No. 17 – Fall 2017
  In This Issue   NY-RAH Completes Phase Two (Year One)
The first year of Phase Two of the NY–RAH project ended on October 23, 2017. From November 1, 2016 to September 30, 2017, participating nursing facilities generated an additional $2.6 million in reimbursement through the use of special facility payment incentives. The NY–RAH Project Management Team (PMT) appreciates each facility's hard work developing new processes to make the new payment reform incentive a success.

Year One's main focus was to introduce the facility and practitioner payment incentives and work with facilities to implement workflows to reduce the number of missed billing opportunities due to on-site visits not occurring within the required timeframe and/or deficient practitioner documentation. Since this is a new program, CMS, the NY–RAH team, and others had to sort through myriad issues during Year One, and we appreciate the patience shown by staff when billing issues arose and additional clarification was required.

The RN Care Coordinators (RNCCs) at Group B facilities provided support to develop and improve the facility payment incentive workflows; this support will continue in Year Two. In addition, 13 of the 27 Group B facilities participated in the United Hospital Fund/Greater New York Hospital Association Antibiotic Stewardship Program, which will again be offered to Group B facilities in early 2018. The RNCCs were also trained to support their facilities with the new CMS Requirements of Participation for Long Term Care, including the facility assessment and Quality Assurance Performance Improvement (QAPI) program. In Year Two, the RNCCs will work on individual NY–RAH performance improvement projects focused on the NY–RAH-eligible residents to model how to use CMS's QAPI tools to design and implement QAPI projects.

NY–RAH is soliciting feedback from all participating facility administrators on how to improve programing in the next year and will release new minimum participation requirements that will be monitored throughout Year Two and evaluated for continuation into Year Three.
Phase One Evaluation Shows NY–RAH's Great Strides in Reducing Avoidable Hospitalizations
The NY–RAH project showed a significant reduction in all-cause and potentially avoidable hospitalizations, according to an independent evaluation of Phase One of CMS's Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. Evaluation of the NY–RAH project showed reductions in all four utilization categories (all-cause hospitalizations, potentially avoidable hospitalizations, all-cause emergency department [ED] visits, and potentially avoidable ED visits) over the course of Phase One, moving each measure in its desired direction.

On October 20, RTI International (RTI), the independent evaluator for CMS, released its final evaluation for Phase One . The report evaluated both the final year of Phase One (2016) as well as the entire Phase One intervention period (2014-2016). RTI's evaluation compares each of the participating projects to a comparison group in each state. For the intervention period, RTI found that the CMS Initiative in total showed strong evidence that its interventions were effective at reducing hospitalizations. RTI also noted that the convincing overall performance of Phase One participants served as justification for funding Phase Two.

The NY–RAH project's performance was deemed statistically significant in the count of potentially avoidable hospitalizations per resident, probability of a resident having a potentially avoidable hospitalization, and probability of a resident having an all-cause hospitalization. In addition, NY–RAH's reductions in the count of all-cause ED visits per resident and the probability of a resident having a potentially avoidable ED visit were statistically significant over the last year of Phase One. NY–RAH's performance across the utilization categories demonstrates its effectiveness in achieving its goal of reducing avoidable hospitalizations during Phase One. The NY–RAH team looks forward to continuing this important work and building on our success in Phase Two.
  NY–RAH Works to Increase Practitioner Engagement
The NY–RAH project has increased its focus on strengthening engagement of participating practitioners and facilities. In September, NY–RAH's Medical and Palliative Care Director, Joseph Sacco, MD, and Faiza Haq, Project Manager, Payment Reform, began individual outreach to Medical Directors and eligible practitioners. The outreach has included NY–RAH team members' participation in facility medical staff meeting call-ins and in-person meetings with practitioners to address concerns and discuss barriers regarding documentation or billing. These calls and meetings helped to resolve billing issues, inform practitioners of best practices, and provide recommendations for more efficient and complete documentation. Practitioners should be aware of the outreach efforts to increase practitioner engagement and should be available for brief, scheduled phone calls and meetings as necessary.

Please contact Faiza Haq, Project Manager for Payment Reform, if you have any questions.
Q3 2017 Facility Payment Incentive Results
The NY–RAH Data Team recently developed facility-specific reports on data collected in the third quarter of 2017. The Quarter 3 (Q3) 2017 Payment Incentive Report, which displays a facility's payment incentive billing patterns against the aggregate billing pattern of all NY–RAH facilities, continued to show progress related to use of the new facility payment incentive codes.

Since NY–RAH began tracking this data in Quarter 4 (Q4) 2016, the percent of facilities that billed for at least one of the six qualifying conditions per quarter increased each quarter. Eighty percent of facilities billed for at least one of the six conditions in Q3 2017, a 13% increase over Q4 2016. This continued improvement aligns with NY–RAH's goal of having all facilities develop strong processes to consistently identify opportunities to bill for the six qualifying conditions. Additionally, in Q3 2017, 89% of all billed conditions improved without a hospital transfer. This marks this metric's highest percentage during the first year of Phase Two, surpassing the previous Phase Two high of 85% achieved during Q2 2017.

If you have any questions about the quarterly reporting or data, please contact Courtney Zyla, Data Analyst.
Med-Allies Mail Tests Version 2.0 with Group B Facilities
MedAllies Mail recently announced that it had begun initial testing of version 2.0 of its Direct Messaging application. Since 2013, 20 of the 27 Group B facilities have used MedAllies Mail Direct Messaging to receive electronic C-CDA Summary of Care documents from partner hospitals when admitting or re-admitting a resident. Since implementation of Direct Messaging, MedAllies Mail has received feedback on the application and has made enhancements to its product.

Although Direct Messaging provides nursing facilities with a secure means to electronically receive crucial, updated clinical information about hospital visits, several technical and operational challenges made having the C-CDA Summary of Care documents less valuable. One of version 2.0's most valuable additions are notifications alerting users when the nursing facility's Direct Messaging inbox has received a new C-CDA Summary of Care document. This new feature will dramatically improve workflow processes for users who are primarily responsible for accessing similar care information, particularly in the facility Admissions Department.

NY–RAH will conduct a three-month test pilot of version 2.0 with two of its Group B facilities to determine how workflow processes should be modified to accommodate the new features. Once the pilot is complete, NY–RAH will share any newfound best practices and work to transition the remaining 18 MedAllies Mail facilities to version 2.0.

Please contact Jeff Paul, Senior Project Manager for Electronic Solutions, with any questions about your facility's transition to MedAllies Mail version 2.0 or any general Direct Messaging questions.
  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

Indiana University, the Regenstrief Institute, and the University of Indianapolis are together known as OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care). OPTIMISTIC's staffing model is similar to NY–RAH's in that it includes 17 specially trained registered nurses (RNs) at 17 Central Indiana Group B nursing facilities. The OPTIMISTIC model differs from the NY–RAH model in that these RNs provide direct clinical support. In addition to education, they:
  • Recognize early the warning signs for changes in condition so treatment can start before a problem escalates
  • Educate residents and families on the transfer process and ensure that the hospital follows the patient's care wishes
  • Engage in advance care planning discussions with residents and families to make decisions about treatment goals
Supporting and coordinating with the RNs is a team of nurse practitioners that each cover three to four facilities and coordinate with primary care providers by completing in-person evaluations and management of residents with acute changes. When necessary, project geriatricians are consulted for recommendations. OPTIMISTIC has 25 additional Group A nursing facilities throughout Indiana, most north of Indianapolis.

For more information on the OPTIMISTIC ECCP, please see OPTIMISTIC's website.
  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