SLIDE 1 Department of Health Care Finance (DHCF) & Comagine Health
Nursing Facility Quality Improvement Collaborative
2020 Outcomes Congress
October 29, 2020
SLIDE 2
- 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.
Comagine Health
SLIDE 3
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
SLIDE 4 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
SLIDE 5 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
SLIDE 6 Collaborative Year Two - DHCF Nursing Facility Quality Improvement Measures
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)
Source: DHCF
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) 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)
SLIDE 7 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
- f 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
SLIDE 8 Nursing Facility Quality Improvement Collaborative Model
WE ARE HERE! 4 Virtual Learning Webinars
SLIDE 9
SLIDE 10 Collaborative Tools & Resources
DHCF Nursing Facility QI Collaborative Website https://dhcf.dc.gov/node/1390591
SLIDE 11 Comagine Health Nursing Facility QI Collaborative Website
http://www.qualishealth.org/healthcare-professionals/collaborative-dc-medicaid
SLIDE 12
Collaborative Year 3 (Y3) – What’s Next?
SLIDE 13 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
SLIDE 14
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
SLIDE 15
Gwen Cox, RN Edy Taylor, RMA
2020 Outcomes Congress – Advance Care Planning
SLIDE 16 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.
Advance Care Planning
SLIDE 17
Poll Question 1
SLIDE 18 This Photo by Unknown Author is licensed under CC BY-SA
SLIDE 19 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.
SLIDE 20 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
SLIDE 21
Poll Question 2
SLIDE 22
Why Advance Care Planning Is Important
SLIDE 23 Importance for Both
Facility
- Enhances patient-centered
care and strengthens the provider-patient relationship
- The facility will understand
the patient’s wishes and guide treatment accordingly
- Facility can assist the patient
and family by providing compassionate care and education on end of life discussions.
Patient
- Allows an individual to express
their preferences on what is important at the end of their life
- More likely to have patient
preferences known and honored
- Reduces the emotional burden
and cost of unwanted interventions
- Improves family coping
- Reduces the burden on
caregivers
SLIDE 24
Durable Power of Attorney for Health Care (POA)
SLIDE 25 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.
SLIDE 26
Poll Question 3
SLIDE 27
Identifying Residents for ACP Engagement
SLIDE 28 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.
SLIDE 29
Post-Encounter Follow-up
SLIDE 30 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
SLIDE 31
Effective Coding and Billing
SLIDE 32 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 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate 99498 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)
SLIDE 33
Thank you!
Gwen Cox, RN Edy Taylor, RMA
SLIDE 34
Break
SLIDE 35
Nursing Home End of Life Care Spotlight
SLIDE 36 Lisner Louise Dickson Hurt Home
Carly Ballard, MSW, LGSW
Social Worker
Lisa Harfoot, MSW, LICSW
Director of Social Services
Isata Sesay, RN Assistant Director of Nursing
SLIDE 37
End of Life Care Storyboard
SLIDE 38 Jeanne Jugan Residence
Daisy Alzate, RN
Director of Nursing
Administrator
SLIDE 39
End of Life Care Storyboard
SLIDE 40
DHCF Quality Improvement Program (QIP) Update
SLIDE 42 Thank you!
Reminders:
- Please complete the online post-event evaluation
immediately following today’s session!
- Please sign up for your upcoming Virtual Site Visit
(November 2020 – January 2021)
SLIDE 43 Contact:
Gazelle Zeya, MBA, MS, RAC-CT Quality Improvement Advisor Lead Comagine Health GZeya@Comagine.org | 800.949.7536 Ext. 292 Derdire “De” Coleman, RN Quality Improvement Advisor Lead Department of Health Care Finance Derdire.Coleman@dc.gov | 202.724.8831
