Patient engagement is a hot topic of conversation among healthcare providers as payment incentives encourage organizations to coordinate care and improve patient outcomes. For skilled nursing facilities (SNF), engaging residents is proving to be an increasingly important piece of maintaining referral volumes and maximizing programs such as the SNF value-based purchasing (VBP) program.
Recently, Cedar Community, a retirement community in Wisconsin, shared their powerful results after a year of partnering with CipherHealth to engage their residents. With CipherHealth’s automated outreach solution, Voice, Cedar has been able to address their resident’s needs quickly with a process that maximizes staff time and streamlines manual processes.
Cedar’s Voice program allows residents to indicate if they need additional assistance after leaving home and is proving to ensure residents are not at risk for an adverse event such as a readmission. In addition to proactively resolving issues, Cedar Community also uses the technology to identify the need for home care services and enables efficient coordination with home health care agencies to schedule necessary visits. Overall, the program has proven to improve outcomes in addition to creating pleasant staff and resident experiences.
Read on to discover more information about CipherHealth’s skilled nursing facility solutions.
Recently, the Centers for Medicare Services (CMS) created the Five-Star Quality Rating System to help consumers, families, and facilities evaluate the performance of nursing homes. Included in the ratings are Quality Measures which are derived from resident assessment data collected at specified intervals during a stay in the nursing home. The intended purposes of the Quality Measures are the following:
Provide information about the Quality of Care at nursing homes to help the public choose a nursing home
Prompt consumers to talk to nursing home staff about the Quality of Care
Provide data to the nursing home to help with Quality Improvement efforts
Provide data to the State Survey Agency for Inspection
With the implementation of the MDS 3.0, Quality Measures have changed. The new Quality Measures will become an enhanced set of publicly reported information available on Nursing Home Compare in mid-July.
Quality Measures for the Future
The Quality Measures continue to be categorized into two types: short stay (or post-acute) and long stay (or chronic) measures.
Short stay measures are related to:
Self-reported moderate to severe pain
Provision of flu vaccine
Provision of pneumococcal vaccine
Long stay measures are related to:
Provision of flu vaccine
Provision of pneumococcal vaccine
Self-reported moderate to severe pain
High risk residents with pressure ulcers
Utilization of physical restraints
Falls with major injury
Urinary tract infection
Catheter inserted and left in bladder
Low risk residents who lose Bowel/Bladder control
Excessive weight loss
Increase in need for help with ADL’s
Although the measures do not appear to be significantly different from those based on the MDS 2.0, there are changes in the resident and record selection processes.
What are Resident and Record Selections?
Resident Sample Selection:
An episode is a period of time consisting of one or more stays. It starts with a new admission and ends with a permanent discharge. During that time, the resident may be out of the facility for a hospitalization, leave of absence, etc. These days are not counted in calculating Cumulative Days in Facility (CDIF).
A stay is the time that a resident is physically in the facility or CDIF. When the resident leaves the facility for any reason, this completes a stay and when the resident returns a new stay begins.
The Cumulative Days in Facility (CDIF) defines the resident sample, with Short Stay CDIF up to 100 days and Long Stay CDIF counting from 101 days. As a result of the methodological shift, more residents are included in the Short Stay measures. The MDS 2.0 measures were limited, using PPS assessments to Day 14. Now all assessments, including OBRA and PPS assessments for residents are included for Short and Long Stays.
Requirements for a qualifying assessment are not based on having an ARD within the Target Period, but are based on the resident’s Episode. Due to this, as assessment can be included even if the ARD is not in the Target Period. In addition, some measures include a look-back scan, in which all assessments within an episode are included. For example, the measure for falls with major injury could include assessments going back one year if they are contained in an episode.
As a result of these changes, it is critical that providers know where residents are in terms of episodes and stays. Providers must have a reliable, effective means of using clinical data to determine trends, challenges and risks, and promote quality improvement. An emphasis on quality will improve clinical outcomes, reduce professional liability claims, potentially lower insurance premiums, and improve resident satisfaction. Well performing facilities benefit from fewer survey deficiencies, higher occupancy rates, and a positive public perception.
Promoting Quality and Coordination Across the Care Continuum: An Interview with Edgewood Place Skilled Nursing Facility on Technology in the Post-Acute Care Environment
In today’s increasingly connected world, it is becoming a standard industry practice for hospitals to interact with patients using technology. With CMS reimbursements now tied to patient satisfaction and quality measures, hospital leaders understand the importance of using technology to capitalize on payment reform. More recently, post-acute care (PAC) providers, including skilled nursing facilities (SNFs), home health agencies (HHAs), and inpatient rehabilitation facilities (IRFs) have turned to technology to comply with similar regulations.
To promote care coordination across the continuum, CMS will soon require PAC providers to standardize and report on quality, outcomes, and satisfaction. This increased transparency pushes PAC providers to improve the experiences of patients and residents, optimize care services, and reduce readmissions. Using hospitals as a model for success, it is clear that technology will be a key factor in this changing PAC landscape.
Recognizing this shift, Edgewood Place at the Village at Brookwood, a skilled nursing facility part of the Cone Health System in central North Carolina, has turned to innovative technology to improve residents’ experiences and outcomes. Edgewood recently partnered with CipherHealth to implement CipherOutreach, a post-discharge follow-up calling platform, and Echo, a digital tool to record personalized discharge instructions. This collaboration demonstrates Edgewood’s mission to keep residents healthy and happy long after they leave the facility.
Steve Swanson and Teresa Pennington, Administrator and Administrative Office Manager at Edgewood Place, spoke with CipherHealth about how they are strategically implementing technology to improve the care experience and prepare for payment reform.
Interview with Steve Swanson and Teresa Pennington
CH: As you were making the decision to implement CipherOutreach for your follow-up calling program, what were the primary challenges that you were trying to address? What specific goals did your organization have when partnering with CipherHealth?
Edgewood: Our goal when implementing CipherOutreach was to receive feedback from residents about our care services and quality in a direct way. We partnered with CipherHealth not only to receive this important feedback, but also to have a better, more streamlined way to address any issues that residents may have related to their care. This program quickly became an essential component in providing high-quality care services.
CH: What have been the residents’ reactions to the automated calls?
Edgewood: The residents have been extremely responsive to the follow-up program. Through the reports we receive from CipherHealth, we see that the majority of our residents complete the entire CipherOutreach call, and when callback is required, tend to be very honest with our staff. This allows us to address issues before they lead to adverse events, such as hospital readmissions. This proactive issue resolution also helps increase resident satisfaction and boost referrals.
CH: Was implementation of the calling system difficult?
Edgewood: From the beginning, the calling program was very user friendly and easy to implement. Should we experience any difficulties, the Cipher team is always available and eager to lend support to ensure that we are comfortable with the technology.
CH: What have you learned about your residents through the CipherOutreach and Echo programs?
Edgewood: We have learned that many residents do not fully understand their discharge instructions at the point of discharge, but may not speak up at that time. Despite this initial apprehension, residents tend to acknowledge that they need help on the CipherOutreach calls. Our staff is automatically notified of these issues or questions, and we can intervene prior to the residents making a medication mistake, improperly managing their care, or returning to the hospital.
CH: What are some of the successes that you’ve seen since implementing CipherOutreach and Echo?
Edgewood: By spotting trends in residents’ behavior and issues reported, we have been able to address several challenges that are typical of SNF residents post-discharge, for example, helping them obtain DME, Medications, and O2. CipherOutreach and Echo have also allowed us to promptly answer medication and therapy questions to prevent mistakes that could lead to hospitalizations.
CH: Can you speak to the value that you see in Echo, the digital discharge instruction recording tool, specifically?
Edgewood: With the Echo program, residents have the option to go back and listen to discharge instructions as many times as they would like at their convenience. This helps ensure that residents understand their care plans and comply properly with instructions. We’ve seen that the residents who listen to their Echoes have required fewer manual callbacks or interventions from staff.
CH: What is the role of innovative technology in SNFs, as players in the industry work to position themselves as a value-base partners to their referral sources?
Edgewood: Innovative technology is the most effective way to consistently receive meaningful feedback and drive improvements. We see the direction that medicine is moving in, and we believe that care does not end when a patient or resident walks out your door. We aim to offer high-quality care from the beginning of a resident’s experience to the end. Care must be coordinated at all levels, from hospital – to SNF- to Home Health – to outpatient – to independence, and on. We must work to prevent readmissions and additional expenditures to the referral sources, insurances, and the patients.
As highlighted by leaders at Edgewood Place, care extends far beyond the point of SNF discharge. Arguably, the window immediately after a patient or resident returns home or transitions to a lower acuity care setting is the most important time for providers to reach out. Having a robust discharge process including patient or resident follow up helps to prevent avoidable complications and hospitalizations, and creates a positive, lasting impression of the care experience. For Edgewood, incorporating CipherOutreach and Echo has allowed the organization to better understand its residents and make informed changes to improve quality of care and outcomes.
To learn how your organization can partner with CipherHealth to improve quality of care and outcomes, and prepare for payment reform, contact us today.