• Top Ten Citations Part Two – Deep Dive into F812 and F656

    Wednesday, November 13, 2019 | Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA

    Last month, we provided members with a list of the top ten federal deficiencies since January of 2019. As a reminder, the top ten deficiencies are:

    1. F880 - Infection prevention and control

    2. F689 - Free of accidents, hazards/supervision/devices

    3. F812 - Food procurement/storage

    4. F656 - Develop/implement comprehensive care plan

    5. F684 - Quality of life

    6. F761 - Label/storage of drugs and biologicals

    7. F657 - Care plan timing and revision

    8. F758 - Free from unnecessary psychotropic med/prn use

    9. F677 - ADL care for dependent residents

    10. F550 - Resident rights

    (The citations above in red reflect the potential to cause substandard quality of care when a facility is cited at a scope and severity of F, H, I, J, K, or L level)

     

    This month, we will take a deeper dive into the number three and four top citations and explore common reasons that facilities are struggling to meet these regulations.


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  • Staffing Solutions Article Series: The Welcome – How to Improve Your Application and Onboarding Processes

    Wednesday, November 13, 2019 | Alexis Roam, RN-BC, MSN, DNS-CT, QCP

    The old saying you never get a second chance to make a first impression is sage advice for healthcare leaders. Nursing homes within the same geographical vicinity are competing with each other to attract talent, sometimes among a very limited pool of people. But nursing homes are also competing with other healthcare settings, and even with industries outside of healthcare. Depending on the market, working in a grocery store may pay more than being a CNA. Fresh approaches to attracting and retaining talent are necessary, but also provide exciting possibilities for healthcare leaders to engage a workforce devoted to caring for elders in their communities. To make a great first impression and improve the odds new employees will stay, nurse leaders should start by incorporating the principles of hospitality into the application and onboarding phases of the hiring process.

     

    What is Hospitality?

    Hospitality is the friendly and generous reception of visitors. Hospitality creates an experience for customers with the overall goal of attracting the customer to engage in the initial encounter and ultimately become a repeat customer. When done well, businesses are able to create loyalty to the brand, and customers share the positive experiences they’ve had with the brand in various social media outlets and return time and again.

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  • Are Your Nurses Meeting Skilled Documentation Requirements?

    Tuesday, October 22, 2019 | Caralyn Davis, Staff Writer

    Under the Patient-Driven Payment Model (PDPM), skilled nursing facilities (SNFs) need to have documentation in the medical record that will allow a medical reviewer, in the case of an additional documentation request (ADR), to determine that Medicare Part A skilled services were provided and that those services were reasonable and necessary, says Suzy Harvey, RN-BC, RAC-CT, managing consultant at BKD in Springfield, MO.

     

    “While DNSs have a higher-level oversight role with regard to most aspects of Medicare Part A, you should have a more active role in ensuring that nursing documentation supports the skilled need. You or whoever you delegate this duty to needs to work with the MDS coordinator or Medicare consultant to ensure that nursing staff are documenting appropriately to support the skilled need.”

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  • Medicare Part A: 5 Key Requirements That Haven’t Changed Under PDPM

    Tuesday, October 22, 2019 | Caralyn Davis, Staff Writer

    Directors of nursing services (DNSs) often take a largely hands-off approach to Medicare Part A coverage issues, says Suzy Harvey, RN-BC, RAC-CT, managing consultant at BKD in Springfield, MO. “In many facilities, DNSs more or less delegate the entire Medicare program to the MDS coordinator or the Medicare consultant. This ability to delegate is important because DNSs have such a demanding job. However, DNSs ultimately are responsible for all aspects of resident care. The MDS is a part of that, as are Part A skilled services.”

     

    Consequently, DNSs still need to provide oversight—to be a member of the Medicare Part A team and to be aware of how well facility systems work by either auditing medical records or reviewing the results of delegated audits, suggests Harvey. “A DNS who just says, ‘The MDS coordinator handles that,’ could run into unexpected problems during medical review.”

     

    “The implementation of the Patient-Driven Payment Model (PDPM) changed the payment system used for traditional Part A residents,” notes Harvey. “It did not change the coverage policies for skilled services.”

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  • At A Glance QM, QRP, and VBP Tool

    Tuesday, October 15, 2019 | AADNS
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  • How to Avoid Citations for the Top Two Most-Cited Deficiencies

    Tuesday, October 8, 2019 | Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA

    The survey process can be overwhelming. Surveyors arrive and begin evaluating whether the facility has met specific quality standards. Often, even the prospect of an impending survey leads to anxiety and fear for facility leaders and staff. Being aware of common citations and proactively putting plans in place to avoid those findings can help lessen the anxiety. Knowing the most-cited deficiencies and being survey ready at all times can help reduce the number of and lower the scope and severity of common citations.

     

    Over the years, the top ten survey deficiencies have remained relatively constant, but the reasons that facilities receive a specific citation do vary across the country. Let’s look at the most-cited deficiencies across the nation since January 2019 and delve further into common reasons for the top two citations.

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  • 10 Keys to Operationalizing Trauma-Informed Care

    Tuesday, October 8, 2019 | Caralyn Davis, Staff Writer

    Once providers conceptually understand trauma-informed care, they often get stuck navigating what to do next. Steps that can help directors of nursing services (DNSs) and other members of the management team begin to operationalize trauma-informed care include the following:

     

    Avoid a checklist mentality

    “It sounds cliché, but trauma-informed care is a process, not a destination,” says Kathleen Weissberg, OTD, OTR/L, CMDCP, education director at Select Rehabilitation in Glenview, IL. “Every time I teach, I’m asked, ‘Where is my checklist? How can I make sure we are doing everything that we are supposed to do?’”

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  • CMS Says Hospitals Required to Share Data on Quality Measures

    Monday, September 30, 2019 | AAPACN
    CMS late last week released the final rule on Revisions to Requirements for Discharge Planning for Hospitals and Home Health Agencies. The rule, following on proposed rules from 2015 and 2016, requires hospitals and home health agencies to give patients more information about post-acute care provider options. 
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  • 5 Ways to Benefit From Skilled Therapy Under PDPM

    Wednesday, September 25, 2019 | Caralyn Davis, Staff Writer

    Therapy utilization will no longer be a payment driver under the Patient-Driven Payment Model (PDPM) in the Skilled Nursing Facility Prospective Payment System (SNF PPS), but skilled therapy services still have a key role to play. Liz Barlow, RN, CRRN, RAC-CT, DNS-CT, senior director of quality for RehabCare in Louisville, KY, offers five ways that directors of nursing services (DNSs) can work with the interdisciplinary team to get the most bang for their buck with therapy:

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  • Staff Training: Is Your Program Ready to Meet New Requirements?

    Wednesday, September 25, 2019 | Caralyn Davis, Staff Writer

    The July 2019 Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency Proposed Rule would give Medicare- and Medicaid-certified nursing homes a break by postponing the Requirements of Participation’s Phase 3 rollout of the training requirements at §483.95(d) in the Code of Federal Regulations (CFR), which is F944 (QAPI Training), as well as §483.95(f)(1) and (2), which is F946 (Compliance and Ethics Training). However, this November 28, providers still must have staff training in place to meet multiple new F-tag requirements under CFR §483.95 (Training Requirements):

    F940 (Training Requirements – General);

    F941 (Communication Training);

    F942 (Resident’s Rights Training);

    F945 (Infection Control Training);

    F947 (Required Inservice Training for Nurse Aides). Note: While most of F947 has already been implemented, the component related to §483.95(g)(3) will implement in Phase 3. This requires that inservice training for nurse aides “address areas of weakness as determined in nurse aides' performance reviews and facility assessment at §483.70(e) and may address the special needs of residents as determined by the facility staff”; and

    F949 (Behavioral Health Training).

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