The app aims to improve the exchange of patient information and better inform the care provided to nursing home patients. It bridges the gap between medical records systems that use different data storage technologies and offers patient information in a format influenced by nursing home workers themselves.

The development stems from a study that started with a team of experienced nursing home nurses identifying key data points and helping shape the way the tool works and its visual format. The process was detailed in the Journal of the American Medical Directors Association.

“The reason that people go to a nursing home after being hospitalized is due to their needs for additional support for medical complexity. Receiving information that is inaccurate or delayed ties the hands of the clinical providers in the nursing home, making it more difficult to provide safe and appropriate care at the time of transition,” co-developer and study author Kathleen Unroe told McKnight’s Long-Term Care News Friday. “Medications for pain or other medical conditions could be delayed due to a lack of up-to-date information.”

Some conditions, especially behavioral health needs, may also be missed by receiving facilities, and those facilities may be unequipped to treat such needs.

 “Not only can this place the patient’s health at risk, it can also put the health and safety of other residents (in the patient’s home or in a SNF), as well as provider staff, at risk,” CMS Director David Wright wrote in a memo to hospitals earlier this year. “These situations can cause avoidable readmissions, complications, and other adverse events.”

Robust info sharing helps staff

Preventing unnecessary readmissions is one of Unroe’s main areas of focus as a research scientist for the Regenstrief Institute at Indiana University.  She’s been bewildered by the lack of consistency or movement toward interoperability between healthcare settings.

“This is an issue we have had the technology to solve for a long time and I and other clinicians are frustrated that the situation varies so much by facility and by discharging hospital,” she said. “I appreciate that CMS is pushing hospitals to take responsibility for transmitting appropriate and timely information to nursing homes to support care transfers.”

The app development project focused on how critical information should be optimally presented and integrated into nursing home workflows. 

“A nursing home admission nurse or admitting physician should not have to sift through a pile of paper or dig through lengthy electronic health records to capture basic pieces of data that we need to know on each admission,” Unroe said.

The app provides “robust” information quickly to support what the research team called a seamless transition of care across settings, regardless of which electronic medical record systems the two facilities use. It addresses residents’ medical needs as well as what supports they might need for activities of daily living, explained co-author Joshua R Vest, PhD, of the Department of Health Policy and Management at Indiana University. 

And the benefits won’t necessarily be limited to patients, Unroe added.

“Costs of staff training are reduced if the time is put into thoughtful, user-centered design, such as the results presented in this study,” she said. “Increasing sophistication of medical record systems and a greater push for interoperability mean it is possible to get widespread solutions in nursing homes into use.”

Unroe now plans to advance the prototype into a fully scaled tool for broad use on computers and handheld devices. The researchers plan to test it in real time with actual transfers to confirm that it will support nursing home nurses “to efficiently and safely admit patients as well as to ensure that there is no disruption in the clinical care plan created by the hospital due to transition to a nursing home,” Regenstrief said in a press release.

This strategic move positions the facility to excel in representing itself to external stakeholders and, crucially, defending against potential reputational challenges. 

Since that writing, my conviction in the concept of appointing a data czar has only grown stronger. Several recent experiences have concretely shown how a dedicated individual in this role can make a substantial difference. These experiences allowed me a more comprehensive understanding of a data czar’s role in ensuring data integrity and contextualizing the data to uphold the reputation of their nursing home. I’ll talk about one of them here.

A recent courtroom case I took part in involved a frail elder admitted to a nursing home with several pressure ulcers, post-CVA. One of the ulcers became unstageable, and shortly after admission the resident was transferred back to the hospital, where he died. Although he resided in the nursing home for less than a month, the nursing home was being held accountable for the pressure ulcers. Low staffing was part of the complaint.

Plaintiffs commonly include low staffing in their complaints, and this case was no different. Here, the plaintiff relied upon staffing sheets, various depositions from staff and family, and their interpretation of the state’s staffing requirements. 

The defense cited PBJ data and presented a more precise analysis of the staffing requirements in the facility’s state. Both of these sources supported the idea that the nursing home met the federal and state staffing requirements. 

Related to the pressure ulcers, while I wasn’t providing expert testimony on them, I did point out that the plaintiff’s expert was using a contemporary MDS 3.0 definition of ulcer coding that didn’t align with the MDS coding conventions that were in place when the nursing home assessed the resident. Thus, the plaintiff’s conclusion of “MDS manipulation” wasn’t valid. 

All that said, as I stood in the courtroom, it became clear that while accurate and contextualized data is undeniably crucial, it has its limits. The jury’s preconceptions of nursing homes, their comfort level discussing sensitive subjects like death, and the emotional state of the plaintiff’s family all played pivotal roles in the proceedings. 

Throughout this legal battle, it became evident that my empathy to the resident’s family and to the nursing home, coupled with my steadfast focus on the nursing home’s data story, was the key to achieving a favorable outcome.

I’d like to acknowledge that finding a jury with a neutral opinion about nursing homes, and about aging in general, may be near impossible. The societal stigma attached to aging and death, and to the institutions associated with those realities, remains deeply ingrained no matter how we try to change it. 

In moments like these, I’m reminded of my favorite W. Edwards Deming quote: “Every system is perfectly designed to get the results it gets.” However, I’d like to take that concept a step further and add a twist. Despite systemic challenges, regulatory constraints, and reimbursement designs, the nursing home industry consistently exceeds what it’s expected to achieve. I fervently believe that this is due to the mission-driven individuals who work with the elderly. But perhaps that’s a topic for another blog!

As the “proxy” data czar during this courtroom case, my experience as a nurse working in nursing homes proved to be irreplaceable. In this role, I wasn’t just capable of telling the quantitative data story; I could also provide the vital qualitative perspective. It was the synergy between my data expertise and my deep understanding of the nursing home’s daily operations, as well as the human side of healthcare, that ultimately contributed to a positive outcome for the defense.

Data without subject matter expertise can be a double-edged sword, capable of being weaponized against you. However, the key to mounting a strong defense lies in knowing your data intimately and having the ability to tell your story in a way that only you can.

Furthermore, the empathy derived from working in a nursing home, where one understands the inherent joy and sadness of aging and the inevitable reality of death, is an invaluable asset. Compassion for residents and their families should be an essential part of the data czar’s job description.

Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

To provide affordable, sustainable, high-caliber, patient-centric care, SNFs increasingly need VBC strategies and advanced technology. 

Improving care quality in SNFs with technology

Care quality metrics are essential for achieving VBC success, and many VBC payment structures center around achieving quality metrics for a patient population. Advanced analytics are a critical success factor to provide the best solution to accurately measure and report on quality scores.

Analytics tools allow facilities to customize data that aligns with distinct organizational metrics and regulatory demands, allowing for flexibility to report on metrics specific to a region or patient cohort. These metrics offer actionable recommendations, allowing users to delve deeper into any metric and data source, fostering collaborative discussions and strategic decision-making.

To generate actionable insights that can help improve care from analytics software, providers need high-value data. That’s where most organizations run into significant challenges. 

Data for SNF patients can come from a variety of disparate sources, including: 

• Primary care providers
• Specialists
• Hospital facilities
• Ambulatory surgical centers
• Lab or imaging centers
• Pharmacies

When information from these sources is inaccessible in a patient’s record, it can seriously impact care quality. In some cases, those gaps can result in harmful (and avoidable) outcomes. Because datasets have different formats, file names and programming languages, integration becomes difficult or impossible. Application programming interfaces (APIs) are a step in the right direction, but even they can’t create seamless interoperability between siloed systems.

More advanced platforms can now normalize patient-specific data within a single “data lake” and enrich it to offer insights. This ensures everyone can access all the necessary information to achieve patient outcomes. That provides analytics with near-real-time data and predictive and prescriptive insights, offering transparency, efficiency and a path forward to improve outcomes. 

Decreasing total cost of care through predictive technology 

To curb adverse outcomes and reduce expenses, SNFs are incorporating predictive technology. They can leverage volumes of patient data insights to reduce more costly care events and the risk of post-discharge readmissions. AI models and algorithms have become central to advanced, preventive and early intervention-focused VBC. These technologies review information from past adverse events and predict the triggers that can lead to future ones. Over time, the software can further enhance its predictive accuracy as it analyzes more data.

For example, machine learning models in analytics software can predict the risk of post-surgical complications for patients with a comorbid chronic condition like diabetes who enters a SNF. Software can quickly sort these patients into a cohort so care teams know who needs additional surveillance or monitoring. Providers can take proactive steps that reduce the risk of adverse events, leading to better outcomes. 

Building a successful VBC network

Analytics technology offers SNFs valuable tools to foster efficient and cost-effective referral networks. These facilities are at the forefront of providing specialized care to patients with complex medical needs. For those participating in VBC programs, having a referral network of providers and facilities who are similarly focused on cost and quality improvements will improve their ability to achieve clinical and financial goals.

Analytics software specifically built for a VBC future enables these types of analyses. Organizations can evaluate and benchmark multiple cost, quality and patient satisfaction metrics to build a high-performing referral network. This ensures smooth transitions in care from acute to post-acute care environments, and after discharge.

Creating a patient-centered care facility

Putting patients at the center of their care is the goal of VBC, and SNFs play an essential role in reaching this goal. Data analytics and predictive modeling can help identify areas for improvement, enabling facilities to continually fine-tune processes and care plans. It’s a pivotal shift from reactive to proactive care, and a profound reshaping of long-term care delivery. 

Technology empowers VBC-focused care facilities to forge a sustainable path toward better outcomes and resource optimization while prioritizing timely interventions that effectively curtail acute events. Advancements in analytics capabilities and predictive tools facilitate informed decision-making based on quantitative insights, helping reach the ultimate goal of enhancing patient outcomes and experiences.

David L. Morris is Executive Vice President and Chief Commercial Officer at Cedar Gate Technologies, managing over 50M covered lives, and supporting over 118,000 providers, 178,000 self-funded employers, 300 health delivery systems, 330 IPAs and 80 MSOs. He has over 30 years of operational and executive leadership experience at blue chip companies throughout the healthcare ecosystem.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

As of late, there is increased scrutiny on the proper use of schizophrenia diagnoses, with investigations relying on proper documentation and background research of each patient. Most people support this. There’s certainly nothing wrong with wanting to prevent wrong diagnoses, and facilities shouldn’t have a problem producing internal documentation as well as supporting documents from referring clinicians. 

However, it’s important to focus on all the details. Many long-term care leaders have concerns that their star ratings could plunge amidst the ever-evolving protocols. Consider all the implications that could create following an investigation. For example, it’s possible that at one point a diagnosis was defensible and accurate but perhaps was not renewed because a resident has been actively on antipsychotics for a long time. 

These are the kinds of specific situations that can make audit preparation a challenge. Three questions can guide you, regardless of your circumstances. 

Is the data working for you?

Audit readiness is an excellent reason to revisit your digital and recordkeeping systems. If you struggle to rapidly access the information that auditors ask for, that can be a red flag.

Determine things like how secure your data is, especially if it is stored in the cloud, and how easy it is to access any record you need. If you’ve outsourced certain responsibilities, like HR or payroll, gather some questions from your organization’s business partner and set up a conversation to review protocols and practices. 

Do you have a thorough staffing plan in place?

It’s widely known that this is a tough labor market, but research proves a causal relationship between nursing home staffing levels and care quality and capabilities. Nonetheless, your workforce will need to be sufficiently up to par to the auditors’ satisfaction. 

If you already know this area is problematic, make it a top priority to put a plan together that contains action items and next steps. A practical approach would be to offer regular compliance-based training and record attendance of when and how employees received vital information to successfully and safely do their jobs.

One often overlooked, but critical, element of recruitment and retention is culture. Like other performance indicators, employment culture can be quantified, measured, goal-oriented and improved. At least some of the reasons why long-term care struggles with recruiting is an often unfair reputation that these careers’ rewards are drowned out by negative job aspects. While nursing care is unquestionably a challenge, creating a strong culture and supportive working environment is possible, manageable and controllable.

What are your care team partners doing?

Returning to the above example of CMS’ renewed and changing focus on schizophrenia diagnoses, think about how many other parties and participants are subject to this process. It isn’t just the resident’s primary clinician or specialist, but pharmacists, pharmacy staff and the diagnostic and prescription guidelines being used. 

You’re not assuming anyone is doing wrong by checking these details. The point instead is to be on the same page as everyone else concerning how residents should be diagnosed and treated. While this is important across the board, it’s especially essential that multi-state operators have robust systems in place to keep track of these relationships and any correlative information.

Nursing home and long-term care audits can and do change because regulatory and legislative standards shift. This isn’t news for tenured administrators and operators. However, it can easily become overwhelming to both stay informed of change and prepare your organization for minor pivots, rather than needing major overhauls – and this is especially true for multi-state operators. 

Planning is critical for success, so take full advantage of resources that keep you informed of changes in real-time. Be proactive in making changes as necessary and give your organization and all impacted parties the opportunity to prepare.

Brian Evans is Adams Keegan‘s Vice President and Senior Care Practice Leader. He has served clients in senior care and home health for more than 20 years, providing guidance on how to leverage people, technologies, and processes to remove administrative burdens and maintain compliance.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

I know you’ve thought that while reading a memo from the Centers for Medicare & Medicaid Services or your state agency, taking in a newspaper or TV report, listening to a politician speak, or even looking through your own policy and procedure manual. 

And I know you’ve thought that more than once. I certainly have during my career. Sadly, the person “laying down the truth,” the person who makes your eyes roll or blood boil, is often the one coming from a position of power.

Over the last few decades, I’ve tried to improve the quality of the nursing home industry, but it feels like I’ve spent just as much time giving explanations to external stakeholders who seem to hold dominion over the industry yet know so little about it. How could that be? They are confident, often armed with data. And since their self-determined insights are “data-driven,” doesn’t that mean they are true? 

Thanks to The New York Times and many other news outlets, plaintiff attorneys, insurers, government bureaucrats, and external stakeholders, I’ve realized that data without subject matter expertise is more harmful than the absence of data. Why? Because data without subject matter expertise can be weaponized against you.

It is essential, therefore, to not allow your data story to be told absent of you, the subject matter expert. I liken it to an opinion piece written by ChatGPT. (Incidentally, I tried writing this blog using ChatGPT. It was fascinating, frightening and laughable.) Without true subject matter expertise, something written by ChatGPT cannot account for context, delve for insights, or express any actual knowledge. 

Instead, all the AI tool can currently produce is a collection of generally accepted concepts that skim the surface of the topic. People who have data but don’t truly understand it can do little better.

To better illustrate my point, I recall the last couple of cases in which I provided expert witness support to the defense team. In each case, the nursing home was being sued and accused of inadequate staffing, among other things. What happened at the bedside could not be determined from PBJ data and cost reports, but regardless, the plaintiff’s attorneys were using this data to present conclusions about care to the jury. Elements of Five-Star, the STRIVE study and staffing sheets were selectively used to present “their” data-driven narrative. What was absent from these cases was deep subject matter expertise — but that was my job.

The data story that I was able to tell was far more compelling. The nursing home wasn’t perfect, but with additional data and deeper insight into how it could and could not be aligned, I was able to authentically represent the home in a far more balanced manner. 

The nursing home was caring for a unique population (people with mental illness) that necessitated the creation of customized benchmarks. These benchmarks included nursing homes caring for similar types of residents in similar markets. With this insight, I was able to supply meaningful context on the nursing home’s staffing patterns, clinical outcomes and regulatory compliance. Healthcare is not a national industry, nor do all nursing homes care for the same residents, so a completely different perspective emerged once appropriate benchmarks were considered. 

To be clear, the need to be your own “data defender” isn’t limited to the courtroom. In our Advisory Services at Zimmet Healthcare Group, we often work with lenders. In a recent project, we were evaluating an operator who was seeking refinancing for a recently acquired portfolio. The Five-Star system and PBJ metrics told a not-so-favorable story. Add to that mix a very concerning regulatory history including SFF candidacy, and on the first pass, the lender didn’t feel positive toward this operator. 

However, a deeper, more thoughtful understanding of these nursing homes’ data, in relation to when this operator took over the facilities and in the context of the operator’s regional peer group, revealed a different story. 

The nursing homes with the most troubled regulatory history as reported through Five-Star and SFF had performance being principally driven by Cycle 2 and Cycle 3 survey periods. In most markets, that could mean anywhere from a year and a half ago to three-and-a-half years ago. However, for these particularly troubled nursing homes, the average interval between annual surveys was more than 700 days! In other words, the new operator was carrying the negative results of the prior owner and would be doing so for several more years. Putting this and other findings into context significantly changed the perception of the operator’s portfolio, and we were able to establish appropriate and more stable short-term success metrics. 

So, how can you be your own data defender? 

First, someone in your organization must be anointed the “data czar.” It’s a big responsibility, and it should come with a corner office with views of the mountains — but in reality, a cup of coffee and a sincere thank you might do just fine. If you don’t have the time or talent to fill this role in-house, it can be outsourced. Either way, it is essential. 

Secondly, the data czar must ensure the accuracy and integrity of all the data that you produce. Likely you have these processes in place already, but having a centralized view of all your data is an additional layer of protection.

Thirdly, the data czar should periodically examine your complete data profile. What story does the data tell? Does the story have inconsistencies or gaps? Is the story consistent with your marketing messages, accurately describing the care that is being rendered? Do you need additional data sets to tell the story better or more credibly?  

Data without subject matter expertise can be weaponized against you, but you can mount a defense by knowing your own data and telling your own story as only you can. If you do, you’ll find that data can guide and protect you while illuminating the path of quality improvement. 

Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

Early this year, the Office of National Coordinator approved the first six qualified health information network (QHIN) candidates to implement the Trusted Exchange Framework and Common Agreement (TEFCA) to support the interoperability of health records.

Over nearly two decades, the federal government and the healthcare industry have spent billions to implement electronic health records in physician practices and hospitals. But government incentives under Meaningful Use did not extend to post-acute care providers. These providers often rely on paper documents for transfer and discharge, papers that can get lost or misplaced and compromise patient care. 

Every patient — regardless of age, race, sex, location, and non-medical social determinants of health (SDOH) — deserves the same access to quality care. Likewise, every care setting, including post-acute care and skilled nursing facilities, needs the same access to secure patient health information in order to provide equal care. 

But as interoperability marches on, many post-acute care providers are being left behind.

Rather than more regulation, post-acute providers need technology that allows them to easily exchange digital documentation and information with other healthcare providers as well as food banks, social workers, charitable housing associations, and other community providers. 

Digital fax provides a viable option for effective data exchange

While the physical fax machine has limited utility beyond mere data transmission, digital cloud fax solutions, on the other hand, can close the technology gap and pave the way for equitable care.

Simply put, paper faxing processes do not meet the security or privacy requirements to enable interoperability across all care settings. However, digital faxing solutions are available today that can solve that problem. Digital cloud faxing, when combined with new technologies like NLP and AI, can intelligently extract vital information from unstructured digital faxes. The data extracted can be used to easily exchange information in an accepted format that both enables interoperability and promotes better health outcomes.

Population health extends well beyond providers

The idea of health equity extends beyond the healthcare setting and providers to encompass the social determinants of health (SDOH). In broad terms, a person’s health is determined by:

• Socioeconomic status: education, income, employment status, family/social support and community safety (40%)
• Health behaviors such as smoking, drug/alcohol use, sexual habits, diet/exercise (30%)
• Access to healthcare and the quality of that care (20%)
• Physical environment (10%)

Eighty percent of physicians believe that the United States cannot improve health outcomes and reduce expenses without addressing SDOH issues, according to a national physician survey. Nearly all physicians (94%) believe that at least one SDOH issue affects outcomes among their patients, which causes stress on a weekly basis. Those frustrations include:

• Limited time during a patient visit to discuss SDOH (71%)
• Insufficient workforce to help patients navigate community resources (64%)
• Unavailable, inadequate, or difficult-to-access community resources (57%)

As interoperability becomes more commonplace, communication will improve among providers and hospitals with EHR systems or similar technology as patients move between care settings. 

But until post-acute care facilities and social services organizations have a similar level of interoperability sophistication, communications will lag or be disrupted as patients move to post-acute care or community-based services. Current interoperability efforts create an uneven playing field between the haves and have nots that exclude many post-acute care facilities from accessing the same data available to those with EHR technology or similar systems.

Post-acute care providers lack sophisticated interoperability technology

Consider Grace Cordovano’s heart-wrenching LinkedIn video post from March, where she described the unnecessary suffering a patient with metastatic cancer endured because an order for hospice was not included with a patient’s discharge instructions provided to skilled nursing. It was after 5 p.m. on a Friday, and no one from the hospice agency was answering the phone. It’s unclear whether information was missing or hadn’t been ordered in the first place. Regardless, the patient was in agony, and Cordovano could do nothing but weep over the plight of the patient.

If discharge papers had been sent via digital cloud fax, before the patient showed up at the SNF, the nursing staff would have had ample time to contact hospice for enrollment confirmation or to ensure that the proper arrangements had been made. Because of the lack of earlier federal incentives, many post-acute providers, which can’t afford to implement the full cost of an EHR, don’t have management systems capable of exchanging data that meets emerging interoperability standards, such as HL7 FHIR (Fast Health Interoperability Resources). And community-based organizations do not have the means or systems in place to exchange data that support patients with food and housing insecurities and other SDOH needs.

Common standards for equitable care

Imagine patient information being sent securely to post-acute providers or social services organizations with the actionable patient data needed to populate intake forms, order prescriptions, or check on the status of social services.

Significant efforts are underway to create common data standards and terminology on SDOH factors to facilitate effective data exchange among providers and other sectors. However, locking providers into one data exchange method doesn’t truly advance interoperable care at all access points or every care setting. When the industry is encouraged to innovate and solve problems such as equal access to digital exchange of patient information, solutions emerge that provide the easy on ramp for post-acute care. 

Acute care hospitals with advanced interoperability systems can start with a FHIR message and easily convert the data to send it as a digital fax. With the right technology, post-acute settings can also ensure that interoperability standards are met (at an attainable price) by upgrading obsolete paper-fax processes to a digital fax platform and adding new technologies in an integrated environment to easily turn digital data into a FHIR message.

Health equity is about ensuring that patients receive the highest level of care, regardless of status or social factors. But, until all care providers are equipped with the right kinds of tools and solutions to effectively exchange data, true health equity will not be available for many who need it most.

Bevey Miner is Executive Vice President, Healthcare Strategy and Policy for Consensus Cloud Solutions.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

Jurutka started as vice president of senior housing for the Denver-based IMA Financial Group about a month ago. He is charged with increasing the skilled nursing and senior housing business for the insurance brokerage firm, which specializes in risk management, insurance, wholesale brokerage and wealth management.

This comes after more than seven years as president of NIC, with two of those also including the title of CEO. He departed NIC last fall.

Jurutka told McKnight’s that he was attracted to the position by IMA’s status as an employee-owned organization “full of good people” as well as the chance to “do something that’s meaningful.”

“That’s certainly something at NIC that I felt every single day. If we did a good job, old Americans benefit,” he said. “And I really, truly believe that same opportunity exists at IMA as well. From a culture perspective, there’s a big component of IMA that is also giving back to the community that you live in.”

Jurutka said that data is the “the thread throughout everything” he’s done over the course of his career. Before joining NIC, he served in the Navy as a nuclear submarine officer; at comScore Inc., a digital analytics company where he was senior vice president of the wireless operator analytics division; and Capital One Direct Banking, where he managed the company’s first deposit product partnership and oversaw strategic partnerships.

“I am kind of a data guy,” Jurutka said. Now, he plans to use data to benefit the long-term care industry.

“Part of what I am hoping to accomplish in the longer term would be having the opportunity to use data to help tell a story around the seniors housing space and ideally look for those solutions that help lower risk for residents, which in turn should lower risk for operators, which should give insurers the opportunity to say, ‘Hey, yeah, let’s get engaged, involved in seniors housing,” Jurutka said. “And that is a very similar mission, from that perspective, to what NIC does, just from a different lens.”

‘Be part of that solution’

While at NIC, he said, he often heard those in the industry speak of the current “tough” insurance market.

“What I mean by that is, all the increases in insurance premiums that have occurred and, quite frankly, instances where deals were falling through because insurance premiums have increased two times, three times, over a very short time period,” Jurutka said. Now, he says, he feels “like there was an opportunity to be part of that solution, to work with a team to ultimately try to craft solutions that are going to benefit operators and owners.”

IMA, he said, has more than 2,000 associates and affiliates across the country. They can cover everything from property and casualty to workers’ comp to benefits, he noted.

“There are world-class skill sets across the entire range of commercial insurance, and so this is an opportunity to pull together the appropriate team to provide solutions in the seniors housing and skilled nursing space, everything from property and casualty to workers’ comp to benefits,” he said. “I have the opportunity of essentially drawing on those resources to put together solutions that are going to help operators. And I’d love to also find solutions that ultimately are also going to lower the risk for residents.”

Some of those solutions, he said, could come in areas related to COVID-19, staffing, inflation and the unpredictability of supply lines.

“One of the big pieces right now, particularly in the insurance world, has been around replacement value associated with properties,” he said. “In the seniors housing space, market values have actually been coming down, on average, but the replacement value — if a community is lost in a flood or it burns down — those prices have been going up because of inflation, because of lack of labor and because of uncertainty associated with supply lines turning a six-month project into nine months. That all has an impact from an overall insurance perspective, because those costs are rising as well.”

Longer-term issues across all congregate care settings for older adults, he said, involve the increasing health needs of residents as well as natural disasters.

“Insurers to some extent [are] pulling back on the amount of risk they’re willing to take,” Jurutka said. For operators, that translates into “instead of just going to one insurer to get a $25 million rights liability insurance, or whatever that might be, or umbrella, you may have to go to three or four different insurers to get that limit, which just takes time, energy and efforts.”

The senior care and living industry also is seeing an increase in what the insurance industry calls “nuclear verdicts,” which are “settlements where in some instances the verdict itself may be seemingly disproportionate and that make headlines relative to the claim,” he said.

Such verdicts often may relate to resident falls or, especially in the case of skilled nursing, pressure injuries, Jurutka said.

For operators, he said, “it means that’s the opportunity to document a lot of that, but it also means if you have a lot of turnover associated with your staff, that’s a challenge in some instances, so you have to look for programs, systems, processes that will allow you to go ahead and minimize some of those risks in a higher-acuity setting relative to others.”

Another hot topic related to insurance, Jurutka said, involves insuring properly against property values. 

Much to be proud of

Looking back at his time leading NIC, Jurutka said he was proud that the organization earned Great Place to Work status.

He also said that he was “incredibly proud” of the weekly calls that he and other leaders of organizations serving the long-term care industry held during the height of the pandemic. Those taking part included American Health Care Association / National Center for Assisted Living President and CEO Mark Parkinson, American Seniors Housing Association President and CEO David Schless; Argentum President and CEO James Balda and LeadingAge President; and CEO Katie Smith Sloan.

The senior living and care industry, he noted, “was the epicenter of COVID, and it was rewarding, the small part that NIC played in that, and the significant part that many of the lobbying associations played, to help ensure that seniors housing and skilled nursing was getting recognized.”

Jurutka said he’s looking forward to reconnecting in person at the NIC Fall Conference. He has been serving as an adviser to NIC since he left as president and CEO. Raymond Braun succeeded Jurutka at the helm.

“Any way I can help Ray, and any way I can help NIC succeed, I’m willing to do that. It’s a fantastic organization,” Jurutka said, adding that he is excited about NIC’s strategic plan and upcoming first-ever Data & Analytics Conference.

“I’m super-humbled to have been on the front line of seeing a lot of that growth and seeing how a lot of that has come together from a planning perspective, and I’m very optimistic and very excited for the future,” Jurutka said.

While most COVID-19 surveillance data sources will continue to be available after the PHE ends, national reporting of certain categories of COVID-19 public health surveillance data will be transitioned to other data sources or be discontinued, according to the Centers for Disease Control and Prevention. This includes COVID-19 community levels (CCL), which long-term care facilities have used to determine transmission risk along with the cadence of viral testing and other mitigation measures. 

CCL relied in part on aggregate case rates, which some jurisdictions may no longer report after the PHE ends. 

“[T]he end of the public health emergency means that CDC will have less authority to collect certain types of public health data,” said Brendan Jackson, MD, head of CDC’s COVID-19 response, in a May 5 briefing. Although that means less data will be available to federal health agencies, “we will have good sightlines into COVID-19,” he added. 

With this future dearth of data in sight, the CDC studied potential backup sources. Based on a study, its researchers have found that hospital admission data will be a strong indicator of COVID-19 status at the local level, Nirav Shah, MD, principal deputy director, said in the same briefing. “In short, we will still be able to tell that it’s snowing, even though we’re no longer counting every snowflake.”

In addition to this hospital data, the CDC will now rely on percentages of positive test results, COVID-19 emergency department visits and COVID-19 deaths. All of these were found to be “suitable and timely indicators of trends in COVID-19 activity and severity,” according to the study, published this week in the CDC’s Morbidity and Mortality Weekly Report. The agency details these and other sources of continuing COVID-19 surveillance data in a May 5 report.

As COVID-19 response is downgraded from pandemic emergency to public health priority,  “We have the right data for this phase of COVID-19,” Shah said.

In related news, the CDC has also this year established the Coronavirus and Other Respiratory Viruses Division, which works with states and other U.S. jurisdictions on COVID-19 prevention. The division, within the National Center for Immunization and Respiratory Diseases, also monitors other circulating respiratory viruses such as influenza and respiratory syncytial virus, and supports prevention measures, including immunization.

Related articles:

Study: Shift to home COVID tests leads to vast undercount of cases

Thursday only heightened frustrations as regulators projected that an interpretive manual and training sessions could still be as long as five months or more away, leaving providers just a few months before an Oct. 1, 2023, implementation date.

Centers for Medicare & Medicaid Services leaders originally indicated that new MDS v1.18.11 data sets would be delivered by the end of this year. That window is closing rapidly. In addition, on Thursday, agency officials told listeners on the agency’s SNF/LTC Open Door Form conference call that the RAI interpretive manual will “probably” be ready in the second quarter of 2023 and training sessions will “probably” be in mid-May, and workshops in June.

In the meantime, skilled nursing providers were advised to take their cues from CMS guidance for other care sectors.

“They seem to think that we can use trainings that have been posted for home health, IRF and LTCH settings related to the standard items that are found on those tools as well,” rued Joel VanEaton, executive vice president of PAC Regulatory Affairs and Education with Broad River Rehab, in a follow-up interview with McKnight’s Long-Term Care News. 

It was Van Eaton’s question during the forum’s call that set off the disappointing answers from regulators.

“Unfortunately, notwithstanding the fact that these were developed for other settings,” he said, “it appears that those are not specifically related to the items we will be most concerned with, namely the new items like the SPADEs (Standardized Patient Assessment Data Elements), TOH (transfer of health information) items and significant revisions to section N and O etc.”

Pregnant pauses during the Q&A part of the call were particularly telling, VanEaton and others felt.

“It was noteworthy that they seemingly have no thought on how we will have to adjust to the effect that the elimination of section G items will have on the QMs, CAAs, staffing acuity and so forth, as they did not know if the trainings that are forthcoming address this issue,” VanEaton noted.

The pace of information reveal is especially bothersome because providers are expecting residual effects in numerous areas affected by the MDS, such as Care Area Assessments, quality measures and Five-Star ratings. 

Others, including software developers, will need to devise new processes based on the MDS specifications that aren’t yet finalized, noted expert Leah Klusch at the time of the draft release. The executive director of the Alliance Training Center, Klusch noted that it also was not known how the payment process will be affected by changed MDS items.

“The industry will not be completely up to speed by Oct. 1 with this timeline,” said VanEaton. “CMS had these changes completed two years ago (but were held back due to the pandemic). My question is why is it taking so long to get us resources? As of today, Dec. 8, all we have so far is the draft comprehensive data set. We have a lot to learn beyond just the data set changes.”

Another caller asked whether the new MDS format would include any changes in hearing or vision assessments since “they are currently subjective assessments, which is not a valid, objective way of assessing” and discussions with CMS about them had begun in 2017.

“When somebody has a hearing problem, it could be seen as a mental or cognitive disorder,” the physician said. “Unfortunately, speech professionals are not screening hearing before doing an evaluation. Ninety percent of people in facilities have a hearing problem.”

There are no changes in this area of the new version, an agency spokeswoman said.

My happy place is standing in front of nursing home providers and honoring them through education. Shining a loving light on these special people and honoring their commitment to better care feeds my soul. So when Moshe Kelman asked me to present at his provider organization’s annual educational/holiday conference, I gleefully accepted. 

“We want to celebrate our staff through education and honoring them in many ways. They are truly amazing,” Mr. Kelman shared. And I agree.

I was asked to present on “the data deluge”: which metrics matter the most and how to best focus on them. The conference attendees would be a mix of administrative and clinical leadership, along with a diverse group of professionals from each facility. Fun! But as the event approached, I wasn’t certain of the best insights to share. What data or metric should be the focal point?

For years I would have answered this call with Five-Star, but not anymore. Overall Five-Star is too broad to be considered “focused.” My number two choice would have been the many hospital utilization metrics; there are so many of them, and like Five-Star, they hook into pretty much everything in post-acute care — including Five-Star, SNF Value-Based Purchasing (VBP), and, ultimately, occupancy. 

Thankfully, I didn’t have to dwell too long in my sea of uncertainty. The Centers for Medicare & Medicaid Services has made it clear what the new focus must be — staffing. Let me make my case.

1. President Biden’s remarks and accompanying fact sheet during his State of the Union address on Feb. 28, 2022, indicated that he will establish a new minimum staffing ratio to protect residents.
2. In July 2022, CMS enhanced Five-Star by adding staffing metrics that call out weekend staffing and turnover rates.
3. Additionally, beginning in July, providers could no longer receive an extra “bonus star” for staffing at a 4-star level. 
4. On Oct. 21, 2022, CMS revised the Special Focus Facility (SFF) program and made the following statement: “Given the importance of staffing and its relationship to quality, CMS is informing SAs [State Survey Agencies] to consider a facility’s staffing when selecting an SFF. For example, if a SA is considering two SFF candidates with a similar compliance history, CMS recommends selecting the facility with lower staffing.”
5. In the FY 2023 SNF PPS final rule, CMS adopted a measure looking at total nurse staffing hours per resident day for the 2026 program year. This measure includes registered nurses, licensed practical nurses, and nurse aides.”
6. In that same final rule, CMS sought stakeholder input on other measures under consideration for the SNF VBP Program, including a staffing turnover measure.

These six reasons are why I elected to highlight staffing data/metrics within my “data deluge” presentation. I didn’t need to solely lean into CMS activities to support my choice; a growing body of professional peer-reviewed evidence is making connections between quality outcomes and staffing. The conference participants have done an outstanding job not only in creating these connections at their facilities, but also improving their staffing metrics.

Yet the CMS measures don’t tell the whole story. We have been wrong to focus only on nursing staff. This ongoing mistake has hurt our industry, our residents and their outcomes. The best way to meet the needs of our frail elderly population is through interdisciplinary teams. 

The initiatives listed above put too much emphasis on nursing and devalue other disciplines. They disincentivize nursing homes from investing in social workers, recreational therapists, dietitians, physical/occupational/speech therapists, and properly credentialed medical professionals. 

Many thanks to my friends in Kentucky and New York for allowing me to speak with your truly inspiring teams!

Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.