Ziegler Senior Living 150 List Offers Noteworthy Takeaways and Details

Posted by CC Andrews

Dec 12, 2017 5:48:26 PM

There’s always something interesting on Ziegler’s list of the largest not-for-profit senior living organizations, and this year did not disappoint. Aside from the obvious—which groups are still in the top five and which ones have shifted—there are some takeaways that likely indicate industry bellwethers.Ziegler image.jpg

According to the report, there are, among other things, revelations about trends in “home and-community-based services, third-party management, rental Life Plan Communities (LPCs), technology adoption, joint ventures, and future growth plans.” Here are some noteworthy highlights:

  • Approximately 54 percent of the providers on the list offer some type of home and community-based services to non-resident.
  • In addition, the community care at home model is now offered by more than 14 percent of the providers on the list.
  • More than one-third of the providers on the list are engaged in a joint venture that involves a health system or home health company. This number has grown by more than 34 percent since last year’s list was published.
  • Related to this is the number of providers that have a formal health care contract with an Accountable Care Organization or a bundled payment agreement: the report notes that just 25 percent of providers on the list in 2013 had such arrangements.
  • Perhaps not so shocking, but nonetheless noteworthy, is the fact that 84 percent of organizations on the list use electronic health/medical records.

If you’re really interested in getting into the weeds, the list also includes details about the pace of growth, aggregate growth, and type of growth. Here are some takeaways from these sections of the report:

  • 75 percent of the providers on the list plan to expand or reposition an existing community in 2018.
  • 30 percent said “maybe” in response to being asked if they would planning to add new communities in 2017 or 2018.
  • 32 percent said they do plan to add new communities in 2017 or 2018.

Whatever might interest you, the Ziegler 150 offers more than a list: it is also packed with details about the largest not-for-profit providers that cannot be found anywhere else.

If you want a focused approach to strategizing your growth— facilitated by experts in the senior living field—contact Quantum Age today.

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Topics: long term care, long-term and post-acute care, aging services

Survey Points to Best Practices for Successful Innovation

Posted by CC Andrews

Nov 1, 2017 12:00:00 AM

No company can ignore the imperative to innovate and failing to do so is an invitation to lose business. This is the introduction to a new report from PwC on—you guessed it—innovation.

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Based on a survey of more than 1,200 executives in 44 countries, the report attempts to uncover a better understanding of how innovating companies are seeking to create business value and financial returns on their efforts. PwC’s survey asked questions about innovation strategy, operating models, culture, metrics, and more.

So what does this have to do with long-term/post-acute care and senior living? Well everything, of course. How’s that? Aging services providers know that they must innovate in order to succeed amid the impending wave of alternative payment models, stiff competition, and threats to Medicaid and Medicare funding.

Titled “Reinventing Innovation: Five Findings to Guide Strategy Through Execution,” the report is packed with juicy insights and stats. Here are some key findings:

1. Growing the Sandbox: The majority of the survey respondents are big believers in bringing more stakeholders into to the “innovation sandbox.” Among other things, PwC asserts that casting a wider net when it comes to getting input and generating ideas can improve innovation’s alignment with business strategy, help companies access fresh ideas and critical talent, and also enable them fail faster and get new innovations to market sooner. With this in mind, the report states, companies are opening up their innovation processes earlier to a broader set of stakeholders—from both inside and outside the company. In fact, the majority of companies surveyed said are bringing customers—as well as employees—into the innovation process at the ideation phase.

2. Reimagine and Experiment: Innovating without aligning it with strategy is not a prudent path for most companies, according to the report, which finds that for any initiative to deliver true value, it must clearly align with a company’s business strategy. The authors offered that example of GE Ventures, which, according to CEO Sue Siegel, means they must focus on reimagining and experimenting with new business models. “Emergent technologies are very powerful, but what we have to figure out is, what is the sustainable business model that we could potentially either partner up with or use within our organization to drive growth? We’ve been able to experiment to translate these major trends and technology enablers and apply them to business model innovation. That is incredibly important to how we stay ‘tip of spear’ at GE,” she said. That being said, the survey found that more than half of innovating companies struggle with bridging the gap between innovation strategy and business strategy, flagging it as their greatest strategic challenge when it comes to innovation.

3. The Right Stuff: Finding employees with the right human judgment and intuition in examining the data is “critical to obtaining useful insights for innovation,” the report suggests. “Soft skills like these are clearly valued by the executives we surveyed, who say their employees are their most important partners in innovation, ranking them above technology partners.” For example, Eddie Copeland, director of government innovation at Nesta, says that senior management’s failure to listen to frontline workers can be a major obstacle to innovation in government organizations. “Frontline employees often see problems and solutions more clearly than their cost-conscious managers,” she said. Also important to remember is that even if an employee doesn’t sit on a company’s core innovation team, they can still valuable contributors to innovation efforts early in the process. As Copeland explains in the report, they can function “as more than just personnel to whom innovations are pushed out for execution purposes.” Finally, don’t forget that employees are also consumers who can bring end-user insights into the innovation process. The survey found that 32 percent of the businesses surveyed said that finding employees with the right skills is their biggest people-related innovation challenge.

4. Technology Leads the Way: Companies continue to look to technology to help create markets for novel products and services that don’t yet exist, a la smartphones and wearables. Nearly one-third of those survey said their innovation is either all or mostly technology-led, while another one-third say they use a combination of technology and market-led innovation. Technology companies unsurprisingly are the leaders when it comes to “breakthrough innovation.” Nearly two-thirds of them make it a focus of most or all of their innovation efforts, according to the report. Maybe a little more surprising is that pharmaceutical and life sciences and health sciences companies follow technology in focusing mostly on breakthrough innovation.

PwC stresses that as companies invest more in innovation, they must strive to do a better job of aligning their innovation efforts with their business strategy. “Innovation spending ultimately has to drive business value and financial performance,” the report concludes. “But for that to happen in any consistent way, innovators should understand and help define future business models that can support the innovations they create.”

If you want a focused approach to your innovation strategies, facilitated by experts in the senior living field and candid feedback, contact Quantum Age today.

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Topics: Senior care, long-term and post-acute care, innovations, aging services

The Need for SNF Care Way More Likely for You and Me (and Everyone Else) But an Opportunity for Providers

Posted by CC Andrews

Aug 29, 2017 4:46:00 PM

FYI: most people who are now between 57 and 61 will experience short stays in skilled nursing facilities (SNFs). Yes, you read that correctly. According to new research from the RAND Corp., 56 percent of people within this age range will stay in a nursing home at least one night during their lifetime.

Why this isn’t getting more ink in the industry press, I don’t know, but the research asserts that the average American’s lifetime risk of needing SNF care is 60% greater than previously estimated. The U.S. Department 

204242-675x450-funelderlylady.jpgof Health and Human Services has previously estimated that only 35 percent of older Americans are likely to use a nursing home in their later years, and other studies have concurred with this finding.

Although the costs of the stays are expected to be “relatively affordable,” the RAND researchers expressed concerned that consumers be informed of their findings so they are prepared. But their message is also an important eye opener (and opportunity) for LTPAC operators.

To get to their conclusion, the researchers analyzed 18 years of data from the Health and Retirement Study, a longitudinal project of the National Institute on Aging and the Social Security Administration. They found that for most people, “nursing home care will be relatively affordable—about $7,300 per person over a lifetime.”

Also interesting about the finding is the fact that some 43 percent of Americans between 57 and 61 will be completely covered by private or public insurance for their nursing home stay, while about one-third will spend any of their money on nursing home care over their lifetimes.

What’s the reason behind this revelation? According to RAND, the cause could be the shift to shorter stays. The study found that nursing home stays of short duration (21 nights or fewer) rose from 28 percent in 1998 to nearly 34 percent in 2010.

In the release, head researcher on the study, Michael Hurd, posited that the increase may reflect efforts to control Medicare and Medicaid costs by more quickly discharging patients from hospitals to nursing homes, where rehabilitation costs are lower.

While the opportunity here for LTPAC operators is apparent, experts who have recently weighed in on the outlook for this segment point to the fact that CMS is on track to ensure that 50 percent of fee-for-service Medicare payments be made through alternative payments models by the end of 2018. Providers who have learned to adapt to this new climate and take on risk through bundled payment initiatives, accountable care organizations, managed care models, among others, will likely be better off in the long run.

If you would like to raise your profile and tap into the longevity economy, contact Quantum Age today.

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Topics: Senior care, long-term and post-acute care, longevity economy, nursing home

A New Report—Packed with Useful Data—Ranks States Based on Delivery of Long-Term Services and Supports

Posted by CC Andrews

Jun 12, 2017 12:00:00 AM

So many reports, so little time. That’s the feeling one sometimes gets when hit with a flurry of surveys, research, white papers, and more at what seems like a continuous pace. A report released just last month, however, is worth taking the time to review. Packed with useful information about how states deliver long-term services and supports, it deserves a closer look.scorecard-11924432.jpg

Titled “Long-Term Services and Supports (LTSS) State Scorecard,” the report uses a series of measures to rank states by how well they deliver LTSS. A joint effort among AARP Foundation, The Commonwealth Fund, and The SCAN Foundation, it is described by its authors as a compilation of data and analyses that highlight measures of state performance for “creating a high-quality system of care in order to drive progress toward improvement in services for older adults and people with physical disabilities and their family caregivers.”

Among its many interesting findings is this: Since 2014, nursing homes in many states have registered progress on three significant measures of performance related to the delivery of LTSS, as follows:

  • Inappropriate Antipsychotic Use. Almost all states (48) significantly reduced the use of antipsychotic medications that are given “off label” for nursing home residents who do not have the appropriate conditions for their use.
  • Long-Term Nursing Home Stays. Most people who leave nursing homes do so in the first few weeks of admission. Once an individual stays in a nursing home for 100 days or longer, they are likely to become permanently institutionalized. About two-thirds of states (35) improved significantly in reducing the percentage of long-term nursing home stays of Medicare beneficiaries that last 100 days or more. There is significant variation between states, ranging from 11 percent of people entering nursing homes in the top 5 states to 27 percent in the bottom 5 states.
  • Nursing Home Residents with a Burdensome Transition at the End of Life. One out of four nursing home residents was hospitalized at least once at the end of his or her life in 2013. While more work needs to be done, more than half of the states (29) made significant improvements in reducing potentially burdensome transitions for people who die in nursing homes. The top-performing states are Alaska, Idaho, Vermont, Wyoming, and Hawaii. Louisiana improved the most, with a 14-percentage-point reduction.

States also improved on two other measures:

  • Person- and Family-Centered Care. Most states (42) improved significantly on this composite measure. This indicator looks at whether:
    • Family caregivers are assessed for their own needs;
    • States have adopted spousal impoverishment provisions in Medicaid home- and community-based services; and
    • States have enacted the Caregiver Advise, Record, and Enable (CARE) Act to notify the family caregiver before the person is discharged from the hospital and to instruct the caregiver on how to perform follow-up medical/nursing tasks.
  • New Medicaid Beneficiaries First Receiving Home- and Community-Based Services. Because many people who enter nursing homes never return home, it is important for state Medicaid programs to provide LTSS to beneficiaries first in their homes and communities if possible, rather than waiting until they go into nursing homes. More than half of the states (29) showed significant improvement in the percentage of new LTSS users who first received services in the community. The eight states with the greatest improvement were Montana, Pennsylvania, Maryland, Iowa, Delaware, Louisiana, Vermont, and Nebraska. However, 30 percent of new Medicaid beneficiaries first receive services in their homes and communities in the bottom 5 states compared with 80 percent in the top 5 states.

States showed the most significant declines in employment rates for people with disabilities and rates of transitioning long-stay nursing home residents back into the community.

One of the most useful components of the report is its individual state profiles, which include each state’s rank compared with other states, as well as rankings for the following measures: affordability and access, choice of setting and provider, quality of life and quality of care, support for family caregivers, and effective transitions.

Each state profile also encompasses a series of data points that project the impact it would have if the state improved its performance to the level of the average of the top-five-performing states. Here’s a look at Maryland’s projections, which was ranked No. 12 overall:

  • 108,770 more place-based subsidized units and vouchers would be available to help low-income people with LTSS needs afford housing;
  • 72,280 more people of all ages would receive Medicaid LTSS to help them with daily activities;
  • 22,386 more home health and personal care aides would be available to provide care in the community; and
  • 13,375 more low-/moderate-income adults with disabilities would have Medicaid coverage.

According to the press release accompanying the report, the goal of the report is to “stimulate a dialogue among key stakeholders, encouraging them to collaborate on strategies for improving a given state’s LTSS system.”

If you would like to explore how this report can help your business via a focused approach that is facilitated by experts in the longevity economy, contact Quantum Age today.

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Topics: Aging, long-term and post-acute care, long-term services and support, data

Wide-Reaching CMS Rule Opens the Door for Innovation

Posted by CC Andrews

Feb 15, 2017 12:24:00 PM

The final rule on the requirements for nursing homes to participate in Medicare and Medicaid is a bit of a behemoth, but it’s an important one since it touches nearly every aspect of a facility’s operations. In particular, there are many implications—as well as opportunities—within the longevity ecpexels-photo-52910.jpegonomy, especially for vendors in the long-term and post-acute care space.

Thanks to the agency’s willingness to meet with providers and educate the public about the rule, we have an idea of what to expect from it, current politics notwithstanding. Karen Tritz, head of the Centers for Medicare & Medicaid Services’ (CMS’) Division of Nursing Homes, offered an inside scoop on the rule at the Jan. 31 meeting of the Advancing Excellence in Long Term Care Collaborative (AELTCC).

Other than the fact that the requirements have not been updated since 1991, Tritz reported that CMS overhauled the rule to further advance its efforts in person-centered care and resident quality of care and quality of life. “Think of rule as raising the bar on quality,” she said.

The first thing to know about the rule is that it will be rolled out in three phases. The deadline for implementation of Phase III is slated for November 2019 (Phase I, which ended Nov. 28, is allegedly complete).

A look at some of these requirements should tell you that some of them may not be easy for providers to track or even implement. Vendors should seize this opportunity to develop solutions and innovations that can make providers’ and operators’ work easier:

The following items are scheduled for release or completion by the end of Phase II (Nov. 28, 2017):
  • New interpretive guidance, as contained in the State Operations Manual (SOM). An advance copy of the SOM will be available to the public early this summer. It will also include an overhaul of the F-tag numbers.
  • Development and testing of a new survey process will begin.
  • Implementation of the Quality Assurance and Performance Improvement (QAPI) program.
  • Update of infection prevention and control programs, which requires an infection-prevention and control officer and an antibiotic stewardship program that uses antibiotic-use protocols and a system to monitor antibiotic use.
  • Care planning improvements for discharge planning for all residents, with involvement of the facility’s interdisciplinary team and consideration of the caregiver’s capacity; giving residents information they need for follow-up after discharge; and ensuring that instructions are transmitted to any receiving facilities or services.
Following are the Phase III items:
  • Finalization of the QAPI implementation and discharge planning and infection control requirements.
  • Implementation of the requirement that call lights must be present at the bedside of all residents.
  • Implementation of new compliance and ethics programs to bring current programs into compliance. Programs must include written policies and procedures to reduce criminal, civil, and administrative violations and must be reviewed and revised annually. For organizations with five or more facilities, programs must include annual training, a compliance officer, and a designated liaison located at each facility.

There are obviously a number of provisions where long-term and post-acute care vendors, such as software solution providers, consultants,  and more can offer solutions and opportunities to make navigating the process easier.

It’s also worth noting that as the rule is rolled out, CMS will implement a new, common survey for all providers by the end of Phase III. The new survey will include elements from both the traditional and the newer Quality Improvement Survey process that has been implemented in more than two-dozen states since 2007. Also part of the new survey will be “new and innovative approaches” and a “balance between structure and surveyor autonomy,” Tritz noted.

I will post more updates as implementation of the rule moves forward. In the meantime, you can read the entire rule here.

If you want a focused approach to creating innovative solutions for elder care, facilitated by experts in the field and candid feedback, contact Quantum Age today. 

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Topics: long-term and post-acute care, quality, longevity economy

A Crystal Ball Look at Post-Acute Care & Senior Housing

Posted by CC Andrews

Jan 31, 2017 12:00:00 AM

A recent National Center for Seniors Housing and Care (NIC) blog post caught my attention about a report from consulting firm Alvarez & Marsal (A&M).

The report, which contains some valuable insights about the entire continuum of senior care, serves as a QA Blog Crystal Ball.jpgreminder that post-acute care stands on the precipice of major change. In fact, the opening line of the report alludes to this conclusion: “A&M believes the post-acute sector will be transformed during the next 10 years.”

Titled “Post-Acute Care: Disruption (and Opportunities) Lurking Beneath the Surface,” the report asserts that this transformation will be driven by the IMPACT Act, the Comprehensive Care Joint Replacement (CJR) model, other payment reform initiatives, and the rise of Medicare Advantage plans.

This is not exactly breaking news, I know. But it is yet another signal that providers that serve patients within the entire continuum of care—hospital, nursing home, rehab, hospice, home care—should already be taking the necessary steps to position themselves for a paradigm shift.

That said, A&M’s insights do offer providers some suggested opportunities that could help you thrive in the longevity economy.

Following are my key takeaways from the report:

  • Interoperable and integrated data systems will be necessary to ensure that patients are connected with the most appropriate sites of care. The results have the potential to improve care transitions, care coordination, evidence-based guidelines implementation, and cost management.
  • Improving patient engagement benefits everyone. But it will take “enhanced patient-provider interaction, the self-monitoring of symptoms, and responding with appropriate actions (e.g., adjust medications, call nurse or MD) when symptom levels indicate a problem,” the report states. Some LTPAC tech companies are acting on this already, including some forward-looking clients of Quantum Age.
  • Facility-based management personnel and systems “will need to adapt to the new reality or be at risk for failure,” A&M says. The reason? The shift of reimbursement risk to providers during the transition and afterwards will be very challenging for management, given their traditional focus on providing facility-based care rather than utilization management across the continuum.
  • A&M also predicts that home care offers the best “longer-term investment opportunity,” while long-term acute care hospitals will be the worst investment risk. In addition, inpatient rehab facilities, hospice, and skilled nursing facilities offer “selective opportunities.”
  • Home care may be a good investment but A&M cautions that an increase in the minimum wage “requires monitoring.”
  • Home care may also benefit from shorter hospital and post-acute care facility stays, which are being driven by the growth of at-risk contracts.
  • Hospice providers are in a good position, A&M says, thanks to a number of factors, including an increased use of advanced directives, Medicare Advantage penetration, and rising acceptance of palliative care.
  • Senior housing (assisted living, independent living, and memory care) have an even more favorable outlook. A&M estimates that unit demand will ramp up by 35 percent for independent living and assisted living between 2015 and 2025. This means that there could be a demand of 30,000 to 35,000 units per year.
  • Another insight offered in the report relates to the advent of capitated reimbursement models. It is suggested that providers will have opportunities to form partnerships to advance preventive care for the following conditions: asthma, chronic pain, chronic obstructive pulmonary disease, diabetes complications, hypertension, congestive heart failure, pneumonia and urinary tract infections.

The report also offers myriad stats, figures, and tables that support their assertions.

Accountable care organizations, according to A&M, are “pioneering but not sustainable.” This conclusion is based on CMS reports of the first two years after roll out, as well as a number of challenges, including “governance; data collection, exchange, reporting and analysis; incentive alignment among disparate stakeholders and patient engagement.”

Finally, although you may be tired of hearing about the explosion of aging baby boomers, A&M stresses the importance of differentiating among the “medical, social, and community needs of the different age cohorts,” each of which are of different sizes and therefore will increase at different rates during the next 10 years. As noted in a previous report, baby boomers are not a single, homogenous cohort.

For help tapping into and thriving in the longevity economy, incuding the post-acute sector of healthcare, from experts in the senior living and care field, contact Quantum Age today.


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Topics: Senior care, long-term and post-acute care, senior housing

New Payment Models Foster Care Innovations

Posted by CC Andrews

Nov 15, 2016 8:39:00 PM

Payment reform is the new driver of innovation in long-term and post-acute care, according to Laurence Gumina, CEO of Columbus-Ohio-based Ohio Living (formerly Ohio Presbyterian Retirement Services). He conveyed his message via a session at the LeadingAge annual meeting last month, along with his colleague, Wendy Price Kiser, executive director of Ohio Living Home Health & Hospice of Greater Toledo.

Gumina recently led the organization through a new strategy development and name change, and the results are indeed innovative. With 12 life plan communities, a home hePHOTO QA Blog innovations pexels-photo-143654.jpegalth and hospice care agency, and a foundation under its umbrella, Gumina says he wanted to step outside the boundaries of a typical model and create an innovative value proposition that would be effective in moving the organization into the new world of value-based purchasing.

What’s more, Gumina saw the writing on the wall; he knew he had to be proactive about adapting to the new payment reforms before it was too late. Another significant factor in Ohio Living’s drive to be more innovative is the impending SNF readmission measure that takes effect fiscal year 2019.

The most interesting of Ohio Living’s new models, in my opinion, is its successful home health and hospice services. Branded as the Home to Stay Program, it was created to improve quality and reduce hospital readmissions for patients.

In outlining Home to Stay’s highly successful relationships with two ACOs, Price Kiser noted that although it took their first partner six months to respond to her call, the care coordination model is now a valued component in the ACO’s continuum. “We told them that we wanted to work with them and that we would see all of the discharges coming out of the hospital,” said Price Kiser. Yes, she said ALL of their discharges. It was a risky offer to provide free transitional care to some patients but they bet on the fact that it would enhance their value proposition for the ACO--and it worked.

And like many creative and innovative models that are rooted in everyday common sense, so too is Ohio Living’s. As Price Kiser said: “It isn’t rocket science.” With some “basic clinical judgment” baked into the program, she pointed to a simple yet critical factor in their model: caregivers meet with the patients the very next day after they are discharged. In addition, they focus on two things: medication safety and medication reconciliation.

Here’s how it works:

  • Day 1-Coach Visit: The patient signs a consent form, the caregiver conducts a medication reconciliation, takes vitals, creates a personal emergency plan, does a fall risk assessment, confirms a follow-up appointment with (and transportation to) a primary care provider.
  • Day 8 – Coach Visit: Review any red flags, determine signs and symptoms and coach interventions, follow up on any issues identified during the first visit, review medication plan, and determine if any PCP appointments and medication changes are necessary.
  • Day 17 – Coaching Call: Confirm a PCP visit was made and discuss the results of the visit.
  • Day 22 – Coaching Call: Determine signs and/or symptoms and coach interventions, if necessary.
  • Day 30 – Coaching Call: Determine signs and/or symptoms and coach interventions and discharge from the program.

As of October, the cumulative hospital readmission rate was 3.6 percent, Price Kiser reported.

Also successful is Home to Stay’s involvement in a Comprehensive Joint Replacement model. Similar to its ACO model, tracking metrics and a focus on patient engagement and education are key to preventing avoidable readmissions under the CJR, Price Kiser said.

The two presenters offered some additional advice for providers seeking their own secret sauce for innovation: Create a value differentiator—something that makes your organization memorable; seek new and unique partnerships; and, last but not least, track metrics, analyze them, and share that data with potential partners.

If you want to create innovative new services or business lines, facilitated by experts in the senior living field, with candid feedback, contact Quantum Age today.

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Topics: home care, long-term and post-acute care, innovations, life plan community

Technology & Staff Training: Taking It to the Next Level

Posted by Edie Deane

Sep 7, 2016 3:43:11 PM

I entered into the long-term and post-acute care (LTPAC) field with the desire to improve my fellow human beings’ quality of life, and one thing I can say with macbook_iphone.jpegassuredness is that this reason holds true for most of us. One of the many challenges we face in this era of health care is accomplishing this task while meeting the myriad requirements necessary to be paid for our services.

So what is the good news? Technology. Yes, that’s right, technology. Now I can hear a group of you moaning, or even possibly cursing me for using that dirty word. And for others it is what you’ve grown up with. But let’s face it—we are working in an amazing time of advancements and we have to put those advancements to good use for us and for our patients.

The appropriate use of technology is the only way to maximize our patients’ outcomes and our professional success. A critical factor in doing this is learning to use the newest tools and systems of our trade. These tools include, but are not limited to, mobile equipment, electronic health records, data analytics, remote monitoring, and the ever-growing arena of telehealth.

So how do busy patient care providers get the training they need to be more efficient and effective with these tools while still maintaining their high quality of care? Those holding the technology tools—the software and hardware companies in our industry—must provide our professionals blended learning opportunities to make the learning experience easily accessible, role-based, and work-schedule friendly.

We are in an age of immediate access via the internet, and our industry’s healthcare professionals need that same approach to training. In my opinion, training should follow what I refer to as DEAP:

  • Divided into manageable chunks: How big is manageable? Think of it as a training break. Develop content that doesn’t take more than 15 minutes to complete.
  • Easily accessible: Training for products and processes should be safely stored where they can be accessed via a secure internet connection. This allows for quick and easy access options that include smart phones, mobile tablets, laptops, and desktop computers. It also eliminates the need to find a manual or require access on a specific computer.
  • Available anytime: Whenever possible, training should be stored so that staff can use secure logins to participate in training whenever the need arises.
  • Process- and role-based training: A content library that is specific to each work role will save significant amounts of time for the professional using a software system, platform, and/or tools. This type of training collection keeps staff members from wasting precious time sifting through training that includes all functionalities available for each work role, rather than the specific process they need to complete.

For example: A patient leaves for the hospital at 11:30 pm with apparent stroke symptoms. This patient will need to be signed out from the facility. However, the nurse responsible for this task has not signed anyone out of the facility yet. Is a short process training video available for them to view when and where they need it? If there is only product-based or training documentation or videos that illustrate what each section/module of the EHR does then the nurse will have to review multiple items to ensure she has completed all tasks required, which may include such as clinical, billing, electronic medication administration record, or electronic treatment administration record. A short training video (10 minutes in length) that illustrates the transfer-to-hospital process will quickly show the exact steps needed to appropriately sign out the patient in a timely manner.

Yes, our industry is moving at a fast and ever-growing pace. And with it comes an increasing dependency on technology to meet patient care and business goals for success. We must be proactive in harnessing technology to our advantage and provide our professionals the training they need, when and how they need it so they can continue to offer high-quality care when and where they need to.

Making staff training content easily accessible and consumable is an important step in this direction.



Edie Deane, MS-CCC, CCM, develops customer- and staff-friendly processes of communication and role-specific training for Quantum Age Collaborative. Edie has worked for more than 30 years in LTPAC in sub-acute/brain injury rehabilitation; facility-based clinical and departmental management; as a national management trainer in the areas of financial management, departmental management, customer service and marketing; in the EHR software sector developing strategic customer and staff product training and communication; and as an owner of an online continuing education company, Care2Learn, for the allied health professionals working in the LTPAC industry.




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Topics: technology, long-term and post-acute care, staff training, education

Five-Star Calculations Demystified

Posted by Meg LaPorte

Aug 16, 2016 10:02:26 AM

The Five-Star Quality Rating System is getting lots of attention these days. Not only did CMS announce that the six new quality measures have been officially added to the rating system, but the program has also drawn criticism from a U.S. senator. According to an Aug. 10, McKnight’s news story, Sen. Robert Casey (D-Pa.) Stars_blog_image.jpgbelieves that while “the updated measures give prospective nursing home residents and their families more information when choosing a facility, they do little to ‘impact the accuracy and reliability of the measures reported.'"

No matter what one thinks about Five-Star, it’s certainly not expected to go away anytime soon. And according to American Health Care Association Senior Vice President for Quality and Regulatory Affairs David Gifford, MD, MPH, the new quality measures will have a modest impact on overall five-star ratings for nursing homes.

However, Gifford, who presented at the eHDS/Ability user group conference in Chicago earlier this summer, explained that the impact on individual quality measures for nursing homes will be more pronounced.

In light of this news, I feel obligated to share Gifford’s compelling presentation about how the staffing measures—as well as the overall stars—will be calculated. Here’s a synopsis:

  1. Staffing Measures: Using a matrix on the staffing measures (see graphic below), Gifford explained that the measure is calculated by combining registered nurse (RN) and direct care staff hours.
    • Each row of the matrix contains the RN hours for each patient day, and each column includes the total direct care staff hours per patient day.
    • Nursing homes with scores that appear in upper-left red box will lose a star, while those that fall within the lower red box area will gain a star.


Gifford explained that CMS has established threshold rates for each measure to determine the points for that measure. “They don’t change those rates,” he said. “They’ve stayed fixed since February 2015.”

With regard to staffing scores that fall within the one-star ranges, Gifford believes that one major reason why a nursing home gets there is its location. If it’s in Texas, for example, the Medicaid reimbursement is “really bad” there and staffing numbers will be low as a result, he said.

The other reason for low staffing scores is related to Form 671–Long Term Care Facility Application for Medicare and Medicaid. “When surveyors coming in and yell at you for obstruction of justice for not filling out Form 671, your staff will, of course, fill it out and hand to the administrator, who will sign it,” he explained. “The problem with this is that no one is likely to check the staffing numbers on it. If that’s the case, unfortunately, there is no way to change it,” and it becomes part of the nursing home’s record. “There is no changing it,” Gifford said. “I’ve never seen it changed in 10 years.”

Finally, don’t forget that starting in 2018, CMS will use data submitted from your time and attendance systems into CMS Mandatory Payroll-Based Journal (PBJ) to report staffing levels and turnover and retention.

  1. Overall Star Ratings: Calculate your overall five-star rating as follows:
    • Assign 20, 40, 60, 80, or 100 points for each quality measure based on the quality measure rate against a set of threshold cut-points.
    • Add up the points for all 11 quality measures.
    • Compare your aggregate score of the 11 quality measures against the threshold cut-points to determine your stars (see graphic below).


All the points will be added together to come up with the final five-star rating, and since there are 11 measures currently, 1,100 is maximum number of points you can get, Gifford reported, while 225 is the minimum number (see graphic 2). “When adding the five measures to the eleven they do roughly the same thing,” he notes. “So there will 16 measures, so your score will be between zero and 1,600.”

If you calculate 760 points out of 1,100, you will get five stars. “So the magic number is 760,” said Gifford. “If you’re less than 544 you’ll get one star, and you will lose a star. Everywhere else, there will be no impact.”

Gifford emphasized that the biggest impact of the new measures is “the fact that the measures will be used by hospitals and ACOs for network selection.”

Half of nursing homes will see their individual quality measures star ratings change at some level, and half of those will go up, while the other half will likely go down, Gifford noted. “The impact on overall star rating will be a lot less, with about 15 to 20 percent seeing changes in their overall star ratings.”

In conclusion, Gifford said that CMS will likely make changes to Five-Star again in a few years. For example, in 2018 staff turnover will be added. In addition, CMS will, at some point, add SNF Quality Reporting Program (QRP) measures, resident review measures, and measures on functional improvement.

Gifford noted as well that customer satisfaction measures will likely be added in about four years.

Keeping those stars aligned will help you stay on track with the news measures 

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Topics: long-term and post-acute care, CMS, quality, five-star, Medicare

Grim Outlook for Medicare Funding Means SNFs Should Prepare Now

Posted by CC Andrews

Aug 5, 2016 10:49:16 AM

Physicians and skilled nursing facilities (SNFs) may be facing a Brexit of their own as to whether they will continue receiving Medicare paymeCherry_Pie_for_QA_Blog_Aug_5.jpgnts, according to the latest troubling results from the program’s trustees report. Published two months ago, the report was mostly ignored in the news cycle as the world focused on the fallout from the United Kingdom voting to exit the European Union (aka the Brexit vote).

According to the report, an aging population and longer-living enrollees are increasing per-enrollee healthcare costs that will not keep pace with the program’s funding sources. The trustees are calling on policymakers to act with urgency to shore up this essential program, stating that “such legislation should be enacted sooner rather than later to minimize the impact on beneficiaries, providers, and taxpayers.”

Although physician payment updates and new incentives established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) led to more significant physician payment issues than would have resulted from the sustainable growth rate (SGR) approach, these additional payments are scheduled to expire in 2025. In their report, the Trustees anticipate that the physician payment rates will be lower than they would have been under the SGR formula by 2048. If subsequent legislation is not passed to correct the problem, the Trustees anticipate that “the availability and quality of health care received by Medicare beneficiaries would, under current law, fall over time compared to that received by those with private health insurance.”

According to a Medscape Medical News survey, four of 10 physicians in solo or small group practices say the new MACRA payment system will lead to many physicians dropping out as Medicare providers because of what the survey notes as “punishing penalties.”

Furthermore, the Trustees predict that the depletion date for the Hospital Insurance (HI) Trust fund of Medicare—known as Medicare Part A and helps pay for SNFs—is 2028, two years earlier than in last year’s report.

For the past five years, the Centers for Medicare & Medicaid Services (CMS) Chief Actuary Richard Foster reported that MACRA’s Medicare provider payment cuts would make hospitals and other Medicare Part A healthcare providers unprofitable and “jeopardize” seniors’ access to care. The report states that Foster claims “by 2040, simulations suggest that approximately half of hospitals, 70 percent of SNFs, and 90 percent of home health agencies would have negative total facility margins, raising the possibility of access and quality of care issues for Medicare beneficiaries.”

So what can SNFs do to preserve their profits if they chose to stay with Medicare? They can embrace alternative payment options such as bundling models, the virtues of which are discussed in a previous post.

SNFs should also prepare for CMS’ value-based purchasing model, which will commence in October 2018 with the SNF Readmissions Measure (SNFRM). The SNFRM is an all-cause rehospitalization measure, which means that any admission directly to a hospital from a SNF will count regardless of why it happened. Readmissions will be tracked within 30 days of discharge “from a prior proximal hospitalization.” Part A rates will then be cut (or not) at up to 2 percent for one year, based on a SNF’s rehospitalization scores.

Although the model does not take effect until 2018, CMS will look at rehospitalizations beginning this January until December 2017. There are myriad resources and tools available to SNF providers to help reduce hospital readmissions. Taking advantage of them may be one of the most important things a SNF can do to prepare for the coming Medicare payment reduction storm.

In addition, MedPAC proposed to Congress an alternative payment concept in a March 2016 report that calls for a unified PAC prospective payment system to replace the current fee-for-service system. A similar SNF-bundled PAC payment legislation is being advocated by the American Health Care Association, which claims that Medicare would receive $1 billion in expected savings over the next 10 years.

Medicare funding may be dwindling faster than expected, but preparation now is key. Embracing alternative payment models, reducing hospital readmissions, and embracing the longevity economy should be high priorities if you want to claim a piece of shrinking Medicare pie.

For insights on how you can tap into the longevity economy, engage with Quantum Age today.

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Topics: long-term and post-acute care, bundled payments, Medicare