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No. 8 – Summer 2015 Newsletter image3
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  In This Issue   Newsletter imagepeople
On July 30 and 31, NY–RAH project management team members met in Baltimore with Centers for Medicare & Medicaid Services (CMS) officials and other organizations from across the country participating in the CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents (also known as the Nursing Facility Initiative or NFI). The meeting provided an opportunity for project teams to discuss successes, share challenges, and hear from CMS and its contractors about their perspective on NFI. Meeting attendees also included Deloitte Consulting, the operations contractor for CMS for the Initiative; Research Triangle Institute, the group responsible for the formal evaluation of NFI; and the Medicare Payment Advisory Commission (MedPAC). (MedPAC requested to attend in order to understand the issues facing nursing facilities caring for long-stay residents.)

Tim Engelhardt, the Acting Director of the Medicare-Medicaid Coordination Office, which is sponsoring NFI, commended the project teams for their hard work and said his office regularly updates CMS senior officials on NFI. Matthew Press, MD, a senior advisor and medical officer for the Center for Medicare and Medication Innovation (CMMI), discussed the portfolio of CMMI projects and their overarching goal of improving care coordination for Medicare and Medicaid beneficiaries. Evan Shulman, Deputy Director of the Division of Nursing Homes, Survey and Certification Group within CMS, discussed the recently released skilled nursing facility proposed rule and how he believed the Initiative positioned the participating nursing facilities to do well in a changing environment, emphasizing quality under CMS' proposed rules.

Representatives from each of the seven NFI participating organizations presented on their projects, discussing their specific approaches, areas of success, and perceived project barriers. In addition, representatives from Deloitte and RTI presented on the data collected so far to evaluate the NFI as it progresses. While much data is still preliminary, NY–RAH representatives and others had a productive discussion on the best use of the data and the overall positive results.
  Advance Directive Performance Report Introduced  
NY–RAH recently introduced the Performance Goal Report, which charts each facility's current quarterly performance for two advance directive metrics: percent of residents with a quarterly advance directive discussion, and percent of residents with a Health Care Proxy. Facility results are reported in relation to the NY–RAH performance goal of 80% or greater. The Performance Goal Report has been added to the quarterly reports package, which includes the Facility Progress Report, Palliative Care Report, and Hospital Transfer Report.

In Q2 2015, 52% of the NY–RAH facilities reached the NY–RAH goal for residents with a quarterly advance directive discussion. This result is an improvement from Q3 2014, when only 3% of facilities achieved at least 80% of residents with a quarterly advance directive discussion. Meanwhile, 24% of NY–RAH facilities achieved the NY–RAH goal for both metrics, and one additional facility achieved the NY–RAH goal for health care proxies alone.

NY–RAH facilities have made great progress with advance directives and the project management team believes the Performance Goal Report will assist in improving all facilities' performance on these metrics. If you have any questions or would like assistance interpreting your facility's specific reports, please contact Scott Gaffney, GNYHA's Senior Research Analyst, at (212) 258-5369 or
  Web-Based Portals an Option for Summary of Care
NY–RAH has been working with its 29 participating facilities over the past year to choose and implement technology that allows them to receive Summary of Care documents electronically. NY–RAH recommended web-based portals or Direct Messaging as solutions. A web-based portal is a closed communication channel that only allows communication between specific transfer partners. In this case, a hospital develops a portal and invites specific health organizations to use it. Direct Messaging, on the other hand, provides a user with an electronic address that can be used by any other health organization or provider to transmit information. Portals are most helpful if a nursing facility does the vast majority of its transfers with only one hospital.

To assist participants, NY–RAH partnered with MedAllies, a Health Information Service Provider (HISP) and Direct Messaging solution, which provided mailboxes to 20 facilities. Eight facilities have elected to use an alternate HISP, and one is in the final stages of selecting a HISP. One of the alternate HISPs includes Surescripts, which connects health systems that use the EPIC electronic health record with nursing facilities. While Direct Messaging continues to be preferred method for the majority of NY–RAH facilities, four NY–RAH facilities have begun using hospital web-based portals.

For more information about HISPs or web-based portals, please contact Jeff Paul, GNYHA's Project Manager for Electronic Solutions, at (212) 258-5308 or
  Palliative Care Learning Community Webinar Held  
On July 21, NY–RAH held the second Director of Nursing Learning Community Webinar, focused on Palliative Care. Following the success of The Conversation Project workshops held on June 30 and July 1, Directors of Social Work, Administrators, Social Workers, and other nursing facility staff were also invited to attend. NY–RAH Medical and Palliative Care Director Joseph Sacco, MD, opened the discussion by defining palliative care, describing the differences between palliative and hospice care, and sharing helpful recommendations on starting the palliative care conversation. NY–RAH Clinical Director Inna Popil, RN, DNP, facilitated a discussion of the successes and challenges of palliative care intervention. The Directors of Social Work and Social Workers from Suffolk Center for Rehabilitation and Nursing, St. Mary's Center, Inc., The Amsterdam at Harborside, and Highfield Gardens Care Center of Great Neck shared their experiences and success stories about starting a conversation, completing advance directives, and implementing electronic-Medical Orders for Life Sustaining Treatment (eMOLST).

NY–RAH thanks all the facility staff who participated in the webinar. If you have any questions, please contact Inna Popil at (347) 714-4014 or
  Reminder: MOLST Guideline Webinar
NY–RAH will host a webinar for facility staff during which Joseph Sacco, MD, NY–RAH Medical and Palliative Care Director, will review each MOLST checklist with special attention on defining capacity. Lorraine Ryan, Esq., Senior Vice President, Legal, Regulatory, and Professional Affairs at GNYHA, will participate to answer any additional questions. Ms. Ryan advocated for the Family Health Care Decisions Act and oversees GNYHA's Palliative Care Leadership Network. The details of the webinar are as follows:

     Date: Thursday, August 20, 2015
     Time: 10:00 a.m.–11:00 a.m.
     To access the webinar:
     To dial-in: (888) 567-1602 (there is no sound on the webinar, you must dial-in)
CMS Outstanding Nursing Facility Recognition
Summer 2015: Barbara McFadden, Administrator, Buena Vida Continuing Care and Rehabilitation Center
CMS Outstanding ECCP Staff Recognition
Summer 2015: Joan Goldman, RN, Care Coordinator, Suffolk Center for Rehabilitation and Nursing and St. Catherine of Sienna Nursing Home
  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.  
  Greater New York Hospital Association
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