No. 13 – Fall 2016
  In This Issue   NY–RAH Welcomes Group A facilities
The NY–RAH project welcomed 33 new facilities ("Group A") that began formally participating in the NY–RAH project at the end of October, following the Centers for Medicare & Medicaid Services (CMS) notification that each facility passed the vetting and readiness review process. Group A facilities are eligible to bill for the payment incentives during Phase Two but do not have the additional clinical support provided to facilities that have been participating since 2012 ("Group B").

With the inclusion of the Group A facilities, there are now 60 nursing facilities participating in the NY–RAH project, almost 10% of the nursing facilities across New York State. Participating nursing facilities are located in New York City, Long Island, the Hudson Valley, the Albany and Buffalo metropolitan areas, and rural locations. On average, Group A facilities are smaller than those in Group B and have fewer specialty populations. Many are located further away from their transfer hospitals and look forward to increasing the level of care offered through the payment incentives to enable more residents to be managed in the nursing facility before transfer.

With the addition of Group A, the NY–RAH project expands its diverse mix of nursing facilities, which helps inform the replication on the Initiative across the country. If you have any questions about the Group A facilities, please contact Ashley Hammarth.
GNYHA Updates Hospitals Regarding NY–RAH Phase Two
Greater New York Hospital Association (GNYHA), which administers the NY–RAH project with the Icahn School of Medicine at Mount Sinai, has notified its member hospitals and other community stakeholders about the 60 nursing facilities participating in Phase Two of the project. GNYHA staff sent a letter to the chief executive officers, chief medical officers, and chief nursing officers of its approximately 150 hospital and health system members outlining the goals of the project and the participating nursing facilities. In addition to promoting the NY–RAH project, GNYHA did this to recognize your participation and commitment to reducing avoidable hospitalizations among nursing facility residents. Sixty nursing facilities and more than 200 practitioners participating in Phase Two of the NY–RAH project went live on November 1 and are now able to use new Medicare Part B payment codes for treating the six clinical conditions and providing care conferences.

The NY–RAH project management team would like to thank facility staff for their patience and hard work during the readiness review process, efforts to implement policies and procedures, and investments in equipment and services required to treat the six clinical conditions on-site. GNYHA will continue to update the hospitals and other community stakeholders on Phase Two successes throughout the duration of the project.
  NY–RAH Website Phase Two Makeover
The NY–RAH website,, was revamped during the last month to include new functionality and information about Phase Two of the project. The NY–RAH homepage now includes short animated "explainer videos," which provide an overview of NY–RAH, the role of the RN Care Coordinator in Phase One, and the goal of the payment incentives in Phase Two.

Additionally, there are now dedicated tabs for Phase One and Phase Two. The Phase One tab includes the resources that have been gathered or developed during the first four years of the project, including Stop And Watch and SBAR tools, Medical Orders for Life-Sustaining Treatment forms, and project guidelines. The Phase Two tab includes information on facility and practitioner incentive payments, CMS facility and practitioner payment guidelines, and the NY–RAH Quick Reference Guides. Lastly, a new Press Room tab has been added to house relevant webinars and news articles concerning the project.

The NY–RAH project staff encourages facility staff to frequently check the website as new content will be uploaded and be made available throughout Phase Two. If you have any questions regarding the NY–RAH website, please contact Megan Burns, Assistant Project Director.
Phase One Results Show Progress towards Project Goals
At the start of Phase One in 2012, NY–RAH set specific goals for the Group B nursing facilities, including increasing staff communication of acute changes of condition (ACOC), advance directives and advance directive discussions, and reducing avoidable hospital transfers. These three areas served as the basis for much of NY–RAH's Phase One reporting, and the progress made in these areas is borne out in the data.

To improve staff communication of acute changes of condition, NY–RAH encouraged Group B facilities to implement the INTErventions to Reduce Acute Care Transfers (INTERACT) curriculum in Phase One. At the beginning of Phase One reporting in April 2014, the percent of ACOCs where a NY–RAH tool (Stop And Watch, SBAR, or AMDA Know-It-All Before You Call) was used was 39%. In November 2015, this percent increased to a high of 60%. Also, NY–RAH facilities' maintained their performance on this measure through the end of Phase One as the percent reached or surpassed 50% in each of the last 14 months.

Throughout Phase One, Group B facilities focused attention on quarterly advance directive discussions to further understand their residents' end of life wishes. In NY–RAH's first Palliative Care Report in Quarter 3 2014, the percent of residents with a quarterly advance directive discussion was 27%. In Quarter 2 2016, this percent reached its project-high when 74% of eligible residents had a quarterly advance directive discussion, a 47% increase from Quarter 2 2014.

NY–RAH's emphasis on facility communication was also reflected in improved hospital transfer rates. After comparing each facilities' average hospital transfer rate for the last four quarters (Quarter 4 2015–Quarter 3 2016) against their average hospital transfer rate for the first four quarters where data was available (Quarter 2 2014–Quarter 1 2015), 13 facilities reduced their hospital transfer rate by 10% or greater. Nine of the 13 facilities reduced their hospital transfer rate by 20% or greater.

If you have any questions regarding Phase One data, please contact Scott Gaffney, Assistant Data Director.
  CMS Initiative Around the Nation
NY–RAH is one of six organizations that received the Phase Two award for the CMS Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents—Payment Reform. The organizations across the Initiative meet annually and speak monthly to learn best practices from each other. NY–RAH will highlight one of the other organizations each quarter and describe its unique features and best practices.

US Map

The Sinclair School of Nursing of the University of Missouri's project is known as the Missouri Quality Initiative for Nursing Homes (MOQI). In Phase One, MOQI placed advanced practice registered nurses at 16 participating nursing facilities to provide hands-on care and work with staff to improve early recognition and management of illness in addition to registered nurses that coached staff on the use of the INTERACT tools. MOQI also set target transfer rates each quarter for participating nursing facilities. MOQI, like NY–RAH, also incorporated an electronic health information exchange system called CareMail with transferring hospitals through the Missouri Health Connection, Missouri's official statewide health information network. MOQI went live with Phase Two on October 1 and provided the other organizations with invaluable information about their experience.

For more information on the MOQI ECCP, please go to
  NY–RAH is supported by Funding Opportunity Number 1E1CMS331492-01-01 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.  
  Greater New York Hospital Association
555 West 57th Street, 15th Floor New York, NY, 10019, United States