HCPro.com - Contemporary Long-Term Care Weekly

Tip of the week: Get to know the chronic care measure domains

Thu, 02 Sep 2010 14:29:00 GMT

Increasingly, SNFs must rely on data and data analysis to objectively view the quality of care delivered to their residents. The data gathered and reported by the quality measure (QM) systems designed for long-term care are information-rich and provide guidance, direction, statistics, frequency, and monitoring of potential quality problems.

Armed with this information, facilities can make positive changes to policies, procedures, practices, and patterns of care to not only improve the quality of care provided to residents, but also improve communication between staff members. For those reasons, it is critical for SNFs to gain familiarity with the chronic care measure domains so they can stay on top of the latest QM systems data and make appropriate adjustments. The domains are as follows:

Accidents
Behavior and emotional patterns
Clinical management
Cognitive patterns
Elimination and incontinence
Infection control
Nutrition and eating
Pain management
Physical functioning
Psychotropic drug use
Quality of life
Skin care

This is an excerpt from the HCPro book, The QM/QI Troubleshooter, Second Edition, by Diane L. Brown.

Skilled Healthcare found liable for improper staffing, fight far from over

Thu, 02 Sep 2010 14:25:00 GMT

Skilled Healthcare, a California-based support provider to long-term care facilities, was found liable July 6 for improperly staffing 22 facilities in the state. As a result, Skilled Healthcare was ordered to pay $677 million in restitution, the largest jury award in the U.S. this year, according to Bloomberg News.

This class-action lawsuit represented about 32,000 former patients of Skilled Healthcare that accused the company of short-staffing facilities, which led to inadequate care. On August 6, defense attorneys for Skilled Healthcare filed for a retrial because of juror misconduct.

To read this brief in its entirety, please visit MDSCentral.

Notice: Last issue of CLTC Weekly

Thu, 02 Sep 2010 14:20:00 GMT

HCPro is sorry to report that this is the last issue of CLTC Weekly. We thank you for being a loyal subscriber.

To keep you informed when it comes to long-term care news, you will soon be receiving another e-newsletter, HCPro’s MDS 3.0 Update, which provides skilled nursing facility staff members with up-to-date information regarding the MDS 3.0. Please add our address, mds_update@list.hcpro.com, to your e-mail address book to ensure you receive your e-newsletter issues, which will arrive in your inbox every other Monday, beginning September 6.

If you already receive MDS 3.0 Update, or if you’re interested in another topic, visit http://www.hcmarketplace.com/free/e-newsletters/ to read about and sign up for one of our other free e-newsletters.

Tip of the week: Develop policies that address key OSHA compliance issues

Thu, 26 Aug 2010 18:39:00 GMT

Although all workers are responsible for maintaining compliance with Occupational Safety and Health Administration (OSHA) standards, the administrator needs to also make sure maintenance personnel, along with the associated housekeeping and laundry departments, develop policies that will address key compliance issues. OSHA inspectors may direct their concern toward worker safety, but maintaining compliance with their standards crosses over and fortifies the safety of residents as well. The following are some key OSHA issues that have to be addressed in any developed policies regularly as they are often the target of OSHA citations:

Means of egress
Emergency and fire prevention plans
Hazardous materials elimination and handling
Hazard communication
Hazardous waste operations
Use of personal protective equipment
Lockout/tagout policy
Emergency flushing
Electrical concerns
Air contamination and proper ventilation
Bloodborne pathogens

This is an excerpt from HCPro’s book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

CMS releases transition information during RUG-IV call

Thu, 26 Aug 2010 18:35:00 GMT

During the RUG-IV National Provider Call on August 24, CMS provided listeners with important information regarding the transition from the MDS 2.0 and RUG-III to the MDS 3.0 and RUG-IV. To receive payment for covered days in September 2010, you must have a RUG-III group, and to receive payment for covered days in October 2010, you must have a RUG-IV group. RUG-III can be calculated from the MDS 2.0 and the MDS 3.0; however, RUG-IV can only be calculated from the MDS 3.0. This creates a problem for residents in a Medicare Part A stay whose RUG assignment from one SNF PPS assessment covers days in September and October of this year.

To read this brief in its entirety, which includes the four transition options outlined by CMS during the call, please visit MDSCentral.

Notice: Second to last issue of CLTC Weekly

Thu, 26 Aug 2010 18:27:00 GMT

HCPro is sorry to report that this is the second to last issue of CLTC Weekly. We thank you for being a loyal subscriber.

To keep you informed when it comes to long-term care news, you will soon be receiving another e-newsletter, HCPro’s MDS 3.0 Update, which provides skilled nursing facility staff members with up-to-date information regarding the MDS 3.0. Please add our address mds_update@list.hcpro.com to your e-mail address book to ensure you receive your e-newsletter issues, which will arrive in your inbox every other Monday, beginning September 6.

If you already receive MDS 3.0 Update, or if you’re interested in another topic, visit http://www.hcmarketplace.com/free/e-newsletters/ to read about and sign up for one of our other free e-newsletters.

National Immunization Awareness Month

Thu, 19 Aug 2010 21:03:00 GMT

August is National Immunization Awareness Month and CMS is encouraging providers to educate seniors and all Medicare beneficiaries about the importance of disease prevention through immunization. Providers should verify that their immunizations are current. They should also encourage Medicare beneficiaries to make use of the appropriate Medicare-covered immunizations.

Medicare Part B includes immunization benefits, such as vaccination coverage for pneumococcal (generally covered only once in a lifetime), seasonal influenza (once per influenza season), and hepatitis B (for medium to high risk beneficiaries). For more information regarding disease control and prevention, immunization benefits, and National Immunization Awareness Month, visit the CMS Adult Immunizations Web site.

Quick poll: Do you think the delay of RUG-IV will be repealed by Congress prior to October 1, 2010?

Thu, 19 Aug 2010 20:07:00 GMT

To respond to this week's question, scroll to the bottom of the long-term care page on HCPro's Web site.

Tip of the week: Comprehending contractual law

Thu, 19 Aug 2010 20:03:00 GMT

Contracts and contractual law are important for long-term care administrators to understand. A contract is a legally enforceable promise between individuals. Contracts can be expressed or implied in nature. With the expressed contract there is an expressed understanding that the parties have agreed to, and although expressed contracts are often written, they can be verbal. Conversely, an implied contract is often inferred through conduct or actions that have transpired and are not necessarily stated. Contracts have some important features, including:

An offer – a specific promise to perform, as well as a specific demand for some duty if the offer is accepted.
Acceptance – occurs when one party agrees to the offer made by the other party.
Consideration – the essence of the contract. Consideration allows each party to understand the specificity of the agreement and the duties they promise to perform.

Contracts are typically binding agreements. Some are fairly straightforward, and often an annual continuation of services with few, if any, changes exist in the new agreement. Other contracts may be complex and should be examined by legal counsel. Remember that the administrator is typically the agent who is authorized to enter into contracts, and therefore little defense can be given to an administrator who did not understand or lacked the capacity to enter into such an agreement because he or she failed to use legal counsel.

This is an excerpt from the HCPro book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

Pharmaceutical company halts Alzheimer’s clinical trials

Thu, 19 Aug 2010 19:57:00 GMT

Eli Lilly, an Indianapolis-based pharmaceutical company working towards developing a clinical Alzheimer’s disease treatment, ended two late-stage experimental trials on August 17. Patients who took the drug displayed worse cognitive functioning and a decreased ability to perform activities of daily living than patients who took the placebo, according to The New York Times.

The drug, semagacestat, is intended to reduce the production of amyloid beta plaques in the brain, which is thought to be a potential cause of Alzheimer’s disease. But the trials, which began in 2008, showed that an excessive reduction of plaques may damage cognitive functions. Lilly is already testing a different drug—an intravenous monoclonal antibody—that reduces the plaques. The company plans on following the 2,600 Alzheimer’s patients who participated in the trials for six more months.

Tip of the week: Critical leadership skills for LTC administrators

Thu, 12 Aug 2010 21:10:00 GMT

Long-term care staff members will rely on their administrator for occasional assistance, support, and guidance. As a result, it is important for administrators to develop and implement a number of core leadership characteristics. Administrators should:

Lead with integrity.
Make some time to move around the facility. Remain close to the environment and routinely talk with staff members, family members, and residents.
Communicate and listen (not just hear) effectively.
Take a stance and do not equivocate – sitting on the fence and waiting for a great, definitive revelation to come about or hoping the problem will work itself out will often lead to disaster.
Admit and learn from mistakes.
Work toward being a proactive manager, not just a reactive manager.
Be receptive to others and their ideas and provide useful feedback.
Be realistic in their management approach and project undertaking (know their resources and their abilities).
Empower their workers and create a smart working environment. Staff members need to know they are trusted and their abilities are respected.

This is an excerpt from the HCPro book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

Updates from CMS' MDS 3.0 Train-the-Trainer Conference

Thu, 12 Aug 2010 21:06:00 GMT

Much is being discussed in Las Vegas at the MDS 3.0 Train-the-Trainer Conference. CMS has provided conference attendees with the case mix index sets E01 and E02 for RUG-IV. In addition, CMS is creating a document highlighting the changes between the revised RAI User’s Manual released this summer and the previous version. CMS officials said this document would be posted on the CMS Web site shortly, but did not provide an exact date.

For continuous updates from MacKenzie Kimball, who is at the conference all week, visit MDSCentral.

Quick poll: When will your facility begin training for ICD-10 implementation (scheduled for October 1, 2013)?

Thu, 05 Aug 2010 17:29:00 GMT

To respond to this week's question, scroll to the bottom of the long-term care page on HCPro's Web site.

Tip of the week: Recognizing parasitic agents in long-term care facilities

Thu, 05 Aug 2010 17:24:00 GMT

Illnesses are common in healthcare settings. Long-term care facilities are no different. The following list offers details about parasitic agents, which do not always lead to immediate symptoms and can take some time to present themselves, that are often found in facilities:

Body mites: These are very small parasitic agents. One of the most common body mites is the scabies mite that borrows under the skin and causes extreme itching and irritation. Most individuals who have been involved in long-term care have witnessed scabies outbreaks. Scabies is transmitted from skin to skin, or from bed linen or clothing.
Trichinella spiralis: This parasitic agent, often transmitted through food, can attach to the muscle and brain tissue and wreak havoc in a person. Since the agent of transmission is often food, especially pork, that is not fully cooked, the most important way to prevent infections is to thoroughly prepare food.
Giardia: This is a protozoan agent that is often found in water, fruits, and raw vegetables. In most areas of the U.S., transmission of this agent is not through water. However, fruits and raw vegetables, often a favorite food of many older adults, is a possible transmission source.
Cryptosporidium: Also referred to as crypto, this is a parasite that lives in a person’s intestines. It is a diarrheal disease that is most commonly picked up from water, but it can also be found in food or on contaminated surfaces. It causes watery diarrhea and it can lead to dehydration.

This is an excerpt from the HCPro book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

Bill introduced to improve LTC survey system

Thu, 05 Aug 2010 17:20:00 GMT

On August 2, Representative Bart Stupak (D-MI) introduced the Enhancing Quality through Survey System Improvements Act of 2010. The legislation aims to modernize the current survey system, which has been in place for decades, used to evaluate long-term and post-acute care facilities nationwide. The American Health Care Association is commending the bill.

In modernizing the system, the hope is that the survey process will become more streamlined, allowing surveyors to spend less time in facilities that do not warrant the need, and more time in those that demand greater attention. Because all Medicare and Medicaid-certified facilities must be surveyed at least once per year as required by federal regulations, the bill enables CMS to make greater use of its resources.

CMS releases updates to ICD-9 codes

Thu, 05 Aug 2010 17:18:00 GMT

CMS recently released its annual ICD-9 code revisions. The changes will be implemented October 1, 2010 and could have a significant effect on your SNF’s reimbursement. ICD-9 codes play a role in both Medicare Part A and Part B coding, providing critical and required information on all Medicare claims submitted to fiscal intermediaries and Medicare administrative contractors.

To review the annual ICD-9 updates, visit the CMS Web site.

Quick poll: MDS 3.0 will be implemented in about two months. Is your facility adequately prepared?

Thu, 29 Jul 2010 20:07:00 GMT

To respond to this week's question, scroll to the bottom of the long-term care page on HCPro's Web site.

Tip of the week: Recognizing bacteria in long-term care facilities

Thu, 29 Jul 2010 20:01:00 GMT

Illnesses are common in healthcare settings. Long-term care facilities are no different. The following list offers details about bacteria that are often found in facilities:

Bacillus cereus: Found in soil, dust, and food products, this bacterium can cause diarrhea and vomiting.
Campylobacter jejuni: This is possibly the most common infective agent for food borne illnesses. It is frequently found in raw poultry. Therefore, it is important for poultry to be thoroughly cooked. Furthermore, avoiding cross-contamination is critical in limiting the spread of this bacterium.
Listeria monocytogenes: Common in soil, waste, plants, and food (specifically inadequately pasteurized milk), this bacterium causes listeriosis, which can be fatal.
Vibrios: There are several species of Vibrios, which are small, curved bacteria. The most well known is Vibrio cholerae, which causes cholera. Others can cause gastroenteritis and septicemia.
Streptococcus pneumoniae: Also called pneumonococcus, this is a diplococcus bacterium that causes some forms of pneumonia. It can also cause other infections, such as endocarditis, cellulitis, and meningitis.
Haemophilus influenzae: There are many forms of Haemophilus influenzae, with most forms being opportunistic, meaning the person can harbor these pathogens without having any disease. Often, disease occurs where there is an opportunity for infection and immunity is reduced. It can cause pneumonia, meningitis, conjunctivitis, and osteomyelitis, among other diseases.

This is an excerpt from the HCPro book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

Rite Aid to pay $1 million in HIPAA settlement

Thu, 29 Jul 2010 19:54:00 GMT

To settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA), Rite Aid Corporation recently agreed to pay a $1 million resolution amount to the U.S. Department of Health and Human Services (HHS). The company, which is one of the nation’s largest drug store chains, also agreed to develop policy improvements in regards to the disposal of customers’ private information. In addition, Rite Aid stores will be subject to external independent assessments.

The settlement is the result of a joint investigation by the HHS Office for Civil Rights (OCR) and the Federal Trade Commission (FTC). The two groups settled a similar case in February 2009. OCR initiated the Rite Aid investigation after discovering through television media videotapes that pharmacies had been discarding materials (i.e., prescriptions and labeled pill bottles) into industrial trash containers that were accessible to the public.

Overview of RAI changes

Thu, 29 Jul 2010 19:47:00 GMT

CMS has released all updated sections of the RAI User’s Manual for the MDS 3.0, except for Appendix F. With no crosswalk to identify the changes between these sections and the previous version of the RAI User’s Manual for the MDS 3.0, many providers are unsure of exactly what changes were made.

To view a complete list of the major changes to each section included in Chapter 3 of the manual, visit MDSCentral.