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LTC: Frontline staff members take larger role in product selection

Medicare & Reimbursement Advisor Weekly, June 24, 2009

If you market or sell to the LTC segment (or if you’re considering this), be advised: Adopting similar strategies and messaging you use for the acute care or physician practice setting won’t work.

LTC facilities differ from other healthcare settings in virtually every possible way; they are staffed and reimbursed differently and treat sicker, more clinically complex patients. Nursing homes’ clinical decision-making process is nearly as complex as the patients they treat.

Although every Medicare-certified nursing home is required to retain the services of a medical director, physicians aren’t necessarily the primary drivers of medical decisions in LTC. Nursing homes provide long-term, intensive, round-the-clock care to often frail and very sick patients. These patients receive medical and personal care from several providers, including nurses, therapists, certified nurse assistants (CNA), social workers, and dietitians. Most facilities rely on interdisciplinary teams, including the director of nursing (DON), a consultant pharmacist, the patient and his or her family, and the MDS coordinator, who oversee documentation and reimbursement (http://blogs.hcpro.com/mdscentral/).

RN role in disease recognition

In this clinically complex patient population, the potential for new diseases and conditions, cognitive and physical decline, and adverse reactions is high. Frontline staff members are often the first to notice and report these changes. In fact, in a recent HCPro survey, 87% of respondents reported that floor nurses are involved in resident disease recognition, whereas 67% responded that the facility medical director is involved. Sixty-three percent of respondents reported that CNAs are the first to recognize and report changes in a resident’s mental, physical, and emotional state.

Even with such complicated issues as medication regimen monitoring, LTC nurses are acutely involved in decision-making processes. Seventy percent of our survey respondents reported that their floor nurses are primarily responsible for monitoring a resident’s medication regimen—only 12% indicated that the medical director is primarily responsible. Further, 43% of 287 responding facilities said nurses are “extremely influential” in medication decisions; 98% of respondents indicated that the nurses in their facility are involved on some level in decisions regarding a resident’s medications.

Conclusion

The clinical decision-making picture in LTC facilities is complex at best, but the marketing and sales message is simple: Understand the patients they treat and how care is delivered. Doctors and pharmacists are important, but so are the frontline caregivers who interact with the residents on a daily basis. No matter which marketing/selling tactics you use, remember that no campaign is complete without considering frontline staff members.

Editor’s note: Feel free to write or call to dive deeper into these questions and findings at bcote@hcpro.com or 860/232-6377.

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