IN THIS ISSUE

CMS Discusses Priorities at Annual Nursing Facility Initiative Meeting

First Round of SSS/Telligen Site Visits & Chart Audits Completed 

NHDD Events Promote Advance Care Planning 

Facilities Use PointClickCare for Secure Texting 

ECCPs Around the Nation 

CMS Discusses Priorities at Annual Nursing Facility Initiative Meeting

On April 23 and 24, NY-RAH project management team (PMT) members joined officials from the Centers for Medicare & Medicaid Services (CMS) for the annual meeting of the six organizations participating in Phase Two of the Nursing Facility Initiative (NFI). The Regenstrief Institute at Indiana University, one of the six project organizations, hosted the meeting in Indianapolis. NY-RAH and the other organizations discussed successes, shared challenges, and received feedback from CMS and its NFI contractors, Social & Scientific Solutions (SSS/Telligen), the operations support contractor, and Research Triangle International (RTI), the evaluation contractor. 

Incorporating Phase One Evaluation Best Practices in Phase Two
During the meeting, Lindsay Barnette, Director, Models, Demonstrations, and Analysis Group, CMS, discussed the agency's priorities for 2018 and beyond for the NFI program, and the potential for changes in the Phase Two demonstration model. CMS reviewed the findings of the September 2017 Phase One evaluation and will incorporate lessons and best practices learned into Phase Two. The six projects will work closely to share and implement best practices. Group B NY-RAH facilities may see changes to the core interventions (INTERACT, palliative care, and eSolutions) based on a more targeted approach for ensuring success in reducing avoidable hospitalizations.

Maintaining CMS Program Integrity
CMS officials discussed maintaining the integrity of the Medicare program by addressing improper payments to nursing facilities and practitioners. While Phase Two provides a unique opportunity for participating nursing facilities and practitioners to bill Medicare Part B for treating one of six conditions in place, CMS reiterated that it has the right to recoup funds from nursing facilities and practitioners who receive payments resulting from improper billing. CMS will therefore implement a recoupment process for any change of condition not in compliance with the NFI's clinical criteria if proper documentation is not found. This also applies to the practitioner acute nursing facility and care conference billing codes. CMS will also recoup payment for any facility claims paid for residents who did not meet the eligibility criteria for residing at the facility for 100 or more days. Additional details on what nursing facilities and practitioners can expect from the recoupment process will be sent in a separate notice to administrators and eligible practitioners in early May.

First Round of SSS/Telligen Site Visits & Chart Audits Completed

SSS/Telligen recently completed its first round of annual site visits and chart audits at 15 Group A and B facilities. One participation requirement for facilities in the NFI is to undergo at least one site visit and chart audit during Phase Two to ensure compliance with criteria and requirements associated with the Initiative; review supporting documentation for a sample of claims submitted; and identify areas that may benefit from additional education and training.

NY-RAH appreciates each facility's accommodations and ability to provide SSS/Telligen with the documentation required to complete the audits. The most common issues discovered across the 15 facilities were clerical errors pertaining to the wrong code or dates, missing daily nursing documentation and lack of SBAR use, missing practitioner documentation for physical exams, and failure to meet clinical criteria. In the next few weeks, the PMT will follow up individually with each facility that received a visit to share more detailed findings from the audits and discuss next steps, including the CMS recoupment process for individual claims.

The PMT will also hold a combined Group A and B Clinical Intervention Learning Community webinar on May 8 from 1:00 p.m. to 2:00 p.m. to review common themes from the visits and the recoupment process. We encourage all facilities to participate in the webinar. If you have any feedback or questions, please contact Faiza Haq, Project Manager for Payment Reform, at 212-506-5421.

NHDD Events Promote Advance Care Planning

On April's National Healthcare Decisions Day (NHDD), which was organized into a weeklong event in 2017, several NY-RAH nursing facilities held events 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. Since 2016, NY-RAH has encouraged facilities to hold events, and has seen great participation each year. In 2016, seven NY-RAH facilities hosted events; in 2017, 20 Group B nursing facilities held events; and this year, Registered Nurse Care Coordinators (RNCCs) supported events at 17 Group B nursing facilities. Four other Group B nursing facilities will hold advance directive events in the coming weeks.

NHDD2018

NHDD followed several months of Group B palliative care training to continue working toward the NY-RAH goal of increasing use and completion of the Medical Orders for Life-Sustaining Treatment (MOLST) forms and the number of residents that have designated a Health Care Agent. NY-RAH promoted the project's available resources to residents' families and staff members. The resources include 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 Phase Two payment incentive for care conferences. New this year was an Institute for Healthcare Improvement guide on How to Choose and Be a Health Care Proxy.

The NY-RAH PMT greatly appreciates the RNCCs for their role in organizing many of the events, and facility Directors of Nursing, Directors of Social Work, Administrators, Social Workers, and Palliative Care Champions for their active participation.

Facilities Use PointClickCare for Secure Texting

PointClickCare, an electronic health record (EHR) vendor, partnered with Tiger Text to provide nursing facilities with access to a securely encrypted, HIPAA-compliant text messaging service. Called Secure Conversations, it can be used on a PC via the PointClickCare EHR or on mobile devices such as cellphones and tablets as a downloaded app.

In Phase One, the NY-RAH PMT explored secure texting as a safe alternative to the growing trend of providers using basic text messaging to discuss resident Protected Health Information (PHI). Several Group B nursing facilities with PointClickCare have been using Secure Conversations since the beginning of Phase Two. To further encourage the use of secure texting as a safe means to communicate PHI, the NY-RAH PMT will coordinate user training sessions for Group B nursing facilities that already subscribe to Secure Conversations (or plan to) through PointClickCare.

If your facility wants to learn more about implementing secure texting, please contact Jeff Paul, Senior Project Manager for Electronic Solutions, at 212-258-5308.

ECCPs Around the Nation

NY-RAH was 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 have worked 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.

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Alabama Quality Assurance Foundation (AQAF) is the quality improvement organization leading the CMS Nursing Facility Initiative in Alabama. During Phase One, AQAF, like NY-RAH, was a "hands-off model," meaning registered nurses (RNs) also worked at Group B nursing facilities on education and building capacity in nursing facilities for quality improvement, and did not provide direct care. For Phase Two, AQAF redesigned its clinical structure for Group B, and 11 RN Care Coaches now provide direct care to assess residents, in addition to providing staff education. The RN Care Coaches work in conjunction with six nurse practitioners who provide direct care, advance care planning, and poly-pharmacy review to Group B nursing facility residents. The 23 AQAF Group B nursing facilities selected to participate in Phase One represented the nursing facilities with the highest hospitalization rates in Alabama. An additional 23 Group A nursing facilities also participate in Phase Two of the AQAF project.

For more information on the AQAF ECCP, please go to http://www.aqaf.com/nursing_home.php.

      NY-RAH is supported by Funding Opportunity Number 1E1CMS331492-01-01 from the US
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.