Department of Health Care Finance (DHCF) & Comagine Health Nursing Facility Quality Improvement Collaborative 2020 Outcomes Congress October 29, 2020
Comagine Health • Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system. • As a trusted neutral party, we work in our communities to address key complex health and health care delivery problems. • We serve people in Alabama, Alaska, Idaho, Mississippi, Nevada, New Mexico, Oregon, Utah, Washington, D.C., Washington State and Wyoming.
Agenda 1:00 - 1:10 pm Welcome, Introductions & Collaborative Year Two (Y2) Review 1:10 - 1:40 pm Expert Presentation: Advance Care Planning 1:40 – 1:50 pm Break 1:50 – 2:10 pm Nursing Home Spotlight: Lisner Louise Dickson Hurt Home & Jeanne Jugan Residence 2:10 - 2:25 pm DHCF Quality Improvement Program Update 2:25 – 2:30 pm Wrap-up & Online Post Session Evaluation
Nursing Facility Quality Improvement Collaborative Overview Background • Department of Health Care Finance (DHCF) funded new contract re-procurement for Quality Improvement Organization (QIO) in 2018 • Five Year (11/1/2018-10/31/2023) contract includes a new Nursing Facility Quality Improvement Collaborative initiative focusing on topics prioritized by DHCF
Collaborative Aims • Partner with DHCF staff to create “all teach, all learn” Learning and Action Networks • Assess nursing facility readiness to participate in pay-for- performance and develop a plan of action on areas of improvement • Provide individual and group technical assistance (e.g. training, education and quality improvement consultation services) to 17 District of Columbia nursing facilities to engage in rapid-cycle improvements to instill high-quality, person-centered care • Ensure nursing facility staff are adequately trained to conduct Minimal Data Set (MDS) assessments • Utilize Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to identify areas for improvement
Collaborative Year Two - DHCF Nursing Facility Quality Improvement Measures Quality of Care Domain Measures Percent of Residents Who Received the Pneumococcal Vaccine (Long Stay) (New) Percent of High-Risk Residents with Pressure Ulcers (Long Stay) Percent of Low Risk Residents Who Lose Control of Their Bowel or Bladder (Long Stay) Quality of Life Domain Measures Resident/Family Satisfaction Survey (CAHPS) End of Life (EOL) Program (Revised) Regulatory Compliance DC Health Inspection Rating – Percent Compliance with DC Health Inspection Citation of 2 Within the Quality of Life and Quality of Care Areas (New) Infrastructure Domain Measures Staff Continuing Education in MDS Training Staff Turnover Rate (Revised) Certified Electronic Health Record (EHR) Implementation (Revised) HIE Connectivity (Revised) Quality Improvement Plan (Revised) Source: DHCF
End of Life Care Collaborative Goals • Is a proxy decision – maker identified and documented in the medical records within 14 days of admission or within 14 days of change in diagnosis/prognosis indicating a significant decline in overall health? • 14/17 NFs responded “Yes” • Is there discussion/documentation of resident goals around care and treatment within 14 days of admission or within 14 days of change in condition indicating a significant decline in overall health? • 14/17 NFs responded “Yes” Comagine Health Nursing Facility QI Collaborative Website http://www.qualishealth.org/healthcare-professionals/collaborative-dc-medicaid
Nursing Facility Quality Improvement Collaborative Model WE ARE HERE! 4 Virtual Learning Webinars
Collaborative Tools & Resources DHCF Nursing Facility QI Collaborative Website https://dhcf.dc.gov/node/1390591
Comagine Health Nursing Facility QI Collaborative Website http://www.qualishealth.org/healthcare-professionals/collaborative-dc-medicaid
Collaborative Year 3 (Y3) – What’s Next?
Collaborative Y3 (11/20 – 10/21) Schedule of Events Collaborative Activity Timeline Prework November 2020 – January 2021 Individual Virtual Technical Assistance Site Visits November 2020 – January 2021 Collaborative Handbook & Change Package January Nursing Facilities Complete Prework January Learning Session 1 February 2021 Action Period 1 February - May Senior Leader Reports February - May Individual Nursing Facility Site Visits March - May Webinar #1 May
Collaborative Y3 (cont.) Collaborative Activity Timeline Learning Session 2 June 2021 Action Period June – September Senior Leader Reports June – September Individual Nursing Facility Site Visits June – September Webinar #2 August Outcomes Congress October 2021
2020 Outcomes Congress – Advance Care Planning Gwen Cox, RN Edy Taylor, RMA
Advance Care Planning Gwen Cox, RN. Ms. Cox is a RN with a broad range of experience in her career. She has worked in critical care nursing, military nursing, behavioral nursing and quality, safety and risk management. She is currently a Senior Improvement Advisor for Comagine Health. Edy Taylor, RMA. Ms. Taylor has 28 years health care experience ranging from a Hospital Corpsman in the US Navy as a Mental Health Tech, to a Registered MA, and Practice Manager. She is currently an Improvement Advisor for Comagine Health.
Poll Question 1
This Photo by Unknown Author is licensed under CC BY-SA
What Is Advance Care Planning? Also known as advance directives. It is a way of letting your family and your health care team what your wishes are should you become incapacitated. • Durable Power of Attorney for Health Care • Living Will • Other documents that express your personal, religious, or other views if you are unable to do that yourself.
What Is the difference in the POLST/MOST and Advance Directives? • Advance directives reflect the patient/family wishes. • Living Will • Organ Donation • POLST/MOST • Are the medical orders that reflect what the advanced directives say. • DNR
Poll Question 2
Why Advance Care Planning Is Important
Importance for Both Patient Facility • Allows an individual to express • Enhances patient-centered care and strengthens the their preferences on what is provider-patient relationship important at the end of their life • More likely to have patient • The facility will understand preferences known and honored the patient’s wishes and guide • Reduces the emotional burden treatment accordingly and cost of unwanted interventions • Facility can assist the patient • Improves family coping and family by providing compassionate care and • Reduces the burden on education on end of life caregivers discussions. • Reduces futile care
Durable Power of Attorney for Health Care (POA)
What Is the Difference in a POA for Healthcare and a Regular POA? • Power of Attorney for Health care: Gives a designated person the legal authority to make decisions on behalf of an incapacitated individual. • Power of attorney: A power of attorney authorizes someone else to handle certain matters, such as finances or health care, on your behalf. • If a power of attorney is “durable”, it remains in effect if you become incapacitated, such as due to illness or an accident.
Poll Question 3
Identifying Residents for ACP Engagement
Who Should Complete Advance Care Planning Directives? • All adult Patients regardless of health condition • Anyone who wishes to have their end of life planning documented • It is also important to talk to your family members about your end of life choices. • 80% of people say, if seriously ill, they would want to talk to their doctor about end-of-life (EOL) care. • 7% of people report having had an EOL conversation with their doctor.
Post-Encounter Follow-up
Why Is It Important to Follow-up Periodically? • Documents may become outdated • Patient health status may have changed • Patient wishes may have changed • Family has changed a decision
Effective Coding and Billing
Can My Facility Bill Medicare for Completing an ACP? • Yes. This is a Medicare covered service. As long as the patient has Medicare Part B Coverage. 99497 99498 Advance care planning including the Advance care planning including the explanation and discussion of advance explanation and discussion of advance directives such as standard forms (with directives such as standard forms (with completion of such forms, when performed), completion of such forms, when performed), by the physician or other qualified health care by the physician or other qualified health care professional; first 30 minutes, face-to-face professional; each additional 30 minutes (List with the patient, family member(s), and/or separately in addition to code for primary surrogate procedure)
Thank you! Gwen Cox, RN Edy Taylor, RMA
Break
Nursing Home End of Life Care Spotlight
Lisner Louise Dickson Hurt Home Carly Ballard, MSW, LGSW Lisa Harfoot, MSW, LICSW Isata Sesay, RN Social Worker Director of Social Services Assistant D irector of Nursing
End of Life Care Storyboard
Jeanne Jugan Residence Sr. Alphonse Marie, NHA Daisy Alzate, RN Administrator Director of Nursing
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