DOH/Provider November Meeting Summary

Nancy Leveille and Karen Morris in Clinical & Quality

Below is the summary of the November DOH/Provider meeting.

NYSDOH Surveyor Access to EMRs – Per S&C letter #09-53 (attached), providers with EMRs “must provide access and technical assistance” to surveyors.  Surveyors must have unrestricted access to the entire resident medical record. This does not include any reports or quality improvement tools such as dashboards. In some cases providers have set up permissions that restrict surveyors from seeing part of the medical record and this is not acceptable. The CMS letter also addresses the issue of access to computer terminals. Surveyors must be “provided access to a terminal at each care location,” per the memo, where the bulk of their work is done. It is not acceptable to assign them to a computer solely in a conference room. The question of surveyors requesting the facility provide them with laptops was raised. If surveyors are assigned to terminals on the unit that they must share with staff, this can cause delays in the survey process and also the ability of the staff to provide care, therefore, it is preferable for surveyors to have sole access to a computer. If the facility is not able to provide “direct print capability”, they must make available all requested records within a timeframe that “does not impede the survey process.” If you have further questions related to this issue, please read the attached memo and/or contact Karen or Nancy.

MDS Coding Webinar – In a recent Member Mailing (Priority Alert dated 11/13/14) registration information was distributed related to a webinar which will be presented by DOH and the School of Public Health entitled, “New York’s Common MDS Coding Errors: Strategies to Improve MDS Accuracy.” This webinar was produced in conjunction with OMIG using the findings from the OMIG audits that have been conducted thus far. The webinar will be available for live viewing twice and then it will be archived and an FAQ document will be developed (late January).

Nurse Aide Certification Exam Payment Option – Prometric cannot accept credit care payments due to the way their contract for payment with DOH is structured. DOH staff agreed this is an issue that needs to be resolved at some point. The current Prometric electronic system for certifying and recertifying CNAs requires the CNA’s email address. There have been times when a CNA does not have an email address and/or they refuse to supply it. In those cases, Prometric has said the facility may use the facility email address, however, then they will communicate through the facility rather than directly to the CNA. The suggestion was made that CNAs be required to supply an email address if this is the mode that will be used to communicate with them regarding their certification status.

QIS Update - The top three F tags cited since October are F 371 Kitchen Sanitation, F 280 Care Planning and F323 Accidents. DOH reports their sanitarians are finding serious infection control and food handling issues in kitchens. We suggest regular audits of the kitchen/food service area using the surveyor QIS “Kitchen/Food Service Observation” tool (CMS-20055).  Several months ago, DOH convened a work group of representatives from the associations to assist providers with the issue of Medication Administration and DOH has seen a marked decrease in citations related to that issue. They also reported a decrease in Immediate Jeopardy citations for the last FY, down by 25%. Both the pressure ulcer rate (7.6% now from a high of 13%) and the use of unnecessary antipsychotics (down 17.2%) throughout NYS have decreased as well. We have requested DOH provide us with a 2014 annual report of survey data in January for both the QIS and Traditional surveys and an organizational chart including Regional Program Directors.

Ebola Update – Deb Sattalano reports that she is preparing an after-action report of the Ebola cases that occurred in NYS. DOH has prepared guidance and anticipate it will be released soon. She confirmed that nursing homes are not required to monitor the health status of employees returning from Ebola affected areas because they will have been screened at the airport and monitored by their local health department. The LHD will make the decision as to whether they can return to work (when asked, she was not sure if the LHD provided the person with any documentation releasing them to work but she will check). NHs should not be admitting anyone from the community who is being monitored through the LHD for exposure to Ebola.

Life Safety - DOH noted they have evaluated a few citations in the downstate area related to the emergency supply of power and the life safety code. DOH agrees some may have been cited without evaluating the age of the building and the life safety code at this time. SNF can be grandfathered in with some of the codes based on these factors. DOH is currently working with those facilities to clarify and/or correct.

E-Prescribing - The group discussed the current situation with implementation. Point Click Care seems to be the leader in EHR vendors getting ready to test their systems, but most are not ready even to test, and many SNF don’t even have an EHR system. NYSHFA and DOH have asked BNE for a follow up meeting and will continue to pursue.

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