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1. 0 0 0 0 Ce e 0 0 ro 0 eXe oo PPS ASSESSMENTS Unscheduled PPS assessments Management tips Caralyn Davis Staff Writer Successful management of unscheduled PPS assessments is critical to avoiding default days and provider liable days says Robin Hillier CPA STNA LNHA RAc MT president of RLH Consulting in Columbus Ohio That certainly makes administration a lot happier and there s really less work for everyone because you re not playing catch up AANAC master teachers offer the following suggestions to help MDS coordinators keep track of or even avoid end of therapy EOT change of therapy COT and start oftherapy SOT Other Medicare Required Assessments OMRAs Meet with therapy daily There needs to be a daily meeting between the MDS coordinator and the rehab coordinator says Lisa Hohlbein rn Bs RAc mt director of clinical reimbursement for LeaderStat in Columbus Ohio The meeting should include a review of treatment in intensity planned or unplanned she says They also need to review possibilities for potential discharge All of these issues need to be reviewed because they have the potential to trigger an unscheduled assessment Schedule afternoon meetings At many facilities those rehab issues are discussed during daily PPS meetings which typically are held in the early morning hours notes Hillier Providers should either move their PPS2. Having skills knowledge to conduct accurate and effective assessment with 95 rating this very important e Members also ranked Being knowledgeable about regulations public policy and their implications as being important 96 eXe oJ e oo o 1e eXe eXe eXe ee eXe 0o e 1e eXe o eXe 0o eXe 0 o eXe 0o oo eXe 0o eXe 0o eXe ee eXe e Perhaps the most significant issue rated as important 95 but which few members 31 believe to be currently the case is that Long term care nursing is positively perceived within the nursing profession The survey process and results exemplified how important itis that we hear from you Overall the survey responses validate that current Results Priorities in our strategic planning are in sync with what you want and you rate AANAC s performance extremely well We don t take that for granted We ask that when we reach out to you in the future whether through on line surveys forums focus groups or other membership events please DO connect with us to help us serve you sincerely aru Camm Carol Siem Board Chair Cost A Maken Carol Maher Chair Membership Linkage Committee v e z n vw O 0 0 O 0 0 O 0 o 0 0O 9 9 o 2 o AANAC LTC LEADER 4 3 2012 do o 9 J e e e e e e 2 e e e J e e 0 0 0 0 O e 0 fe 0 0 e
3. e e e e e amp e e e e eXe oo foe foe foe foe oo oo foe that the potential is there for the EOT OMRA and the rehab director might not realize that the resident didn t get therapy possibly missing an opportunity to schedule a therapist to pick up this resident on Saturday and make up the missed Friday therapy Late afternoon meetings give providers greater flexibility allowing them to identify residents who are potential candidates for unscheduled assessments as early as possible says Hillier That s particularly important going into weekends and holidays continued on page 5 v 2 oe 8 e B wv O 0 O 0 0 fe 0 0 o 9 9 0 o 7 0 o AANAC LTC LEADER 4 3 2012 o Oo 2 e e e e 3 J i 6 e re 0 0 eo 0 0 O 0 O 0 O 0 0 O O 0 SKIN CARE Pressure Ulcer Prevention and Management Aee MN AN Mearem Betty Frandsen RN NHA MHA C NE For each pressure ulcer whether present on admission or developed afterward determine the factors that influenced its development the resident s potential for development of additional areas or F314 pr essure Sores l for deterioration of the pressure ulcer omprehens ive A new pressure ulcer suggests that the Based on the esident Lhe adequacy of the prevention plan should AS sessment of ar nate be reevaluated Include the following
4. oko O re 00 dd 1 e O Rr e ce e O i v v O 0 0 ce 0 AANAC LTC LEADER 4 3 2012 d d d d e a a a a k we eae ee fete ofo OO exe Unscheduled PPS assessments continued from page 6 submit it on day 28 or day 29 she points Q out The problem with that is If this resident discharges unexpectedly on day 31 for example and goes to the hospital that 30 day MDS will not be used for payment The new rules say that you need to have a COT OMRA but that COT OMRA will now be late because the ARD can t be set any earlier than day 31 four days after day 7 of the COT observation period However if the MDS nurse in this example had set the ARD for the 30 day MDS as day 27 but not been in sucha hurry to submit that MDS when the resident went to the hospital on day 31 and you realized you needed a COT instead of the 30 day you could just change the type of assessment because that MDS is not locked and submitted yet advises Hillier That would save a lot of work having to inactivate the 30 day and doa new COT which is going to be late MDS nurses have to set the ARD timely to be in compliance with Medicare regulations but once you set the reference date timely you have 14 days to complete the MDS and then you have another 14 days to submit the MDS the first seven of which is that encoding period w
5. real time information which is going to keep you from getting surprises and being late on assessments or finding out that Your Primary Resource for Medicare Coverage you missed assessments Ramp up activity on Thursday Friday MDS nurses need to remain vigilant five days a week to AANAC s Medicare University MU manage unscheduled assessments but Thursday and Friday helps you know what you don t are the most important days to set up your weekend advises know when it comes to Medicare Amy Franklin RN CDON RAC MT director of RAI for Metron e We cover the complex details in a Integrated Health Systems in Grand Rapids Mich Facilities a Ae 5 have amaximum of two days to set the assessment reference simple understandable ana concise date ARD after the ARD window for an unscheduled MENRE Ael provides you e assessment has passed So for example if you think you need knowledge to sort through the a COT ARD where day 7 falls on Saturday or Sunday enter paperwork and requirements improve it into your computer by Friday You can always cancel the OUr ceii meine n Un on E assessment on Monday but you won t be late light for others in your facility Pay attention to payment But don t take our word for it Understanding the rules for unscheduled PPS assessments Listen to what our students have said is not easy these days given that CMS has already revised This course re energized our eyes to
6. s arrival Adequate preparation will reduce the potential negative impact of survey AANAC offers valuable resources to help nurse leaders prepare for either the traditional or the Quality Indicator Survey Survey Preparedness teaches the reader to be ready for survey every day of the year This and other helpful resources are available at www aanac org Betty Frandsen Rn NHA MHA C NE bmacfran gmail com A new resident was admitted on Part A from home on March 16 She had been discharged to home from a rehab hospital on February 15 2012 We were told she qualifies for Part A even though she didn t have a new 3 day qualifying hospital stay because she is within her 30 day window I think she was admitted to us on her 31st day which would be outside the 30 day window When she was discharged to home on February 15 does that count as day 1 or o Actually it is the day after discharge that is day 1 From the Medicare Benefit Policy manual In determining the 30 day transfer period the day of discharge from the hospital is not counted in the 30 days Ronald A Orth Rn NHA crc Rac mT raorth clinicalreimbursement com I am finding there is a lot of confusion surrounding what is meant by a Local Contact Agency for Qo600 Some feel this is the normal protocol we follow for a discharge for a short term stay when we refer to a home health agency or other support services Others view it as a referral to services that the resident
7. www aissystems com Commencing October 1st 2011 the MDS 3 0 assessment data collected at your facility will be used by CMS for the new Quality Measure QM reports The new QM reports will be made available starting April 1st 2012 In order to help your organization be better prepared for the new QMs AIS has created a new eLearning module called QMs and the MDS 3 0 See what AIS is doing to help educate your staff on all of the recent changes Contact sales aissystems com for more information AIS is a provider of comprehensive on deman provides solutions to support RAI educ delivery of Web based Training Compe sting and Education Analytics solutions are easy to use provide a substantial Return on Investment and an important role in reducing risk in the areas of reimbursement survey compliance and quality of care AlS solutions are being used by the most influential Providers in the LTC Industry encompassing over 2 500 Long term care centers in three countries around the world i lt o o o ro o p 7 ro o ooo oOo O88 08 0 AANAC LTC LEADER 4 3 2012 e e e o o ro o o ro o ro re O O O O oo ee oJ e ee e 1e ee e 1e o oo 0o eXe 0 o oo ee oT e ee oe ee oo 8 fete oo oo o1 o oo oX o A y After our annual survey everyone is encourages them to draw strength from the survey as a learning exper
8. Hohlbein MDS coordinators should do some teaching so that the interdisciplinary team IDT members understand why we are scheduling unscheduled assessments and what potentially triggers them staff to try to change the appointment to a different day of the week where the Don t forget billing resident missing therapy won t result in three consecutive days without therapy suggests Hillier Furthermore you should try to schedule follow up appointments for the afternoon which would allow you to deliver therapy to residents in the morning before they go out to the follow up appointment Often facilities that take the time to adjust scheduling to set up the resident to Whoever handles the facility s Part A billing needs to know the correct assessment indicator AI code and the number of days to be billed for each unscheduled assessment says Hohlbein Those items should be reviewed by the MDS coordinator the business office and rehab before claims are submitted to make sure everyone has accurate information be more successful hitting therapy targets will reduce the need to do unscheduled assessments she points out CERTIFIED lt Uv fe fe fo fe o o e e e o e o e e 0 o 0 e e e e fe e e e oo oo o0 oo oo foe oo oo oo e10 QMs for MDS 3 0 IS COMING APRIL 1 2012
9. family can access once discharged for additional supports Please explain Each state has arranged for a specific agency or agencies to act as Local Contact Agencies to provide information about supports and services in the community The LCA provides information about community living options and available supports and services beyond what facility generally provides such as locating housing transportation employment social engagement opportunities home modification setting up a household community inclusion planning Usually it is not necessary to callin the LCA when the discharge is what might be called routine but even with a routine discharge for a short term resident a referral may be made to the LCA if a complication occurs that may be able to be resolved with the more advanced services provided by the LCA See the instructions for completing section Q in chapter 3 of the RAI User s Manual Rena R Shephard mua RN RAC MT c ne RRS2000 aol com We have a COT OMRA that resulted in RUG level LC2 But according to our calculations it should have been an RMB I don t know what happened and I want to make sure our billing department can bill for the appropriate RUG and we get billed the appropriate RUG from the therapy company Here are some specifics ST 135 individual minutes 4 days of treatment OT 105 individual minutes 3 days of treatment Both disciplines continued through the ARD If your facility is urban and
10. meetings to mid to late afternoon or they should have a quick follow up meeting in mid to late afternoon with at minimum the MDS nurse and therapy The problem is When you have discussions in the morning you plan based on what you think is going to happen for the day not what actually happened Consider this example Resident X is scheduled for therapy five days a week Monday through Friday If the facility has a PPS meeting on Friday morning they assume this resident is going to do the therapy that is scheduled during the day Hillier points out But for whatever reason Resident X refuses therapy That establishes day 1 of the three day window for the EOT OMRA going into a two day weekend The MDS coordinator and the rehab coordinator need to examine rehab patterns to look for any changes in intensity planned or unplanned says Lisa Holbein minutes and the number of days and disciplines The MDS coordinator and the rehab coordinator need to examine rehab patterns to look for any changes lt Uv fe fe 0 o o o e e e o e o o e e 0 0 0 e e e e fe e e e If the MDS nurse and the rehab director don t have another 10 minute meeting late in the day on Friday to say Resident X didn t receive therapy as anticipated then the MDS nurse doesn t know o o e e 0 ce 0 0 o Oo Oo Oo Oo e fe e e e
11. point out the good stuff to others Each library entry has a five star rating system similar to amazon com and other sites where you can flag things you like By rating a document you can help others judge the quality of the information contained in the file s Commenting allows you to add additional information if a document was helpful and why if it contains incorrect information etc LTC Network Thread Subject Hypodermaclysis Posted by Cheryl Druce recently had a discussi i on with my team ab i IV use in the facility We currently do not E AA ment The DON and NP are suggesting h Instead have never seen this done an would benefit us for reimbursement Is this still in use ees ane tie risks of clysis vs IV therapy How well do elderly clients respond to the treatment offer IV manage ypodermaclysis d don t think it Wh l er are a variety of treatment options it s always is O know what s available This is especially true en one option could have a noticeable impact on N MDS Connection Thread Subject Overnight Posted by Rose Pauly at 9 15 Monday morning for a tal They plan on keeping her Resident is going out edure at the hospi m meee for observation Am I correct that if s i the not back by 9 15 on Tuesday we will have to do i i e interviews etc as this Is a planned discharg Sometimes it s better to be safe than AR ie it comes to missing interviews How wou He alk t
12. sity must ensure a factors in the assessment of the ulcer a enters the fac Te Type pressure related versus non A resident who re sores does not oe n pressure related Stage Characteristics u iwidaua Monitoring progress toward healing and strates that for potential complications Presence of infection Pain assess monitor treat Dressings and treatments Pressure Points and Tissue Tolerance It is critical that clinical staff conduct regular skin assessments for each resident identified as at risk for development of pressure ulcers Assessing resident s skin helps team members design individualized prevention strategies Pressure ulcers typically are located over boney prominences although they may The intent of F314 is that a resident does not develop a pressure ulcer unless it is develop where pressure impairs tissue clinically unavoidable Employees must understand what unavoidable means and circulation such as pressure from be equipped to attain that standard of care An unavoidable pressure ulcerisonethat positioning or from medical devices like develops despite the following oxygen tubing over ears and at the nares e The resident s clinical condition and pressure ulcer risk were thoroughly evaluated Nutrition or Hydration Deficits e Interventions were defined and implemented consistent with resident needs Residents with nutritional or hydration goals and industry standards of practice defici
13. whether or not to restart the Prospective Payment System PPS schedule when a resident with Medicare replacement APRIL 5 2012 plan converts to traditional Medicare CMS reported clarity on this issue is forthcoming The AANAC Expert Advisory Panel appreciates the ability to discuss these concerns with CMS and will keep members apprised of any updates as soon as they are available As members are aware CMS has issued further clarifications and the Expert Advisory Panel encourages members to as CMS stressed in the clarification memo take full advantage of the Encoding Period to avoid repercussions of the first two items that were discussed with CMS The AANAC Expert Advisory Panel appreciates the ability to discuss these concerns with CMS and will keep members apprised of any updates as soon as they are available Courage doesn t always roar Sometimes courage is the quiet voice at the end of the day saying I will try again tomorrow MARY ANNE RADMACHER foe fete 2011 MEMBERSHIP SATISFACTION SURVEY AANAC Announces Results of 2011 Membership Satisfaction Survey From the AANAC Board of Directors The AANAC Board of Directors would like to thank the 1568 members 14 who completed the recent Membership Survey Having so many participants ensures that the results have high Statistical reliability With more than Summary of results We asked numerous questions to identify the extent
14. AANAC s Board and Expert Advisory Panel Working with CMS on Clarifications By Jennifer Pettis RN BS WCC RAC MT Chair of the AANAC Expert Advisory Panel WWW AANAC ORG The AANAC Expert Advisory Panel and members of the AANAC Board of Directors recently met via conference call with representatives the Centers for Medicare and Medicaid Services CMS to discuss concerns that members have communicated based on the recently released April 1 2012 RAI User s Manual changes Below are the issues which the Expert Advisory Panel raised with CMS e The inability to correct Assessment Reference Dates ARDs and Reasons for Assessments RFAs and resubmit the same assessment and instead requiring the provider to complete a new assessment with the current date as the ARD Unexpected discharges resulting in Change of Therapy Other Medicare Required Assessment COT OMRAs that should have been done because the assessment that stopped the seven day rolling window was not used for payment due to the discharge for instance the 30 day was done on day 27 day seven of the COT observation period but the patient went to the hospital on day 30 so the 30 day was never used for payment resulting ina COT that should have been done on the 27th and The inability to submit MDSs done for reasons other than those completed for OBRA and PPS purposes Additionally the Expert Advisory Panel requested clarifications as to
15. N Healthcare Vanguard Healthcare Services LLC At every step in your long term care journey AANAC has the resources you need to succeed AANAC 400S Colorado Blvd Suite 600 Denver Colorado 80246 Phone 800 768 1880 Fax 303 758 3588 2012 AANAC No part of this publication may be reproduced without written permission from AANAC The information presented is informative and does not constitute direct legal or regulatory advice
16. O ettort speak o ore attention o O continued on page 14 RANAC Nurse Assessment AANAC PROUDLY i i a recocnizes Coordination DENY May 8 2012 Held in conjunction with National Nursing Home Week amp National Nurses Week Nurse Assessment Coordination Day is a special day we ve created to honor you the picture perfect champions of resident care accurate assessment and voice and choice We invite you to visit our NAC Day web page coming in early April to find a variety of AANAC resources sponsoring partner discounts and much more that show just how much we appreciate the support and care you provide your residents today and every day We ll keep adding surprises throughout April so check back often and see what s new COMING SOON www aanac org NACDay2012 AANAC LTC LEADER 4 3 2012 BETTER TOGETHER THE 2012 AANAC ANNUAL CONFERENCE You ve probably noticed that there are all sorts of new and exciting reasons why the 2012 AANAC Annual Conference in Jacksonville Florida is going to be our best yet As the deadline for online registration gets closer we wanted to give you at least I0 additional reasons why you simply can t afford to miss this event Read on for our Top Ten reasons to attend JACKSONVILLE FL Hyatt Regency Riverfront CONFERENCE April 18 20 PRECONFERENCE April 16 18 A LONGER CONFERENCE We expanded our conference to offer you more op
17. continued on page 6 AANAC LTC LEADER 4 3 2012 Unscheduled PPS assessments continued from page 5 caseloads she advises If you are saying That is therapy s job and somehow an EOT OMRA or a COT OMRA gets missed it ultimately hurts the facility That monitoring can occur via daily reporting by therapy at the end of the day or the MDS nurse can have daily access to the therapy treatment logs suggests Hillier But staying on top of EOT and COT OMRAs is such a critical thing that you really need two sets of eyes looking at it Try to set Sunday ARDs for scheduled PPS MDSs If you are going into a window for a scheduled PPS assessment and you determine that you ll get the same RUG score no matter which ARD you pick for example day 13 and day 18 for the 14 day assessment will both generate the same RUG you should consider using Sunday as the ARD recommends Hillier When Sunday is the ARD for an MDS you are setting up your COT observation period going forward to be Monday through Sunday she points out And that gives you the most flexibility to have residents hit their therapy level during that week If they miss therapy one day from Monday to Friday you have the option to provide therapy on Saturday or Sunday However if your Saturday or Sunday falls at the beginning of your COT observation period instead of at the end and you are not normally scheduling the resident for
18. elopment of a repositioning plan Consider those at risk of friction or shearing during repositioning as lifting devices may be needed For detailed information on pressure ulcer prevention staging and management access F314 Pressure Ulcers by visiting http www cms gov manuals Downloads somrozap pp guidelines ltcf pdf What s New in AANAConnect continued from page 12 Want to share something of your own You can upload a file directly to a library or you can attach it to a message To upload a file directly go to View Libraries under Communities in the top navigation and click on Add a New Entry from the submenu Follow the steps on the page and be sure to choose the correct library from the dropdown box labeled Library To attach a file to a message you are posting click the Attach button beneath the message box on the Post a Message page Follow the steps on the form click Finish and send your message g v o o o ro E 7 o O O O O O O S E j E z 7 oo o o eo o 0 o o AANAC LTC LEADER 4 3 2012 O O O O O O O O O e e o e e e e e e e e e e eXe eXe eXe e10 foe oo oo foe oo 0 0 oO 0 0 e e Oo e e oO e e o e 0 0 oo oo oo foe oo oX o AANAC Board of Directors Carol Siem MSN RN BC GNP Chair Ruth Minnema RN MA C NE RAC CT V
19. ghts into the mix on your resume oOo oo Unscheduled PPS assessments continued from page 7 At Franklin s facilities MDS nurses use a paper 100 day PPS tracker They are going to do a double check system she explains They are going to make a check mark when they first set their ARD Then two days later they are going to make another check mark to make sure that that is the right assessment that they re using the item set they really wanted It s almost like doing a medication reconciliation Identify operational fixes EOT and COT OMRAs often become necessary because of operational activities that the provider should consider doing differently says Hillier For example residents who are going to go out for a follow up doctor s appointment on Monday are always potentially dangerous They re often gone most of the day and even if therapy is still in the building when they return sometimes the residents won t participate in therapy because they are tired or in a bad mood Many residents don t have therapy on Saturday or Sunday Consequently if they miss Monday they will be in an EOT OMRA situation The solution When a facility admits a resident with orders for a follow up appointment scheduled for a Monday the standard procedure should be for facility Keep the IDT in the loop All the disciplines that participate in the MDS need to be armed with knowledge says
20. here you could still make changes to it she notes So many of the struggles with unscheduled assessments could be avoided if providers weren t quite so quick to get assessments completed and out the door as soon as they set that ARD Double check assessment types With the new rules for inactivations using an incorrect item set and not catching the error until after submission makes the facility subject to default payment days at minimum or even provider liable days says Franklin So it s a good idea to institute a simple practical review of assessment types for both scheduled and unscheduled PPS assessments continued on page 8 The best recipes start with quality ingredients So do the best resumes and job postings AANACareer provides the resources that helo promote your best assets to launch yourself into a new role or entice prospective employees into applying for your job Want to know the other three Employers WVant to know how effective your ad is AANACareer provides you with job response metrics to help you track candidate activity that your post is generating in real time Job Seekers When you only have 10 20 seconds to impress a prospective employer what are the key ingredients to include in a resume We ll give you the first one 1 Focus on the employer s needs not yours Always keep in mind what you can do for them not the other way around Always incorporate these thou
21. his situation Click on the thread subjec iar you compare with those that answered this se member question Reimbursement Tip CMS has clarified in the March 2012 SNF PPS Clarifications Memo that both an early and a late COT reset the COT calendar so that the next COT evaluation period would be 7 days after the ARD of the early or PU ONE Jennifer Pettis RN BS WCC RAC MT Director of Program Development Treatment of Members Policy AANAC has posted the Treatment of Members Policy on the website If you need to access it please click here Get Answers Now When you need answers fast the best place to start is AANAConnect We have thousands of member questions that have already been answered by our experts who moderate the communities 24 7 Just type your topic into the search box to see the discussions tools and peer submitted resources that may be just what you re looking for O1 eXe oc exe fete oo Pressure Ulcer Prevention and Management continued from page 4 to lose weight needs increased calories or correction of other conditions that are the root cause When instituting a nutritional care plan address the following aspects severity of nutritional compromise weight loss rate loss of appetite the individual s prognosis the expected clinical course and resident wishes and advance directives Interventions When developing an individualized skin plan use the comprehe
22. ht s Long Term Care News NADONA Provider Magazine Professional Development Partners American Baptist Homes of the Midwest Avalon Health Care Benedictine Health Systems Berkenshire Healthcare Systems Brookdale Senior Living Care Initiatives Catholic Health Services Centura Health at Home Christian Homes Inc Colavria Hospitality ConvaCare Management Inc Cornerstone Health Services Group DaRT Chart Systems LLC Ecumen Elim Care Inc Ensign Facility Services Inc Episcopal Ministries to the Aging Inc Evangelical Lutheran Good Samaritan Society Evergreen Healthcare Extendicare Health Services Inc Five Star Quality Care Inc Friendship Health and Rehab Center The Goodman Group Goshen Care Center Greystone Health Care Management Hattiesburg Medical Park Corporation Health Dimensions Group Kingston Healthcare Company Lexington Healthcare Lutheran Senior Services Magnum Health Care Management New Courtland Elder Services NHS Management LLC Paramount Health Care Company Pinon Management Plantation Management Company Plott Healthcare Preferred Care Partners Management Group Prestige Healthcare Regent Care Center Rockport Healthcare Services SavaSeniorCare Senior Care Centers Skilled Health Care St Francis Health Services Ten Broeck Commons Trinity Senior Living Communities TRISU
23. ice Chair Carol Maher RN BC RAC CT Secretary Peter Arbuthnot AA BA RAC CT Treasurer Susan Duong RN BSN NHA RAC CT C NE Patrice E Macken MBA RHIA LNHA RAC CT Gail Harris RN BSN RAC CT C NE Joanne Powell NHA RHIA Diana Sturdevant mS GCNS BC AANAC Expert Panel All articles published in LTC Leader are reviewed by a National Editorial Advisory Board to ensure the accuracy of the information we provide AANAC is pleased to introduce you to our panel of volunteer reviewers who represent the best and the brightest in our field Jennifer Pettis RN WCC RAC MT C NE Chair Harmony Healthcare International Topsfield MA Betty Frandsen RN NHA MHA C NE Nichols NY Robin L Hillier CPA STNA LNHA RAC MT President RLH Consulting Becky LaBarge RN RAC MT Vice President Clinical Reimbursement The Tutera Group Deb Myhre RN C NE RAC MT Nurse Consultant Continuum Health Care Services Ron Orth RN NHA RAC MT Clinical Reimbursement Solutions LLC Milwaukee WI Andrea Otis Higgins RN MLNHA CDONA CLNC RAC MT CEO Administrator St Andre Healthcare Biddeford ME Rena R Shephard MHA RN RAC MT C NE AANAC Executive Editor President RRS Healthcare Consulting Services San Diego CA Judy Wilhide Brandt RN RAC MT C NE Regional MDS Medicare Consultant President Judy Wilhide MDS Consulting Inc foe oc exe oo oo Q A continued from page 9 of the survey team
24. ience that so down How do we avoid fallinginto each other Guide staff to separate their will enhance care even more Provide the doldrums after the exit conference emotions from the survey experience further training where it is needed Tiare avetea events neo Acknowledge that they are working Encourage feedback from staff members nursing home that are more stressful diligently every day to care for their to distinguish between deficient than survey Several approaches can residents The survey processisan practices requiring further training and be taken to promote resilience and to experience that everyone tn the facility deficiencies related to other factors that avoid or reduce the feelings you describe goes through Talk about itandtogether may call for different solutions Conduct Take time during and after survey to resolve the negative feelings that could root cause analysis before developing listen to your staff and give thema hinder progress Apathy detachment an action plan so everyone understands E EEIN ee ee ee ee eee and loss of interest after a difficult the root of the issue Re look at the survey experiences A daily debriefing survey can prevent staff from getting preparations made prior to survey and during survey helps foster a sense of back to normal routines Acknowledge determine if there are areas that need everyone s hard work and effort Speak of more attention or education in advance oneness among team members and TONGS
25. not rural then LC2 pays more than RMB You are seeing an example of index maximization where the software selects the RUG that pays the most You must continue to follow the COT observation process in this case But it does appear that your software calculated the RUG correctly You will know for sure when you transmit the MDS If the federal data base does not report a RUG error then the RUG on the MDS is correctly reported Carol Maher rn Bc Rac ct Cmaheror21 earthlink net o o ro ro o p 7 ro ro O O S p j i j i v e e e o o ro o ro o re AANAC LTC LEADER 4 3 2012 O O O O O O O O O a e e e e J e 6 oo foe foe foe foe oo oo foe oo 0 0 0 0 0 0 e e fe e Oo e e oO e oO Oo fete oo oo o1 o oo oX o BUSINESS amp PROFESSIONAL DEVELOPMENT PARTNERS Diamond Business Partners SIMPLEL Platinum Business Partners Cerner Dementia Care Specialists eHealth Data Solutions Golden Living Harmony Healthcare International MED PASS Purdue Pharma Find out More Gold Business Partners Accu Med Technology Solutions AIS Inc AOD Software LeaderStat MDI Achieve PointClickCare PointRight Inc SunSolutions Consulting Affinity Partners AHCA LeadingAge LeadingAge New York Long Term Living at aanac org McKnig
26. nsive assessment to provide the basis for defining approaches that address residents at risk for or who already have a pressure ulcer A resident determined to be at high risk has significant implications for preventative and treatment strategies that must be communicated to all levels of nursing staff Monitoring Nursing staff must remain alert for potential skin changes and at least daily evaluate and document identified changes The interdisciplinary team should develop a care plan that includes prevention and management of skin care interventions with measurable goals An evaluation should be conducted at least weekly to include skin color moisture temperature integrity and turgor Moisture Exposure Exposure to urine and feces irritates skin and makes it susceptible to breakdown Skin irritation from this exposure makes skin more susceptible to damage from friction and shear during repositioning Support Surfaces and Pressure Redistribution Pressure redistribution incorporates the concepts of both pressure reduction and pressure relief Match a device s potential therapeutic benefit with the resident s specific situation The effectiveness of any support surface or device is based on the potential benefit for the resident s specific situation One product does not meet everyone s needs Repositioning Assessment of the resident s skin integrity and achievement of pressure reduction or redistribution should guide the dev
27. oo oo oke e1 o oX o What s new In What are resource libraries Resource libraries are where documents and files uploaded by members are kept Each community has one and each library is searchable You can also search across all of the libraries on AANAConnect Files and documents can get into the library in one of two ways 1 Each time an attachment is shared in a discussion group it is automatically uploaded into the group s library 2 Files can be uploaded directly to the library of your choice You can access a community s resource library in several ways 3 Click on the link paper clip icon in an email you receive from a discussion group 4 Click on the link named Files for the community you wish to access on the View Community Discussions page 5 Go to Communities in the top navigation and choose View Libraries From there select All Libraries to browse or Search Library to look for specific files 6 From the Communities page locate the community you want and click on the number located to the right of the Book icon Save and store the resources that you need Library entries can contain several files To view and download an attachment click on its name under Attachment s If you want all of the files click on the library entry name and then the Download all link found at the bottom of the Attachment s section Help
28. portunities choices and chances to get the vital updates and information you need LEARNING TRACKS New education tracks will help you focus on the information and skills that you need most PRODUCT THEATERS Get in person demonstrations of the products and services that have been designed to ease your workload and make your job simpler CLINICAL SESSIONS Learn how to utilize your physical assessment capabilities to manage and support residents who suffer from skin wounds chronic pain or dementia THE 2012 AANAC AWARDS Join us as we celebrate our celebrities in long term care with a fantastic evening event complete with food beverage and an entertaining reception to follow INCREASED EXHIBIT HOURS You ll have more time than ever to interact and learn about the newest trends and products right from the source And maybe even win a prize during our Exhibit Hall Scavenger Hunt NETWORKING WITH THE BEST Join forces with hundreds of other long term care leaders experts and enthusiasts by being a part of this conference Spend time sharing success stories and challenges and get insider information from others who have been through similar situations as yourself A VIBRANT CITY Witha growing population a strong economy and diverse cultural and recreational opportunities Jacksonville distinguishes itself as one of the nation s most dynamic and progressive cities CONNECTED COMMUNITY Meet other attendees before you even arrive on
29. site and start putting faces to all the friends you re going to make through the AANAConnect online conference community ONLY ONE CHANCE Since we ll only have one conference this year this is your best opportunity to join colleagues to ensure you re up to date on the most current regulatory updates survey preparedness skills quality control tactics and resident voice and choice issues SHARE THE FUN THE KNOWLEDGE AND THE EXPERIENCE WITH OTHER LTC PROS REGISTER TODAY AT WWW AANAC ORG 2012CONFERENCE AANAC 2012 UPCOMING WORKSHOPS TRAINING PARTNER MASTER TEACHER DATES CITY STATE AANAC RAC CT Certification Robin L Hillier Apr 16 18 Jacksonville FL AANAC C NE Certification Jennifer Pettis Apr 16 18 Jacksonville FL LeaderStat Lisa Hohlbein Apr 10 12 Dallas TX Duran Consulting Services Sandy Biggi June 4 6 Portsmouth NH Harmony Healthcare International Jennifer Pettis June 4 6 Charleston SC v Z o o o ro fo o p z ro lo J 5 g j i p 7 e 6 amp e 2 U ro o o o o lo o o re AANAC LTC LEADER 4 3 2012 U ro O O O O O O O ro v J e amp e eS J e 6 B 6 o ro lo o ro o ro lo ro fe ro fo lo o lo o ro le lo O O O O oo
30. some of the instructions its officials issued during the MDS teach staff to increase our awareness 3 0 National Conference in early March Look for the latest and get us back on track clarification memo here However MDS coordinators need This course has given me additional to think about how the decisions they make impact payment support and confidence for my position says Hohlbein They must have an awareness of ARDs and with the MDS I feel more secure with how scheduled assessments relate to unscheduled assessments the information I have learned For example they need to be able to determine whether it will This course has really helped us benefit the facility to do a scheduled assessment with an ARD tighten up our current practices set before an unscheduled assessment Become a student of accurate reimbursement There is a misconception among some MDS nurses that the responsibility for monitoring therapy for unscheduled Ci ck h ere t O earn MOre assessments solely rests on the therapy department says Or register today Hillier The problem with that attitude is that the penalty lies on the SNF not on the contract therapy company or the therapy department alone if an unscheduled MDS is missed Share monitoring duties So both the MDS department and the therapy department should be equally responsible for monitoring therapy throughout the week for residents who are on therapy
31. therapy on the weekends then you already missed the ability to deliver those two days That makes it harder if something happens during the week and the resident misses a day of therapy Use the time that CMS gives you MDS coordinators are understandably under pressure to complete and submit MDSs at the end of the month because the facility can t bill Part A until the MDSs have been accepted into the QIES Assessment Submission and Processing ASAP system acknowledges Hillier But aside from that end of the month pressure MDS nurses can obtain more flexibility simply by giving themselves a few more days between when they set the ARD and when they complete the MDS sign off that it has been encoded and submit it Hillier offers this example On day 27 of the Part A stay which is day 7 of the COT observation period Resident Y potentially needs a COT OMRA because one therapy discipline has discharged her resulting in a drop in therapy RUG category The MDS nurse decides to avoid doing the COT OMRA by completing the 30 day PPS MDS with an ARD of day 27 In this situation MDS nurses often will set the ARD for the 30 day MDS on day 27 complete that MDS on day 28 and continued on page 7 New MDS 3 0 April 25 of 2 orn ET S129 cosmpouter Quality Measures Register for the Webinar today e amp lt pa Q ee 0 pa O1 gt A O O O ry oo OO O 0 C oX o OO oC 00
32. to which members agree with our current priorities which guide AANAC s strategic planning Below isa brief summary of the survey results We are happy to report that respondents indicated great satisfaction with the return on investment they receive as AANAC members with 78 of respondents agreeing that AANAC is their primary source of accurate timely and affordable information and tools The single most important need you look to AANAC to fulfill is Having skills knowledge to conduct accurate and effective assessment with 95 rating this very important 12 000 members this feedback helps us a great deal in serving your needs The Board and its Membership Linkage Committee are analyzing the survey results and will be addressing next steps throughout the year At the April AANAC conference in Jacksonville the Board is hosting a roundtable event to explore some of the key results further with the membership through a focus group style session If you are interested in attending this session please contact AANAC to add this session to your conference registration Uv v e e e o 2 o e o e e e 0 e e 0 e e e e e e e e e e In rating overall satisfaction with AANAC membership 89 reported being very satisfied or satisfied 9 were neutral and fewer than 2 reported dissatisfied e The single most important need you look to AANAC to fulfill is
33. ts experience weight loss which e Staff monitored and evaluated the impact of the identified interventions indicates a caloric imbalance A resident Approaches were revised as appropriate with a pressure ulcer who continues Conversely an avoidable pressure ulcer develops because staff do not follow these continued on page 13 expected steps Education for nursing staff should include the following topics v v o o o o o o o o E 7 o O O O O O O O O O S 7 j 7 7 7 2 7 v e e 4 v o o o o o o o o o o AANAC LTC LEADER 4 3 2012 o Y o rs O O O O O O O O O O O O O 7 v e e e J e J e o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Unscheduled PPS assessments continued from page 3 Cultivate relationships Regular meetings are important but they are just the start notes Hillier It goes without saying It is increasingly MEDICARE important for MDS and therapy to have a good working relationship so that they communicate well and frequently UNIVERSITY throughout the day The only way to truly stay on top of unscheduled assessments is for MDS and therapy to work together as a collaborative team every day as opposed to finger pointing at each other Then you will always have accurate
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