No. 16 – Summer 2017
  In This Issue   New Project Manager Joins NY–RAH Team
The NY–RAH project welcomes Faiza Haq, who joined in mid-August as Project Manager, Payment Reform, a new role created based on a yearlong assessment of the project's needs. Ms. Haq has experience in quality assurance and conducting chart audit reviews, and most recently served as Chief Scribe in the emergency room of a large medical center in Maryland.

Ms. Haq will work closely with NY–RAH's Medical and Palliative Care Director and Associate Project Director to help both Group A and B nursing facilities with workflow development for facility and practitioner payments, documentation, and billing. In upcoming months, she will visit sites, meet medical directors and eligible practitioners, and learn about all aspects of NY–RAH to help find ways to ensure that each facility maximizes use of payment incentives.

NY–RAH's Project Management Team (PMT) looks forward to working with Ms. Haq as the project enters the second year of Phase Two. She can be reached at or 212-506-5421.
Group B Facilities Set New Advance Directive Record
In early September, all facilities will receive facility-specific reports on data collected in the second quarter of 2017. Group A will receive reports on the six conditions, hospital transfers, and data quality. Group B will receive the same reports, plus the palliative care report, which displays facility-level performance on certain advance directive and palliative care measures. Group B facilities remain successful with advance directives. In fact, based on the data, the facilities have the highest percentages to date for both the percent of eligible residents with any advance directive and the percent of eligible residents with a Medical Orders for Life Sustaining Treatment (MOLST).

Throughout Phase One and Two, NY–RAH maintained that each resident's end-of-life wishes should be discussed and documented to ensure effective and comprehensive care planning. In the second quarter of 2017, 97% of eligible Group B residents had an advance directive, exceeding the previous high of 95% for the first quarter of 2017. This sustained improvement exemplifies NY–RAH's goal of communicating with residents and their families on care planning and documenting residents' end-of-life wishes. Another major NY–RAH advance directive intervention is the implementation of the MOLST form. MOLST implementation has experienced great improvement since NY–RAH began measuring it in the second year of Phase One. And in the second quarter of 2017, 46% of eligible Group B residents had a MOLST, which surpassed the previous high of 40% reached during Phase One.

The NY–RAH PMT is pleased to see Group B facilities continue to improve processes for palliative care and advance directives in Phase Two, especially considering the tremendous progress of all Group B facilities during Phase One.

If you have any questions regarding quarterly reporting or data, please contact Scott Gaffney, Data Manager.
  Group B RNCCs Develop Facility Payment Workflows
To ensure each Group B facility maximizes use of the facility payment incentive, Group B Registered Nurse Care Coordinators (RNCCs) are developing a workflow diagram to document each facility's workflow, from identification of a resident's change of condition, through to the RNCC notification of the facility receiving payment for eligible episodes. Over the next month, RNCCs will present Group B facility leadership with workflow diagrams that identify areas of improvement to ensure facility payment incentives are used for every eligible condition. Areas of improvement may include education for nursing staff on monitoring clinical criteria and tracking the duration of an episode; documentation review for practitioners; and assigning specific roles to help notify the billing department of eligible conditions. The NY–RAH PMT expects Group B leadership to work with RNCCs to create a sustainable model for facility payment incentives.
MedPAC Discusses New Quality Measures
The Medicare Payment Advisory Committee (MedPAC), a nonpartisan agency that provides policy and analysis advice to Congress on the Medicare program, released a report last June that included a chapter on hospital and skilled nursing facility (SNF) use among long-stay nursing home residents. The report featured findings from a MedPAC review of existing initiatives for long-stay residents, results from a MedPAC analysis on hospital and SNF utilization, and recommendations for future Medicare policy analyses related to long-stay residents.

To identify effective ways to reduce hospital use among long-stay residents, MedPAC interviewed individuals who participate in existing initiatives and programs for long-stay residents, such as the CMS Nursing Facility Initiative that sponsors the NY–RAH project. MedPAC identified increased staff communication, enhanced staff training and advance care planning as successful tactics to reduce hospital use among this population. MedPAC's findings aligned with NY–RAH's interventional goals. MedPAC's quantitative analysis showed that—on average—members of the long-stay population use hospital services less than other SNF patients. It also found a large variation between the highest- and lowest-performing SNFs across these measures, which may indicate there is poor care coordination and quality of care among the lower-performing SNFs.

Based on its findings, MedPAC discussed the feasibility of CMS establishing hospital and SNF use measures specific to the long-stay population. The measures would serve as an indication of the quality of the SNF. The report also suggests incorporating a hospital use measure for long-stay residents into Medicare's SNF value-based purchasing program to impact payment only for the lowest-performing SNFs. Lastly, due to the great variation in the hospital use measures, MedPAC also advised that CMS and its auditors consider further reviews of low-performing SNFs to ensure that all provided care that is reasonable and necessary.

If you have any questions regarding MedPAC's June Report, please contact Scott Gaffney, Data Manager.
NY–RAH Partners with GNYHA Stakeholders on the C-CDA
NY–RAH will collaborate with the Greater New York Hospital Association (GNYHA) to further promote use of the C-CDA electronic Summary of Care document in the next few months. NY–RAH has received numerous inquiries since releasing its 2017 Nursing Facility Electronic Solutions Report, which outlined opportunities for increasing use of Direct Messaging, which is used to transmit the C-CDA, and RHIO integration, which allows access to patient data across care settings. NY–RAH has identified several uses for the C-CDA electronic Summary of Care document. One of the most valuable was using the document for medication reconciliation with other discharge summaries, such as the New York State PRI and paper discharge, since the C-CDA contains the entire list of patient medications at the time of hospital discharge. NY–RAH—with GNYHA colleagues and a small pilot group of nursing facilities and their hospital partners—will explore ways to design specific use cases involving medication reconciliation to combat multidrug-resistant organisms and support antibiotic stewardship.

If your nursing facility is interested in participating in this collaborative, please contact Jeff Paul, Senior Project Manager, Electronic Solutions.
  ECCPs Around the Nation
NY–RAH is one of seven Enhanced Care Coordination Providers (ECCPs) that received the Phase One award for the CMS Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. The ECCPs across the Initiative meet annually and speak monthly to learn best practices from each other. Six of the seven ECCPs continued to Phase Two and work together to develop educational and promotional materials for facilities and practitioners. NY–RAH will highlight an ECCP each quarter and describe its unique features and best practices.

US Map

The Aging Institute of University of Pittsburgh Medical Center (UPMC), the University of Pittsburgh, and the Jewish Healthcare Foundation are together known as RAVEN (Reduce AVoidable hospitalizations using Evidence-based interventions for N ursing facilities in Pennsylvania). RAVEN's staffing model is a mix of nurse practitioners who provide hands-on clinical care and nurse educators who help train staff on communication of acute changes of condition, palliative care, and medication risks. In addition, RAVEN uses telemedicine to enhance around-the-clock communication among facility nursing staff, physicians, acute care clinicians, and nurse practitioners. Clinicians on the receiving end of telemedicine are employed by the ECCP. Eighteen nursing facilities participated in Phase One, 15 of which continued to Phase Two as Group B, with an additional 20 facilities in Group A.

For more information on the RAVEN ECCP, please visit:
  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