of-life.

This is not an uplifting book, but it is an important one.  I encourage everyone to discuss end-of-life choices with their loved ones.  It is not an easy conversation, but it can save heartache and provide peace.  Mr. Gawande supports this notion and provides an excellent guide to help begin those difficult conversations.

For more information: http://atulgawande.com/book/being-mortal/

Contributed by Valerie Connor, SJC instructor, law and ethics courses.

New Continuing Qualification Requirement (CQR)

Are you prepared to meet the new CQR   directive to maintain your certification?  The American Registry of Radiologic Technologists (ARRT) has been working with multiple constituents in the profession to develop a pathway for continued education.  Certification is now time limited to 10 years. Recertification will require the completion of the new CQR process.

The first CQR deadline is set for 2021. However, this will impact those who earned their certification in 2011 (effective January 1, 2011) and subsequent years. According to the ARRT website, the compliance phase will begin in 2018, which allows three years to complete the professional profile, the self-assessment section and targeted continuing education component by 2021.  The professional profile is a reflective exercise that compares clinical experiences to others in the discipline. Next, you must complete the structured self-assessment process, which is a learning tool designed to evaluate knowledge and skills on the qualifications that are expected of those who are certified. From this, a report will be generated with the results of the assessment and whether or not standards have been met. If standards have not been met, the ARRT will identify the necessary components that will be required for completion in order to be recertified. Please visit www.arrt.org/registration/CQR for additional information.

Submitted by Brenda Rice, Program Manager, Radiologic Science Administration

Emotional Intelligence?

An article was recently published in The Health Care Manager - a journal that 

provides practical, applied management information for managers in institutional health care settings - that was written by Dr. Twila Weiszbrod, Program Director.  The article is titled "Health Care Leader Competencies and the Relevance of Emotional Intelligence."  The article describes the relationship found between emotional intelligence and competencies identified being important for healthcare administrators!  You can read the article at: 

http://journals.lww.com/healthcaremanagerjournal/Fulltext/2015/04000/Health_Care_Leader_Competencies_and_the_Relevance.8.aspx

New Course!!

Scott Campbell, one of our adjunct faculty members, is currently completing the development of a course titled "Healthcare Delivery Models."  This highly interactive and completely relevant course will be available fully online in a 12-week term starting in October!!!

As Scott stated, "Health care delivery systems are evolving with new models that cut across the continuum of care being developed.  This evolution is being driven by a number of factors including the implementation of the Affordable Care Act, continuing pressure to provide care in a more cost-effective model, a growing emphasis on managing the health of a population over time rather than through episodic care, and an understanding that maintaining and improving health status is the key to the future of health care.  There is a need for a course that looks at these evolving systems and the forces that are changing health care delivery.  Health care administrators in the future will be expected to operate health care organizations in response to these changes."

Watch for more information to come about this new course!

What is the IMPACT Act of 2014, and Should It Be Affecting Your Operations?

The IMPACT Act of 2014 was signed into law on October 6, 2014.  IMPACT stands for “Improving Medicare Post-Acute Care Transformation” and this is indeed what this Act has begun to do.  In summary, what the Act does is that it reforms how post-acute assessment data is collected across different Medicare settings.  There was a resounding need not only for a standardization in data, but also for the instruments which collect it.  Obviously, as this is specifically geared towards Medicare, this Act will streamline their processes first and foremost, and it will enable several beneficial things overall regarding the services which they oversee.  The Act will allow for the collection of data which will further allow for quality comparison, for improvement of hospital and post-acute care discharge planning, and for further scrutiny towards Medicare payments for post-acute care (United States Senate Committee on Finance, n.d.).  This Act will also benefit from the upcoming ICD-10 implementation we can look forward to in October, 2015.  The increased number of codes available at this time for not only diagnoses, but also procedures, equipment, services, etc., will allow for a much easier transition towards implementation of the IMPACT Act.  The ICD-10 implementation will be a huge step towards easier compliance from post-acute providers of all specialties.

The question becomes, how should this be effecting your operations at current?  The answer is not a simple one.  The Act requirements will be phased in over time which begins in October 2016, one year after the implementation of ICD-10 coding.  Our focus needs to shift towards the three broad aims that the IMPACT Act is working towards regarding quality which include better care, healthier people and communities, and affordable care (Centers for Medicare and Medicaid Services, 2014). Obviously, on the heels of doing this, we must also ensure that we are working towards the implementation of the required standardized forms into our operations, electronic health records, or other systems which we might use.  This information will need to be reported in some interoperable way when the Act begins to be implemented in earnest.  Many post-acute providers already have systems in place such as the OASIS (home health), RAI/MDS (skilled nursing facilities), IRF-Patient Assessment Instrument (inpatient rehabilitation facilities), and LTCH-Continuity Assessment Record and Evaluation (long-term acute care hospitals).  All of these required forms are in use today by providers, however the ability for them to be interoperable with each other is what we need to start questioning.  The main point here is to ensure that services are not being inadequately utilized and that there is no duplication of those services across providers.  This will force each of the different post-acute care types to ensure that they are using the same ICD-10 codes at that time as other providers, and that their information meets these new interoperability requirements.  Indeed, a tall order for providers who are already stretched in the area of resources.

Some important websites with further information:

Centers for Medicare and Medicaid Services. (2014). IMPACT Act of 2014 & Cross Setting Measures.  Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014-and-Cross-Setting-Measures.html

United States Congress. (2014). The Improving Medicare Post-Acute Care Transformation Act of 2014 (Full Text).  Retrieved from http://www.gpo.gov/fdsys/pkg/BILLS-113hr4994enr/pdf/BILLS-113hr4994enr.pdf

United States Senate Committee on Finance. (n.d.).  The Improving Medicare Post-Acute Care Transformation Act of 2014.  Retrieved from http://www.finance.senate.gov/imo/media/doc/IMPACT%20Summary.pdf

Pitts, P.W., Christy, D.S., and McCurdy, D.A. (2014). Analysis and Impact of the Improving Medicare Post-Acute Care Transformation Act of 2014.  Retrieved from http://www.reedsmith.com/files/Publication/a0c30fb6-81bd-4739-9be5-169e20aad8ae/Presentation/PublicationAttachment/1841b086-dd16-4a9c-a0fa-2cc2081dadb6/Analysis%20and%20Impact%20of%20the%20Improving%20Medicare%20Post-Acute%20Care%20Transformation%20Act%20of.pdf

  

Contributed by Dr. Michael Mileski, DC, MPH, MSHEd, LNFA, SJC Faculty

Health Information Professionals week!

This week is Health Information Professionals week! We are so excited about our new BSHIM program at Saint Joseph's College! We are continuing to add entry-level courses to our curriculum while we wait for the next step in the CAHIIM accreditation process. We submitted our self-study last October and hope to receive a response this month from the CAHIIM review of our material. We will then make necessary adjustments and hopefully have our site visit by summer!

So far there are about 18 students that have applied to the program, with a few students already enrolled in courses. The remaining applicants are providing transcripts so they can work toward BSHIM degree completion!

For more information about Health Information Professionals week, as well as some great articles, please visit the AHIMA site at:
  http://www.ahima.org/~/media/AHIMA/Files/ConferencesEvents/MX10214_HIPW15PlanningKit.ashx?la=en

Hot Topics in Rad Science

Healthcare administrators today are concerned with providing quality care in a safe environment. 

Patient feedback is an important aspect of implementing and monitoring health initiatives that are tracked in health facilities. Patient safety rates, infection rates, drug reactions, etc. are to name a few initiatives that are monitored with corresponding action plans to prevent infections and readmissions.

The Affordable Care Act will change the arena of hospitals regarding issues such as reimbursement rates, in how physicians will order tests, etc.

In addition, in an effort to stay competitive, administrators need to evaluate the benefits versus the costs of purchasing new medical technologies, as patients are researching and requesting them. Diagnostic Imaging departments have been transformed over the past decade, due to recent advancements, such as magnetic particle imaging, information technology systems, new digital imaging systems, etc.

Wireless and mobile radiology systems allow physicians more freedom and the ability to treat patients at their bedside, in rural areas, etc. Remote viewing systems have allowed multiple physicians, who are in multiple locations to simultaneously access and consult on a patient. The Cloud or web-based systems are used to access images outside the hospital’s system.

With reimbursements decreasing, administrators are looking for ways to improve the work flow in radiology departments by incorporating more automation and ergonomically designed equipment, while working on a fixed budget. This can be very challenging. Patient safety comes first.  

By Brenda Rice, Program Manager RSA

Value Based Payments and the Physician Quality Reporting System

One of the newest provisions of the Affordable Care Act which went into effect on January 1, 2015 was the provision which ties physician payments to the quality of care that they provide.  The main idea behind this system is to move the physician practice from the model as it was where volume of patients was the focus.  This system had physician practices running to see huge numbers of patients in a day, sometimes double or triple booking to meet this end.  Value-based payments are beginning to be instituted this year to allow these same physicians to slow down and provide more meaningful care to patients than what has been furnished in the past. 

As of 2015, this provision will only apply to practices of 100 or more eligible professionals and is focused only on Medicare providers.  The value based payment model includes an opt-in payment adjustment for those practices which have reported satisfactory measures of quality under the newly instituted Physician Quality Reporting System (PQRS).  The PQRS will quickly become a method by which practices will be able to receive incentive payments, or negative adjustments, over the upcoming years of continued expansion of the Affordable Care Act.  As it stands, the PQRS allows for reporting of different measures by providers such as clinical conditions treated, types of care, settings where care is provided, quality improvement goals for the practice for the year, and other measures yet to be defined.  Physician practice payments will not be affected by this reporting as of this fiscal year, however, they can receive incentives or penalties in the future based upon what they report currently.  As such, those physician practices that do not provide information to the PQRS system in FY 2015 will see only penalty adjustments in the future. 

Forecasting the future is a very important part of what practice managers do.  Realizing the impact of this new system of reporting in current forecasts, budgeting, capital management, and marketing should be at the forefront of operations today.  Doing nothing now will hurt your practice in the future! 

Some important websites with further information:

American College of Physicians. (2013). Value based payment modifier.  Retrieved from: http://www.acponline.org/advocacy/where_we_stand/assets/vii2-value-based-payment-modifier.pdf

Berenson, R.A. (2010). Moving payment from volume to value: What role for performance measurement? Retrieved from: http://www.urban.org/uploadedpdf/412344-moving-payment-volume-value-performance-measurement.pdf

Centers for Medicare and Medicaid Services. (2014). Medicare FFS physician feedback program/Value-based payment modifier.  Retrieved from: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Background.html

Centers for Medicare and Medicaid Services. (2013). Physician quality reporting system (PQRS) overview.  Retrieved from: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_OverviewFactSheet_2013_08_06.pdf

Contributed by Dr. Michael Mileski, DC, MPH, MSHEd, LNFA, SJC Faculty

High Deductible Healthcare

Background on high-deductible plans or otherwise known as “consumer-driven healthcare.”

According to the Leapfrog Group, 1 in 5 are now utilizing plans that are high-deductible or consumer-driven healthcare plans. One of the characteristics of these types of plans are that the patient is responsible for the first $1,000 or more. As stated on HealthCare.gov, the annual out-of-pocket maximum/limit can go up to 6,600 for an individual or $13,200 for a family. The benefit for a higher out-of-pocket is a lower monthly premium, but even with the best planning, one cannot truly prepare for the costs associated with an unexpected illness that may require a hospitalization or outpatient services.

What is this doing to the healthcare consumer? How do they pay for services that fall into this valley of co-pays and deductibles? Well, there are an increasing amount of finance options to help out. For example, there is one called Healthcare Finance Solutions that can offer short term loans for as little as 0% for the consumer and the provider can be paid within 48 hours. In addition, they offer infrastructure that will support the registration clerks and admissions staff as they are meeting with a patient or their family that will enable them to access the system and process their application in no time at all. Everything is integrated into the EMR or as a stand-alone that has easy access for the registration clerk or admissions staff. Now, the facility can collect upfront these large deductible plans, give the patient peace of mind that their financial responsibility is taken care of, and their focus can now be centered on getting better. More importantly, this can take the question of should I get this procedure done to when do I want to get this procedure done.

Most people, if not all, sign up for the high-deductible plans base on the monthly premium. I hope that over the next year a more robust education process is afforded to the purchaser of healthcare so as to avoid, this seemingly, one dimensional decision process.

HealthCare.gov. 2014a. Out-of-pocket maximum/limit. Retrieved from https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

Leapfroggroup.org. 2013. High Deductible Health Plans & The New Era of Consumerism in Healthcare. Retrieved from http://www.leapfroggroup.org/media/file/AnnualMeeting2013Program.pdf  

by Kevin (Michael) Harrington