The world we live in is becoming more litigious with each passing day. Malpractice and neglect are two of the most common reasons that a patient or a family member may file suit against a medical provider. LTPAC nurses need to know how to be proactive and ensure their documentation will hold up in a court of law. Here are my top ten ways to avoid the orange jumpsuit.
In a world of multiple audit agencies looking at providers’ claims for the sole purpose of identifying inappropriate payment, not to mention additional scrutiny from Medicare Administrative Contractors (MACs) and other federal agencies under the direction of the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG), it cannot be said enough how important it is for Skilled Nursing providers to audit themselves first. The most effective way to accomplish this is through the Triple Check Process – prior to submitting claims for payment.
When you hear the words “patient experience” it may evoke thoughts of a survey reviewing either your own or a family member’s experience. How would you review, if given the opportunity, a stay in an LTPAC facility? Would you evaluate the care, the environment or physical plant, the caring or education of the staff – or all of the above? What were your expectations? Were they met? No matter to whom you speak, the resident or the family, the constant expressed desire/need is for personalized quality of care. Of course, personalized quality care can be subjective just as a review is subjective.
Topics: Clinical Consulting
Are you one of the many LTPAC providers being bombarded by Additional Development Requests (ADRs) and subsequent denials? Then you know how overwhelming the process can feel. Wouldn’t it be great if you need not worry when those ADRs come in the mail? Following some simple steps at the time that the patient/resident is picked up on therapy caseload can make your ADR process a straightforward one.
Financial reports are documents you put together or create to review and track how much money your business (facility) is making (or not). Many facilities have outside investors, owners, shareholders, board members or lenders who require the information contained in the financial reports and have a right to know if their money is being spent wisely or returning a profit. After all, they are partially supporting your business and it’s essential that they be kept up-to-date with your financial position. Use of integrated software such as PointClickCare allows you to perform clinical and billing functions with the added benefit of the general ledger and accounts payable module where you can customize your own financial statements. This integration allows you to automate the reporting process and results in less potential for human error that is more prevalent with excel-based statements.
Many EHR platforms incorporate reports or review management areas allowing you the opportunity to oversee resident status and documentation. Are you utilizing these valuable and time-saving tools? Many persons are not for various reasons such as;
Policy & Procedure is the root of all PROCESS, and process is everything in the LTPAC organization. Without process, we have inconsistency and inefficiencies. Policy & Procedure is not a manual on a shelf that collects dust. It is a “living” document that is updated to meet the needs of regulatory requirements and the organization – it has to weather changes (as these come fast and furious these days). Policy is the backbone of WHY we do WHAT we do, WHO does it, WHEN it is done and WHERE we document it. Procedure is HOW we do it. Without these components, we do not have PROCESS, and process is everything.
No matter the name you use or the method to create it, the outcome should be the same; an individualized plan of care identifying the needs of an individual and how to meet them.
Population Health is defined by Wikipedia as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. The concept sounds new but in reality, the idea has been around for awhile. Most of us in healthcare are always giving thought to projections regarding future needs. Remember Ken Dyctwald’s “Age Wave”? It prompted many developers to get into the Assisted living industry. We were all awash in anticipation for the ”baby boomers” to come of age. Huge waiting lists were forecasted for SNF. Hoteliers immediately started building hospitality oriented retirement communities. Many of the Not for Profit providers set about strategic plans that helped them to project and prepare for the needs of their aging residents, offering more options to remain in the campus community by bringing services to the people vs. bringing the people to the services. But Population Health is less about building places and creating services and more about delivering outcomes and payments models that support collaborative care relationships.
Topics: Clinical Consulting
Sometimes, in order to grasp a new concept, you have to put it in terms that are personal and relatable. For example, when I was in college, two semesters of a world history class were mandatory. I heard about a professor who had a really unique style of teaching. Professor Dober’s shtick was to write on the blackboard backwards. So if you wanted to be able to take notes and understand the material, you had to learn how to read his cursive writing backwards. His style was catchy and memorable, and his classes were packed.
Remember Y2K? At the time many providers were concerned that their systems would break down at the stroke of midnight on January 1st. People anxiously anticipated the drop of the ball on New Year’s Eve and there were widespread fears that the electrical grid would shut down altogether. Some providers had maintenance and IT staff on site at midnight to deal with whatever was to come. Thankfully, those fears did not live up to the hype. One thing I took away from that time is that our industry does not handle change management all that well – we wait for the pain. Not much has happened to change my mind since. Recent examples that come to mind are the transitions to MDS 3.0 and ICD-10. Some providers were up to date and ready to go on day one, but so many others were scrambling to get processes in place.