No. 9 – Fall 2015
  In This Issue   ED Only Visits, Observation Stays Reduced
During Quarter 3 2015, NY–RAH achieved its lowest quarterly Emergency Department (ED)-only visit/observation stay rate in more than a year as facilities focused on reducing unnecessary transfers and establishing interventions that allow for treatment in place.

The NY–RAH Project Management Team (PMT) has continuously emphasized the importance of reducing all avoidable hospital transfers regardless of hospital status (i.e., ED-only visit, observation stay, or inpatient admission). During Quarter 3, the NY–RAH rate for transfers to the hospital that resulted in an ED-only visit or observation stay was 0.54 transfers per 1,000 resident days. This is the lowest rate for this metric since NY–RAH began measuring it in Quarter 2 2014, and validates the NY–RAH facilities' efforts to reduce all avoidable hospital transfers among their eligible resident populations.

The PMT will continue to work with all participating facilities to advance all data metrics through the end of the year. If you have any questions or would like assistance interpreting your facility's specific reports, please contact Scott Gaffney, Senior Research Analyst, at (212) 258-5369 or
  HCP, Advance Directive Discussion Rates Increase  
NY–RAH facilities have made significant progress in increasing the rate of advance directive discussions and completion of health care proxies (HCPs). In Quarter 3 2015, the NY–RAH project hit a new high for the percentage of eligible residents with a quarterly advance directive discussion, which increased from 58% in Year 3 Quarter 2 to 68% in Year 3 Quarter 3. NY–RAH facilities also increased the percentage of eligible residents with an HCP, with 53% of eligible residents having an HCP in Quarter 3 2015—the first time this metric reached or exceeded 50%.

Each NY–RAH facility has received an updated Quarter 3 2015 Performance Goal Report, which highlights the facility's progress towards achieving the NY–RAH facility goal of 80% or greater in each of these measures. The PMT commends the work that each facility has engaged in to improve these rates and looks forward to working with them to help achieve the project goal over the next year.
  Year 4: Renewed Focus on INTERACT, Potential Phase Two  
The NY–RAH project began Year 4 in September 2015 with a renewed focus on implementation of INTERACT. During the beginning of Year 4, the PMT also submitted its application for Phase Two of the CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents.

Phase Two will introduce a payment reform intervention to complement the existing clinical interventions. As part of this, it would offer nursing facilities and their practitioners, families, and staff a means to advance facility-based care for eligible residents and reduce unnecessary hospitalizations. Should NY–RAH receive the award, NY–RAH will expand the project to include approximately 50 additional nursing facilities across New York. The new facilities would only participate in the payment reform intervention, and will not work with a Registered Nurse Care Coordinator (RNCC). The PMT anticipates that newly participating facilities will be located in counties that are not part of the Fully Integrated Duals Advantage (FIDA) demonstration. CMS expects to announce the award for Phase Two on or around January 15, 2016.

Year 4 of NY–RAH will have a renewed focus on the INTERACT tools Stop and Watch and SBAR, with an emphasis on the quality of the tools being completed by facility staff and ensuring that the use of these tools is optimized. The PMT will also work with facilities to promote the use of a quality improvement transfer review tool. Palliative care guidelines are also under development and will be distributed to assist facilities interested in establishing clinical standards for appropriate treatment of residents receiving palliative care. Direct Messaging will continue to be promoted as a means of obtaining better communication from hospital transfer partners, and the NY–RAH project will start working with the Regional Health Information Organizations (RHIOs) to align with the goals of the Statewide Health Information Network of New York (SHIN-NY).
  Joseph Sacco, MD Speaks at NYMDA Conference
On November 11, NY–RAH Medical and Palliative Care Director Joseph Sacco, MD, presented at a meeting of the New York Medical Directors Association (NYMDA). The meeting brought together medical directors, attending physicians, and others practicing in the long term care continuum from across New York State. David Siskind, MD, Medical Director, Gurwin Jewish Nursing and Rehabilitation Center, and current NYMDA chair, invited Dr. Sacco to review the status of the NY–RAH project and the successes and challenges to date. Dr. Sacco also commented on the potential for Phase Two and the practitioner requirements and payment reforms.
  DSRIP and NY-RAH Data Collection  
Many NY–RAH facilities are members of performing provider systems (PPSs) as part of New York's Delivery System Reform Incentive Payment (DSRIP) program, and many NY–RAH nursing facilities are also participating in DSRIP care transitions projects to reduce avoidable hospitalizations. The PMT has had discussions with some PPSs to determine whether the NY–RAH data collection efforts performed by RNCCs might be leveraged to reduce DSRIP data collection efforts for NY–RAH nursing facilities.

The PMT is continuing these discussions with PPSs and will assist NY–RAH participating nursing facilities where it can. In the meantime, NY–RAH nursing facility leadership should note that RNCCs should not be asked to or expected to assist with any DSRIP data collection efforts.
  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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