Issue: May 13, 2013

Published on May 13, 2013

Articles in this issue:

DOH/OMIG Meeting on CMI Audits

Author: Nancy Leveille and Karen Morris Carl Pucci* Published in Finance & Reimbursement

DOH and OMIG met with the associations Thursday, May 9, 2013 to provide their findings related to the phase one audits of the MDS data.

79 provider audits have been completed, including preliminary exit conferences, as well as optional second exit conferences via telephone.  The accumulated data is now being reviewed by OMIG for final accuracy, and will be sent to DOH rate-setting by the end of this month.  (OMIG noted that audits resulting in increased RUG scores would be documented for provider educational purposes only, and would not adjust the CMI upwards.)  DOH will then reach a decision-point on the release of the remaining $70M (which again, include increases both to the 79 audited facilities, as well as the remaining 171 facilities still subject to OMIG audit.)  DOH then estimates it will need 2 – 3 weeks in early June to process the rates, which then will be sent on to DOB and finally to EMEDNY for processing.  Best estimates as to actual payments to providers would be sometime during July, again subject to the above timetables being met.

As for the audit findings, see the attached document from the meeting.  They describe by category the findings.  One issue to note, after these initial audits, OMIG will drill deeper into the RUG categories for evidence of meeting the qualifiers.  Specific documentation, care planning and evaluation of goals needs to be a focus of the SNF staff with attention centered on easy ability for the auditor to assess.

Going forward, DOH may combine reviews of both the January 2012 and July 2012 census collections in an effort to get current and achieve a rolling six month audit cycle, which is their goal.  In addition, OMIG will consult with IPRO to potentially use their resources to assist in the ongoing audit requirements.

NYSHFA will continuously monitor this important issue and keep members informed on a regular basis.

NYSHFA CONTACTS:

 

Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36
  Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20
  Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15

Refer to #2013-259

NYS Nursing Home Quality Pool

Author: Nancy Leveille and Karen Morris* Published in Clinical & Quality

The NYSDOH sent out a DAL last week on the 2013 Nursing Home Quality Pool.  Included in the DAL are quality measures, compliance elements and the unnecessary hospitalization measure that will be included in the 2013 pool and their respective weights for the overall pool calculation.

NYSHFA has worked closely with DOH to advocate for a balanced process; recognizing regional differences on specific measures/compliance elements; and the ability to recognize the best of best and the most improved facilities during the time period.

NYSHFA CONTACTS:

 

Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20
  Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15

Refer to #2013-262

Advancing Excellence Medications Goal (Antipsychotic Drugs)

Author: Nancy Leveille and Karen Morris* Published in Clinical & Quality

Advancing Excellence is offering a free webinar on May 16, 2013 regarding reducing off-label antipsychotic medication.  This is a national goal for CMS and AHCA.  It is also on the New York State Nursing Home Quality Pool.  See attached information for registration.

NYSHFA CONTACTS:

 

Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20
  Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15

Refer to #2013-261

Downstate RN Nurse Educator Program -Applications Due May 31st!!!

Author: Gayle Farman & Rick Patterson* Published in Education, Foundation for Quality Care News

ATTACHED is the brochure, information sheet, and application for the RN Nurse Educator Program  being held in July-August 2013.  Application deadline is Friday, May 31st!!!  Space is limited, so we encourage interested participants to apply as soon as possible.   

If you have any questions, please contact Gayle Farman at (518) 462-4800 ext. 34 or gfarman@thefqc.org.
 

NYSHFA contacts: Gayle Farman
Sr. Director of Resource Development
Foundation for Quality Care
518-462-4800 x34
  Rick Patterson, Jr.
Executive Director
Foundation for Quality Care
518-462-4800 x19

refer to mm2013-248

AHCA Announces Quality Initiative Recognition Program

Author: Nancy Leveille and Karen Morris* Published in Clinical & Quality

Today, Monday, May 13, 2013, AHCA is launching the Quality Initiative Recognition Program for skilled nursing centers which achieve one or more of the Quality Initiative goals. AHCA and NYSHFA hope to applaud the great work of our skilled nursing centers on the local and national stages.

Below is quick synopsis of the program. But you can find all the information, levels of recognition and additional details on AHCA’s website under the Quality Initiative section: http://www.ahcancal.org/quality_improvement/qualityinitiative/Pages/RecognitionProgram.aspx.   

Recognition

Nursing Centers
The program will be based on skilled nursing centers reaching the Quality Initiative goal targets.  Centers can be recognized for reaching one, two, three or all four goals.  AHCA will inform each state association of their members who will be recognized and hope that we will partner with us in acknowledging their achievements. 

In order to participate in the recognition program, nursing centers will need to ensure they submit staff turnover data for 2011 and 2012, as well as their customer satisfaction results for 2012.  To help centers with data submission, we will have the following tools available on the website:


The deadline for these submissions is Monday, July 15, 2013.

Facilities do not have to worry about reporting the hospitalization and antipsychotic goal rates since AHCA already collects that information.

Also attached is a handout describing the recognition program to share with your staff.

State Affiliates
AHCA will also recognize one state affiliate through our “Innovation Award,” to highlight an affiliate’s unique approach to advancing the Quality Initiative among their membership
Through an online survey located on the Recognition Program’s website, state affiliates must tell about their innovative techniques to promoting the Quality Initiative in their state.  The AHCA Quality Cabinet will then select one state to recognize at the 2014 Quality Symposium.  Again, the deadline for submission is Monday, July 15, 2013.

Any inquires and questions about the recognition program, feel free to contact Sandy Fitzler: sfitzler@ahca.org or Urvi Shah: ushah@ahca.org.

NYSHFA CONTACTS:

 

Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20
  Karen Morris, RN, MS
Director, Clinical &Quality Services
518-462-4800 x15

 Refer to #2013-260