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No. 6 – Winter 2015 Flag3
In This Issue DSRIP Program Promoting INTERACT Toolkit Adoption
New York State's Delivery System Reform Incentive Payment (DSRIP) program is focusing on using INTERACT tools to help reduce avoidable hospitalizations among nursing facility residents. DSRIP is the major component of the State's five year Medicaid waiver and is designed to achieve delivery system transformation and reduce avoidable hospitalizations in New York by 25%. The State Medicaid waiver provides Federal reinvestment of funding in the State's health care system for a total of $8 billion; DSRIP accounts for $6.42 billion of that funding.

DSRIP program implementation is being led by 25 "performing provider systems" (PPSs), collections of health care organizations, clinical providers, and community-based social service organizations. PPSs were required to select their initiatives from a menu of projects focused on reducing hospital admission and readmissions through integrated care delivery, chronic disease management, and public health improvements. One of the projects that PPSs could select requires the adoption of the INTERACT toolkit in PPS partner nursing facilities. Seven PPSs selected this project as part of their integrated care delivery project requirement, and will begin formally working on it with their partner nursing facilities beginning in April 2015. Currently all PPSs are developing an Implementation Plan for each of the various projects they selected. The final Implementation Plan must be submitted in draft form to the State on March 1, and in final form on April 1.

To assist with this effort at widespread INTERACT adoption, NY–RAH project management team staff have been discussing their insights with PPS leaders. The NY–RAH project experience has provided an outstanding learning platform for the PPSs that wish to better identify acute changes of conditions in nursing facilities, strengthen partnerships between hospitals and nursing facilities, and support nursing facility efforts to provide excellent care. Most notably, the DSRIP INTERACT requirements for the advance care planning tools, clinical tools (Stop And Watch and SBAR), and conducting a root cause analysis have been the focus of NY–RAH in the past year.

For DSRIP questions, please contact Tim Johnson, NY–RAH Project Director, at tjohnson@gnyha.org or (212) 506-5420.
Directors of Nursing Discuss Best Practices and Reports
On February 12, Directors of Nursing from NY–RAH-participating facilities met in New York City. NY–RAH Clinical Director, Inna Popil, RN, MSN, ACNS-BC, CCM, invited participants to discuss the benefits of being part of the project, as well as the successes, challenges, and collaborative efforts facilities have undertaken.

Participants expressed appreciation for the project's monthly and quarterly reports, and indicated they found them to be helpful with identifying areas for improvement and in line with other reports their facilities use. There was a discussion about when and how to most appropriately use SBAR, as some facilities currently use the SBAR form only as a transfer tool, rather than a tool to communicate an acute change of condition to a physician with the hope of preventing a transfer. The Directors of Nursing in attendance explained that during emergency situations, there is sometimes not enough time to properly complete the SBAR form. However, they stated that their nursing staff has benefited from the SBAR principles and communicates to the physician using the SBAR format nonetheless.

The NY–RAH project management team understands that during emergency situations, a completed SBAR form may not be feasible. However, the NY–RAH team will continue to support facility leadership and staff in improving early recognition of acute changes of conditions and manage residents appropriately in the facility before an emergent situation occurs.

At the meeting, Denise Lawson, RN, Director of Performance Improvement at The Silvercrest Center for Nursing and Rehabilitation, gave a presentation describing how the facility uses a number of NY–RAH reports, including Acute Change of Condition Report, Acute Change of Condition Trend Report, Facility Progress Report, Palliative Care Report, and Hospitalization Report with their Project Workgroup. The Silvercrest Project Workgroup meets weekly and discusses the reports, in addition to the transfers that may have been avoidable or possibly avoidable, as determined by the NY–RAH Quality Improvement Tool. The NY–RAH project management team encourages all participating facilities to create a Project Workgroup and work with their RN Care Coordinator to maximize the utility of these project reports.

A second Director of Nursing meeting is scheduled from 12:00 noon to 2:00 p.m. Wednesday, March 4, 2015, at Island Nursing and Rehabilitation Center for those who were unable to attend February 12.

For questions, or to RSVP to the Long Island Director of Nursing meeting, please contact Clinical Director Inna Popil at inna.popil@mountsinai.org or (347) 714-4014.
Potential Delay for e-Prescribing Mandate
Earlier this month, legislation was introduced to delay the New York State electronic prescribing (e-prescribing) mandate currently expected to go into effect on March 27, 2015. By March 27 all clinicians licensed to prescribe medication will have to do so via a certified electronic system. There are concerns that many health care providers may not meet the mandate due to significant challenges—technical, operational, and cost-related—that hinder implementing e-prescribing by then. Despite the potential delay in the effective date for the mandate, the NY–RAH project management team is evaluating a vendor to provide e-prescribing services for interested facilities.

There are two bills, A.4274 and S.2486, in the Legislature that would provide a one-year delay. The Senate passed S.2486 on February 10; the Assembly Health Committee passed bill A.4274, and the Assembly is expect to vote on it when they return to session on February 24. Should a bill not pass and be enacted into law, there will be a process by which providers experiencing hardship can request a waiver that would absolve them of penalty. The Greater New York Hospital Association (GNYHA) supports the one-year delay and the waiver process.

For any questions please contact Jeffrey Paul, Project Manager for Electronic Solutions, at jpaul@gnyha.org or (212) 258-5308.
Direct Messaging Survey
In January, the NY–RAH project management team conducted a Direct Messaging survey of all facilities to better understand how Direct Messaging and Summary of Care documents are used in each site. The feedback was informative, and has identified areas where nursing facility workflow could improve, and how hospitals could improve the transmission process. All 29 NY–RAH facilities have either successfully activated a Direct Messaging mailbox, or are in the final stages of acquiring a mailbox. While facilities are ready to receive the Summary of Care document, many hospitals have encountered operational and technical barriers that have delayed the transmission process.

According to the survey results, one third of the NY–RAH facilities are receiving the electronic Summary of Care documents. Due to the aforementioned barriers, 40% reportedly do not receive these documents within 24 hours of the resident being admitted to the nursing facility. Unfortunately, this lengthy lead time compromises the document's value for the admission process. Of those who are receiving the document, 30% have efficiently incorporated it into their workflow and to the resident medical record, while several facilities have not yet found the best way to use the Summary of Care document. Of those receiving the document, 60% use it in some form for care plan purposes and compare it to the written records that arrive with the resident when they are admitted to the facility.

Many hospitals systems are still implementing Direct Messaging, or refining their existing Summary of Care transmission process. GNYHA and the NY–RAH project management team are confident that this new transition of care process will improve over time as hospitals have expressed intentions to also meet the needs of nursing facilities.

As each NY–RAH facility is unique in its operations, Jeffrey Paul, Project Manager for Electronic Solutions, will work closely with each facility and their hospital partners towards optimal use of the system. For any questions, please contact him at jpaul@gnyha.org or (212) 258-5308.
CMS Outstanding Nursing Facility Recognition
Winter 2015: Elizabeth Zimmermann, RN, Director of Nursing, Smithtown Center for Rehabilitation & Nursing
CMS Outstanding ECCP Staff Recognition
Winter 2015: Martine Pericles, RN Care Coordinator, Trump Pavilion for Nursing and Rehabilitation and Highland Care Center
The project described was supported by Funding Opportunity Number 1E1CMS331086-04-02 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.
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