No. 15 – Spring 2017
  In This Issue   NY–RAH Discusses Progress at CMS Annual Nursing Facility Initiative Meeting
On May 9 and 10, NY–RAH project management team members joined officials from the Centers for Medicare & Medicaid Services (CMS) for the annual meeting of the six organizations participating in the CMS Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents – Phase Two (also known as the Nursing Facility Initiative, or NFI). The Regenstrief Institute at Indiana University, one of the six project organizations, hosted the meeting in Indianapolis, Indiana. The meeting provided an opportunity for NY–RAH and the other organizations to discuss successes, share challenges, and receive feedback from CMS and its NFI contractors. Meeting attendees included Social & Scientific Solutions (SSS)/Telligen), the NFI operations support contractor, and Research Triangle Institute (RTI), the NFI evaluation contractor.

RTI Report on NFI Evaluation
RTI presented the 2015 NFI evaluation results and indicated that the Initiative was causing a reduction in Medicare expenditures, and that, overall, Phase One's performance was encouraging. The RTI final report for 2016, which will be comprised of all 2012-2016 data, is expected to be released to the public by the end of 2017.

RTI clarified that as part of the Phase Two evaluation, Group A (facilities that began in November 2016 and are now engaged in the payment reform intervention) and Group B (facilities that began in 2013 and are now engaged in both clinical interventions and payment reform interventions) will not be directly compared to one another. Instead, each group will have its own comparison group to measure its success. The Phase Two quantitative analysis will focus on utilization and expenditure data for the six qualifying conditions as well as measures related to end-of-life care, use of both the facility and practitioner payment incentives, and Medicare Advantage/I-SNP penetration. The qualitative analysis will involve annual site visits, in-person interviews, and phone calls to Group B facilities, and site visits and in-person interviews to Group A facilities in Years 1 and 4 (2017 and 2020). Annual phone calls will be included. A web-based survey will also be sent to Group A and B facility administrators as well as to participating practitioners in Years 2 and 4. The site visits for Year 1 are expected to occur in the fall of 2017 for both Group A and B facilities.
  SSS/Telligen Report on Annual Site Visits to Facilities
SSS/Telligen presented on the structure of the annual facility site visits that are a requirement of participation in the Initiative. In March 2018, approximately eight Group A and six Group B facilities will participate in a full-day chart audit and a half-day interview. This review will allow SSS/Telligen to confirm that the clinical criteria for one of the six clinical conditions was met; identify successes, challenges, and opportunities; and identify significant lapse in capabilities relative to the readiness review. Chart audits will be conducted for up to 10 facility claims for the six qualifying conditions, six care conference claims, and six acute nursing facility visit claims. Facilities selected in this round of site visits will be contacted at least six weeks in advance. All facilities can expect to be selected for a site visit at least once during the duration of the Initiative.

Phase Two Challenges and Lessons Learned
SSS/Telligen facilitated four breakout sessions for the representatives of each of the six organizations to share best practices related to Physician Engagement; Learning Community Activities; Data Collection Challenges and Successes; and Strengthening Communication and Tool Usage. All the organizations reported challenges with physician engagement, as many practitioners have been difficult to engage. The organizations also reported that the use of the practitioner payment incentive for care conferences has been minimal across the Initiative. Other project barriers, including payment issues and software upgrades, were also identified by the organizations. The organizations agreed that finding and sharing the success stories from both facilities and practitioners on the Learning Community webinars could help drive other facilities and practitioners struggling to use the payment incentives to implement better workflows.
NHDD Events Promote Advance Care Planning
In recognition of National Healthcare Decisions Day (NHDD), which was organized as a weeklong event in 2017, several NY–RAH nursing facilities held events in April to promote the completion of advance directives. NHDD occurs annually on April 16 and is part of an initiative to promote the completion of advance directives and advance care planning. In 2016, seven NY–RAH facilities hosted events, and this year, Registered Nurse Care Coordinators (RNCCs) supported events at 20 Group B nursing facilities.

This year, NY–RAH promoted the resources available through the project to residents and families as well as staff members, including the Medical Orders for Life-Sustaining Treatment (MOLST) forms and brochures; health care proxy forms; NY–RAH palliative care brochures; The Conversation Project Starter Kit; and information for practitioners on using the new payment incentive for care conferences that is part of Phase Two. Also new this year was a guide from the Institute for Healthcare Improvement (IHI) on How to Choose and Be a Health Care Proxy. Hebrew Home for the Aged in Riverdale showed The Conversation Project TedTalk with its founder, journalist Ellen Goodman. Good Samaritan Nursing Home had several staff members complete their own health care proxy forms, as most staff did not have one. Staff at Smithtown Center for Rehabilitation and Nursing also inquired about how they could hold advance care planning events at their churches.

The NY–RAH project management team greatly appreciates RNCCs' role in organizing many of these events, as well as the active participation in the events from the facility Directors of Nursing, Directors of Social Work, Administrators, Social Workers, and Palliative Care Champions.
  Q1 2017 Facility Payment Incentive Results
In early June, NY–RAH will distribute its Quarter 1 2017 facility-specific reports to all participating nursing facilities. The quarterly reporting results are calculated using the data that each facility's data portal users enter into the NY–RAH data portal. It is a requirement of project participation that each facility complete the necessary information in the data portal. As part of the package, all facilities will receive a Payment Incentive Report that allows the facility to view its own billing patterns when using the new facility incentive payment. In addition, the report includes aggregated information on billing patterns of all NY–RAH-participating nursing facilities.

For the first quarter of 2017, NY–RAH facilities reported managing 81% of all reported qualifying condition episodes in the facility. Eighty-one percent represents a four percentage point improvement from the fourth quarter of 2016. In addition, only 6% of the qualifying condition episodes during the first quarter of 2017 resulted in a hospital transfer, a three percentage point reduction of this measure from the fourth quarter of 2016. The most commonly billed conditions continued to be Urinary Tract Infection (31%), Pneumonia (29%), and Skin Ulcers/Cellulitis (21%).

As facilities refine their processes to identify, treat, and manage residents with qualifying conditions, NY–RAH is hopeful that it will continue to report positive results throughout Phase Two of the project. If you have any questions regarding your quarterly reports, please contact Scott Gaffney, data manager.
Antibiotic Stewardship Training Spots Now Available
GNYHA and the United Hospital Fund (UHF) are conducting a new antimicrobial stewardship program (ASP) for nursing facilities starting in June, at no cost to participating nursing facilities. Additional spots for interested nursing facilities have just been made available. Establishing an ASP is a component of the new CMS Requirements of Participation finalized and made effective as of November 28, 2016. According to CMS, "the facility's infection prevention and control program must also include an antibiotic stewardship program that includes antibiotic use protocols and systems for monitoring antibiotic use and recording incidents." Interested New York nursing facilities should register for the GNYHA-UHF ASP certificate program as soon as possible. To date, 13 of the 27 Group B facilities have signed up for the ASP.

The multidisciplinary certificate program is designed to help nursing facilities develop or move existing ASPs to the next level through a facility assessment; home study and exam; half-day webinar and full-day in-person training; UTI point prevalence study; and coaching calls with faculty to help design interventions and policies. Continuing education credits will be available for pharmacists, physicians, and nurses. Each participating facility must have a pharmacist and a prescriber in attendance. A third attendee is optional. Interested nursing facilities must elect to attend the webinar and in-person training based on the group number below. All participants from a specific facility must attend the same sessions together.

ASP Certificate Program Schedule
  Webinar Date and Time In-person Date and Time
Group 1 Tuesday, June 6; 2:30 p.m. 5:00 p.m. Wednesday, June 14; 8:30 a.m. 3:00 p.m.
Group 2 Monday, June 12; 2:30 p.m. 5:00 p.m. Thursday, June 15; 8:30 a.m. 3:00 p.m.

To register, please contact Logan Tierney at (212) 554-7207 no later than June 2.
  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 is highlighting one of the organizations each quarter to describe its unique features and best practices.

US Map

HealthInsight is the quality improvement organization leading the CMS Nursing Facility Initiative in Nevada called Admissions and Transitions Optimization Program (ATOP). During Phase One, ATOP placed one advance practice nurse and two registered nurses in five different pods to provide direct clinical care and education on INTERACT throughout the 24 participating nursing facilities across the State. In Phase Two, ATOP's clinical intervention staff will continue to provide the following services for 14 of the original 24 comprising Group B in Phase Two:
  • Discuss residents' conditions with physicians
  • Execute orders
  • Provide education and training for facility staff
  • Assist with end-of-life discussions
  • Perform medication reconciliation
  • Participate in care conferences
  • Assist with coordination of care
Due to the relatively small number of nursing facilities in Nevada (50 in total), ATOP is partnering with 24 Group A nursing facilities in Colorado to participate in the payment reform only part of the intervention.

For more information on the ATOP 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