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.

Never before have PA/LTC facilities been held more accountable or more scrutinized internally as well as publicly. Yet, many facilities have little or no experience in analyzing data. Using data to identify, and impact, areas of performance improvement is a major function of quality assurance and performance improved (QAPI) success. Unfortunately, staff get stuck wasting time, and money, comparing this month’s measures to numbers last month or last quarter, because they don’t know what to do differently. This session is going to be an eye-opening, no holds barred expose of what we are doing wrong with data and how to make it right. We will delve deeper into the data facets of QAPI using real facility examples to demonstrate how to use data for sustainable process improvement. This will be an interactive session with participation opportunities and clear guidance on strategies for change. It’s time we solve long-standing problems in our facilities for good, and for the greater good.

Learning Objectives:
(1) Recognize the futility and unintended misleading effects of common analyses like bar graphs, trend lines, rankings, and benchmarking and more importantly, what to do differently.
(2) Demonstrate how process-oriented thinking is crucial to every improvement effort.
(3) Explain common cause and special cause variation, and how this knowledge will transform improvement efforts.
(4) Discuss how to choose the right improvement strategy based on the type of variation identified.

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.

Rural LTC is a challenge for medical directors at a number of levels, including: coordinating regulation with practice, systems development and process, and staff mind set. Rural facilities that are community supported and single entities have a unique set of issues as do rural facilities that are part of corporate chains. Clinical outcomes and care delivered should be raised to acceptable levels. This session will discuss the challenges encountered in rural LTC facilities and provide successful strategies to overcome these challenges.

Learning Objectives:
(1) Discuss challenges that Medical Directors and PCPs encounter in rural LTC settings.
(2) Describe strategies successfully used in rural settings to remain current with new regulations and evolving practice principles in Geriatric Medicine.
(3) Explain approaches that have been successful in rural settings to keep staff focused on LTC initiatives and QAPI supervision.
(4) Utilize strategies to reach out to rural families to educate them on the aging process and LTC expectations.

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 ethical dilemmas involved in an advance directive that asks the provider to withhold food and fluid in patients with dementia. The presentation will focus on the dilemma of autonomy and the injustice inherent in a decision to implement or to refuse to implement the advance directive. A panel discussion by members of the Society Ethics Committee will follow.

Learning Objectives:
(1) Discuss the concepts of Voluntarily Stopping Eating and Drinking (VSED) and Stopping Eating and Drinking by Advance Directives (SED by AD).
(2) Describe the various ethical issues involved in implementing SED on a patient with advanced dementia.
(3) Explain the difference between critical and experiential interests and how they contribute towards ethical decision making.
(4) Appreciate the practical difficulties in implementing SED in the nursing home or assisted living setting.

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.

Serious weather-related or other types of disasters can severely impact our ability to safely care for our residents. The evaluation and decision process to shelter in place or to evacuate residents is critical to best care for our communities of residents. Last fall’s Hurricane Harvey posed a widespread risk to several nursing facilities in the Houston, Texas area. This session will cover case presentations and group discussion of the following aspects of responding to a disaster: ongoing baseline disaster preparedness for nursing facilities, the decision-making process when a substantial threat is identified, mobilizing resources to assist in facility evacuation, tracking the evacuation of individual residents, assuring that medications and other services remain available for residents throughout the process.

Learning Objectives:
(1) Discuss the physical and regulatory risks of hurricanes and other natural disasters.
(2) Demonstrate knowledge of the components of a comprehensive disaster response plan.
(3) Explain how effective coordination of the interdisciplinary team is crucial to a successful response.
(4) Describe how effective communication with the electronic medical record system is essential for coordination of pharmacy providers, administrators, directors of nursing, and medical directors in the facilities that are evacuating and receiving residents during a natural disaster.

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.

Centers for Medicare & Medicaid Services (CMS) has made several changes to the Quality Measure Domain (QM) of the 5- Star Quality Rating System, as well as the staffing data submission. The new quality measures are related to successful discharges to the community, emergency department visits, re-hospitalization, and improvement and maintenance of a resident’s function. This session will primarily focus on the impact of the new changes in the overall star rating and its effect on the facilities, with a particular emphasis on practical approaches, case studies, and QAPI interventions to improve on the new quality measures.

Learning Objectives:
(1) Describe the 5-star quality rating system and its three domains.
(2) Identify the new developments in staffing data submission- Payroll Based Journal (PBJ).
(3) Explain the five new quality measures (QM), QAPI interventions to successfully improve quality and the new QM Metrix.
(4)

This session features two experienced medical directors of PA/LTC facilities with many years of experience in providing consulting and expert witness services to providers and attorneys involved in various types of litigation in the PA/LTC arena. They have distilled unique teaching points from many cases and will discuss how providers and facilities can learn from these and implement various interventions, policies, and process improvements pertinent to their own facilities to improve exposure to common areas of liability and potentially avoid litigation.

Learning Objectives:
(1) Describe the main areas of litigation commonly encountered in PA/LTC facilities.
(2) Discuss ways the medical director, attending physician, administrator and DON can glean lessons from PA/LTC litigation to use for performance improvement activities in their facilities that can serve to lessen the chance of being involved in litigation.
(3) Recognize the importance of recognition of 'near miss' events and subsequent implementation of follow-up action to prevent liability with adverse outcomes.
(4) Describe the importance of updated care plans that reflect appropriate goals of care for nursing facility residents in reducing the chance of litigation involving nursing facility residents.

This session will provide details about billing for services that have recently been approved by the Centers for Medicare & Medicaid Services. Participants will learn the peculiarities of the billing changes for these codes. The session will also review and explore the finer points of some classical billing and coding enigmas that continue to be challenging for many PA/LTC practitioners.

Learning Objectives:
(1) Discuss details of billing complexities for recently approved billing codes used in the geriatric care continuum.
(2) Review details of some recurrently perplexing PA/LTC coding and billing issues.

The Center for Medicare & Medicaid Services (CMS) issued a comprehensive reform of the requirement for LTC facilities to participate in Medicare and Medicaid programs. This session will review the changes relevant to infection prevention and control and antibiotic stewardship, from the perspectives of an infection preventionist, a consultant pharmacist, and an infectious disease physician.

Learning Objectives:
(1) Discuss the infection preventionist’s role and responsibilities indicated in the 2016 Reform of Requirements of Participation.
(2) Review the pharmacy services and the consultant pharmacists’ expanded role in infection prevention and control and antibiotic stewardship programs.
(3) Describe basic components of an antibiotic stewardship program, including an antibiotic stewardship policy and antibiotic use protocols appropriate for PA/LTC settings.

This breakfast panel is an opportunity for attendees to engage leaders in medical direction in a dialogue on best practices. The focus of this panel is on the management aspect of medical direction.

Learning Objectives:
(1) Discuss the newest trends and developments in medical management.
(2) Implement recommendations for best practices in medical direction.