What are your top tips for participating in an accountable care organization or other multi-provider arrangement?

Post-acute organizations that serve seniors are increasingly being faced with payors offering “value-based” contracts and fewer fee-for-services contracts. 

Many states are implementing Medicaid managed care programs to reduce their costs. Since the ACOs and other payors are focusing on value-based contracting, post-acute care providers must factor in the following:

1. Show you are cost-effective and efficient (reduced unit price).

2. Show you have full services (home care, rehab, subacute Medicare, case management).

3. Establish protocols and practices to reduce hospital readmission.

4. What services are you contracting to provide, and at what price?

5. What policies and procedures of the payor are being incorporated into the contracts?

6. How you establish that higher quality is being provided.

7. How you and the payor establish that you are a lower-cost provider.

8. Under the contract, do you share in the costs-saving bonuses or increased payments received by the payor, and do you share in the risk if there are no cost savings?

9. Do you help the payor establish cost saving or readmission reducing protocols, or establish other wellness outcomes by patient populations?

10. Should you become a part owner of the ACO and/or have a representative serve on the board of directors?

11. Can you help design how an ACO or provider keeps its data?

Undertaking risk-sharing and value-based contracting with payors will increase in importance and the process for such contracting should not be taken lightly.

Delirium among skilled nursing residents needs to be treated more seriously than it currently is by providers, according to authors of a recent research review.

Researchers found that delirium affects nearly 1 in 5 long-term care residents, but often goes undiagnosed or misdiagnosed in seniors due to the similarities of its symptoms to dementia. 

Residents also were more likely to show delirium symptoms if there was no clock or telephone in their room, the authors found.

Results of the review are in the Journal of the American Osteopathic Association.

Federal officials struck back at providers in January, filing notice that they were challenging efforts to stop a ban of pre-dispute nursing home arbitration agreements.

It was unknown at press time, however, what the new administration might pursue on the matter.

Health and Human Services Secretary Sylvia Mathews Burwell and Centers for Medicare & Medicaid Services administrator Andrew M. Slavitt appealed a judge’s injunction that effectively allows the agreements to continue. The judge’s decision in November was part of a lawsuit launched in October by the American Health Care Association against HHS.

“An injunction is necessary and appropriate, as it will allow the court time to examine the arbitration ban,” Beth Martino, senior vice president of public affairs for the American Health Care Association, told McKnight’s.

LeadingAge’s policy team said in a statement that the organization is “not surprised, but nevertheless disappointed” that CMS is choosing to appeal the injunction.

“LeadingAge supports the use of arbitration to resolve disputes,” organization officials said. 

LeadingAge, along with 71 other nonprofit aging organizations, sent a letter in mid-January urging then-President-elect Donald Trump to preserve some nursing-home related provisions of the Affordable Care Act.

The Leadership Council of Aging Organizations’ letter championed 12 aging-specific provisions that “have broad support and should remain intact.” 

Among them are segments aimed at improving nursing home quality standards, combating elder abuse, extending Medicare solvency and creating new demonstration programs under the Center for Medicare and Medicaid Innovation.

“These recommendations
represent the common ground among our organizations,” wrote Katie Smith Sloan, president of LeadingAge and chairwoman of LCAO. “If changes to the ACA affecting older Americans are considered, we respectfully request that you engage and work with LCAO.”

Providers can make good use of some new strategies and tips to be prepared for surveyors around the clock, says Paula Sanders, principal and co-chairwoman of the Health Care Practice Group at law firm Post & Schell P.C.

Sanders will provide just that as a featured speaker at the 11th annual McKnight’s Online Expo, which runs March 14-15. 

The free virtual trade show, which has attracted thousands of LTC professionals annually, offers up to five CE credits. 

Other sessions will cover Medicare compliance, assessing injuries for potential malfeasance, capital trends and how providers can make better use of available data. Registration is ongoing.

“Should I stay or should I go now?

If I go there will be trouble,

And if I stay it will be double.”

Mick Jones allegedly wrote “Should I stay or should I go” in 1981 while contemplating whether to leave The Clash. The context may be different this time, but many long-term care operators can well relate to the song’s sentiment.

This time, however, the choice is not about musical allegiance. Rather, it relates to whether facilities should comply with temporarily shelved overtime rules.

The Department of Labor’s updated overtime regulation was supposed to take effect in December. It would have instantly made most skilled care employees eligible to earn more pay for work exceeding 40 hours a week. Currently, salaried exempt workers who earn $23,660 or more a year (or $455 per week) do not automatically qualify for additional pay. The regulation would have doubled the yearly threshold to $47,476.

Most facilities have spent grueling months adjusting schedules, duties and even salaries in order to prepare. But a federal judge’s temporary injunction has put the rule’s legality — and future — in doubt.

Judge Amos L. Mazzant III ruled that the Obama administration overstepped its bounds by increasing overtime limits so dramatically. Long-term care industry lobbyists quickly hailed the Nov. 22 decision. They added that the new rules would have required higher outlays for operators, and meant fewer hours of work for many front line employees.

The Labor Department responded predictably, by filing an appeal.

“The Department’s Overtime Final Rule is the result of a comprehensive, inclusive rule-making process, and we remain confident in the legality of all aspects of the rule,” the department said.

At this point, it’s unclear how hard the department wants to push that confidence. After all, a new president from a different party was sworn in on Jan. 20. 

So we’ll see what happens. For now, the best advice is probably this: Try not to do anything you’ll regret later.

Investigators at the National Institute for Occupational Safety and Health (NIOSH) and their Canadian partners reported that cognitive impairment is the same among men and women who work shifts, despite the fact that women typically get less sleep and have more work-related stress.

The findings were published in November’s Occupational and Environmental Medicine.

Researchers at NIOSH and the Institute for Work and Health in Toronto found health and age played an important role in cognition directly and through sleep.

The findings also underscore the need for occupational health and safety programs that address cognitive function among all shift workers. They conclude that such programs should focus on stress, health and sleep hygiene to improve quality.

The study used data from 4,255 respondents to Canada’s National Population Health Survey in 2010. The participants’ average age was 43, and slightly more than half were women. 

All participants held jobs, with 75% working regular daytime hours and the remainder working either shift hours, rotating day and night hours, or on-call hours.

An online support program helped nurses manage workplace challenges and reduce stress in a randomized study.

Participants using BREATHE: Stress Management for Nurses experienced significantly greater reductions than a control group on the full Nursing Stress Scale, and six of seven subscales. Results were published in November’s issue of Applied Nursing Research.

Those with more nursing experience derived more benefit, according to Rebekah K. Hersch, Ph.D., owner of ISA Associates, a behavioral science research group that  developed BREATHE. The program is designed to give nurses the skills needed to deal with occupational stressors.

“[S]chedules and workloads of nurses can pose problems for implementing in-person interventions,” the authors wrote. “Web-based interventions might be ideally suited to addressing the high levels of stress among nurses.”

BREATHE tackles issues such as death and dying, staff conflict and heavy workload. In the study, 104 nurses at six hospitals in Virginia and New York participated as desired over a three-month period, with an average of 2.5 log-ins.

In pretests and posttests, they described coping mechanisms across modules for perceived stress, symptoms of distress, work limitations, job satisfaction, use of substances to relieve stress, and understanding depression and anxiety. 

I struggle with staying in touch with what is happening at the bedside. Any suggestions?

This is a fabulous question. Adopting a routine approach to conducting rounds can be a powerful tool to assess clinical care and customer experience, and to build morale.  

Setting the intention for the purpose of rounding is key. Clinical rounds can have the general focus of assessing general care, staffing levels and deployment. Or rounds can be specific, such as assessing for proper clinical management of residents who have had a change in condition or for evidence of comfort, cleanliness and positioning. Teams that conduct interdisciplinary walking rounds can reinforce resident engagement in care and support a prompt, holistic response to the needs of the resident. 

Rounding with the rehab manager can be effective for finding opportunities for clinically appropriate therapy interventions for residents triggering on the center’s Quality Measures Resident Roster Matrix.  

A nursing director can round with a nurse or a certified nursing assistant to learn how the care associate is interacting with their residents and families, and observe how care is being delivered. This offers opportunities to acknowledge care excellence, and provides teaching moments.  

One of my favorites to rounding uses the “Studer” approaches for promoting staff engagement and building relationships with the team. The DNS asks the following questions while rounding: Is there someone I can acknowledge today for doing a good job? Do you have the equipment you need to meet the care needs of your residents? What is working? What is not working?  

So, make an appointment with yourself to round regularly. Through routine rounding, you will keep your finger on the clinical pulse of your facility.

A Pennsylvania-based healthcare provider has agreed to hand over $300,000 to settle allegations that it fired employees who requested religious exemptions from the organization’s vaccination policy.

Saint Vincent Health Center in Erie, PA, was sued by the U.S. Equal Employment Opportunity Commission after six employees claimed they were unfairly terminated because they asked for an exemption from the providers’ mandatory seasonal flu vaccination requirement.

The policy stated that workers who received an exemption for religious or medical reasons could instead wear a facemask while caring for patients during flu season.

The employees who requested the religious exemptions were denied; during that same period, the EEOC’s suit claimed, 14 other workers were granted exemptions for medical reasons. When the six workers continued to refuse the vaccine, they were fired, the EEOC said.

In a statement to
McKnight’s, spokesman Daniel Laurent said Saint Vincent “respectfully” disagrees with the EEOC’s claims, and reached the settlement in order to avoid the costs and burden of further litigation.

“We continue to believe that annual vaccination for influenza among healthcare professionals is in the best interests of our patients and our employees, and we will continue to provide easy access to vaccinations at Saint Vincent and across our organization for the many employees who voluntarily receive them each year,” the statement added.

Saint Vincent agreed to pay damages and back pay to the employees, and reinstate them to their positions, according to the December EEOC settlement. In addition, Saint Vincent must grant religious exemptions to its vaccination policy if it continues to be a condition of employment, unless an exemption “poses an undue hardship on the health center’s operation,” the EEOC said.