ANNUAL CONFERENCE 2018

This session will present novel approaches to using a skilled nursing facility's own quality measure data to engage its medical director, unify its healthcare team, and improve quality measure performance.

Learning Objectives:
(1) Determine how to use their Quality Measure data to engage the leadership and accountability of their Medical Director.
(2) Describe novel methods for creating high impact presentations of Quality Measure data.
(3) Use a SNF's Quality Measure data to unify their healthcare team and motivate improved performance.
(4) DIcuss the value of trending, tracking, and visualizing their Quality Measure data as a means to improve Quality Measure scores.

This session will present a comprehensive approach to nursing home improvement based on key clinical and management principles, focusing on clinical reasoning. The presenters are jointly responsible for overseeing approximately 60 facilities across multiple states as regional medical directors. In collaboration with those of other key disciplines, they have conceived, developed, and implemented a program that cuts across all measures and topics. The “Thinking Right and Acting Right” program, based on clinical reasoning and across-the-board accountability, has been deployed successfully across multiple facilities and in multiple states. This session will show in detail how this common approach has led to multiple desirable outcomes including sustained improvement in care, improvement in diverse quality measures, better regulatory survey outcomes, more effective medical practitioner roles, and a general strengthening of facility processes and systems. The session will show in detail how medical directors can provide leadership for comprehensive, facility-wide improvement of care and performance in nursing homes. Actual cases and data will be presented to show how this common approach is sustainable and reproducible across settings, and can be understood and applied by those of all disciplines, not just medical practitioners.

Learning Objectives:
(1) Identify key clinical and management principles for meaningful and sustained improvement in a nursing home's care and performance.
(2) Discuss the critical role of medical directors in leading a nursing home to analyze and improve its entire approach to care.
(3) Identify and address in meaningful ways challenges to improvement including the major impact of cognitive biases on care quality.
(4) Implement meaningful, sustained improvement in a nursing facility using efficient and effective clinical and management strategies.

Quality measures are the largest determinant of your 'value' under all Medicare/Medicaid programs. Beginning with 2017, they determine how all physicians, APNs, and PAs are 'rated'. Those ratings follow you across all employment settings. Understanding how to manage your quality scores is becoming professionally critical. Each practitioner can be enrolled in multiple programs with different reporting requirements. You'll learn about managing quality for different audiences, reporting for regulatory purposes (CMS), and how to improve shared-patient care. This program is designed for clinical and administrative leaders with responsibility for quality reporting and quality strategies.

Learning Objectives:
(1) Select a menu of MIPS Quality Measures that are likely to yield better scores in 2018.
(2) Describe the design of the quality metrics through the APM model, and how to participate.
(3) Discuss how do practices contribute to I-SNP quality?
(4) Identify how AMDA members can redefine PAC and LTC quality that's appropriate for patients, the practitioner, partners, and payors.

Health care is changing fast and no setting is being affected more than the PA/LTC setting. Stakeholders are demanding high quality, and so are patients and their families. In the context of these changes and funding constraints, the value of innovation and implementation has been amplified. Last year, the Society conducted an Innovations Forum that provided members a platform to voice their ideas around the Society's role in PA/LTC innovations. The message was clear: the Society needs to be the leader in PA/LTC innovation and change. In response, the Board of Directors nominated the Innovations Platform Advisory Committee (IPAC) that consists of clinicians, entrepreneurs, and academicians to promote the Society as an innovations leader in the PA/LTC setting. In this session, IPAC leaders will provide an overview of the IPAC charter and initial projects undertaken by the group. The session will also invite several PA/LTC innovators to present their work to the audience who will then select the two winners of the first ever Society Innovations Challenge.

Learning Objectives:
(1) Describe the Innovations Platform Advisory Committee (IPAC) Charter for AMDA Innovations.
(2) Discuss next steps to incorporate Innovations in to AMDA's culture.
(3) Review finalists selected by the IPAC to compete in the Shark Tank competition.

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Are YOU an Innovator? Have you created a system, device, or technology that will revolutionize care in PA/LTC medicine?

Submit your innovation to the Society’s Shark Tank Competition to promote your idea to the largest national audience in PA/LTC.

The Society’s first-ever Shark Tank Competition will highlight how innovators are tackling PA/LTC issues. This competition will feature innovation in the PA/LTC setting by showcasing new systems, devices, and technology with the goal to improve PA/LTC processes and outcomes.

DON'T MISS THIS CHANCE TO GAIN NATIONAL RECOGNITION FOR YOUR DISCOVERY!

For more information about this opportunity or to submit your idea, please go to https://paltc.org/shark-tank.

This session will discuss the importance of Post-Acute Network formation, the processes involved in selection and maintenance and the impact it will have on post-acute care providers. The importance of networks to the value-based payment (VBP) concept will be reviewed, along with suggestions as to how to assist with positioning your facilities for participation. An integral part of these changes will be advanced alternative practice models (Advanced APMs), which are designed to move clinicians away from fee-for-service to value-based payment. Advanced APMs are APMs where providers must bear more than “nominal financial risk” for monetary losses and ensure quality, in addition to other criteria. Currently there are no specific PA/LTC APMs, but there are some that will involve these settings. There is a significant opportunity for the Society to not only participate effectively in pertinent APMs, but more importantly to create new models specific for the populations we serve.

Learning Objectives:
(1) Discuss Why Post-Acute Networks are being formed, and how participating Facilities are chosen.
(2) Compare the merits of MIPS and Advanced APMs.
(3) Review current Advanced APMs that include PA/LTC care sites.
(4) Describe the potential advantages of a PA/LTC specific Advanced APMs.

In this session, we present 8-15 articles published in the past year which have the potential to impact the practice of medicine and the processes of care for frail elders in the continuum of care. All articles are chosen through a Modified-Delphi approach and critically appraised by experienced, multidisciplinary practitioners and educators. This presentation has been well-received each year and is often the site of spirited discussion.

Learning Objectives:
(1) Consider changes in your practice based on recent publications.
(2) Identify publications that are controversial and/or may affect the direction of research.
(3) Describe techniques for critiquing publications.

While federal and state regulations require quality assurance performance improvement (QAPI) meetings, which are often led by the administrator or medical director, the full potential of the meetings is often limited by individuals’ contributions to the meetings, interprofessional relationships, and follow-up of identified issues. Interdisciplinary team (IDT) members may struggle with understanding the value of their roles during QAPI meetings and how to better participate in a productive manner. The collaborative relationship among the medical director, administrator, and director of nursing provides the foundation for leading productive and efficient QAPI meetings. In this session, sponsored by the American Board of Post-Acute and Long-Term Care Medicine (ABPLM), experienced IDT members build upon the previous years’ session to assist the triad of leadership in nursing facilities in their goals of improving QAPI meetings and subsequent care outcomes, resident experience, and the quadruple aim. Based on trends and past performance, create a vision and direction for your facility which guides QAPI meeting.

Learning Objectives:
(1) Build a foundation for a productive QAPI meeting and subsequent performance by developing and/or improving skills in collaboration among the Medical Director-Administrator-Director of Nursing leadership triad.
(2) Based on trends and past performance, create a vision and direction for your facility which guides QAPI meetings.
(3) Develop a plan to maximize the value of technology, such as an EMR, in a facility’s QAPI meeting.
Leverage value of each individual members’ participation in the QAPI meeting.

This session will discuss the need for medical leadership in LTC and the larger health care system. Effective leadership characteristics and behaviors will be reviewed. The participant will learn the process of leading organization change. The session will include a presentation followed by small group discussion.

Learning Objectives:
(1) Explain why the need for medical leadership in the LTC continuum has changed.
(2) List common characteristics of an effective leader.
(3) Outline the process of leading an organizational change.
(4) Explain the different skills needed for clinical practice versus change leadership.

Clinical challenges such as pain, wounds, and heart failure are prevalent in the PA/LTC setting and managing these conditions effectively requires that the interprofessional team develop a plan of care that supports patient-centered goals that are both realistic and achievable while striving to provide optimal care to each patient. Pain in the PA/LTC setting affects rehabilitation and mood and pain management should be considered a patient’s right in the PA/LTC setting. However, with the opioid epidemic and new rules it is essential to follow the regulations, but also address pain effectively. Pressure ulcers and other wounds remain a major cause of morbidity and mortality, affecting an estimated 2.5 million patients per year and costing up to $11.6 billion dollars per year in the United States. Readmission after a hospitalization for heart failure is still common among PA/LTC patients, with almost half of the patients readmitted within 6 months. Furthermore, for each of these conditions, older adults almost always have multimorbidity that influences the treatment of the primary condition. The workshop will utilize the clinical practice guidelines and their accompanying pocket guides as a framework for discussion of common patient scenarios involving acute and chronic pain, wounds, and heart failure. During the workshop, there will be specific attention to strategies for utilization and implementation of the evidence-based guidelines in the real world.

Learning Objectives:
(1) Discuss best practice methods to promote the interprofessional implementation of clinical practice guidelines in their facilities.
(2) Incorporate the pain management, pressure ulcers and other wounds, and heart failure clinical practice guidelines in their facilities.

By reviewing the quality improvement (QI) process, this session will offer the PA/LTC health care provider evidence-based and practical suggestions to implementing deprescribing, or more specifically a deprescribing initiative, into clinical practice. It will also review communication techniques for deprescribing utilizing case-based vignettes.

Learning Objectives:
(1) Review the role of deprescribing in management of polypharmacy or potentially inappropriate medications in PA/LTC residents.
(2) Explore and debate the elements of a successful PA/LTC deprescribing initiative within the QAPI format.
(3) Practice communication strategies for deprescribing with residents, family and caregivers, and other practitioners.