Harmony Healthcare Blog

AHCA Provider Lounge Series: Defining and Refining Patient Population for the Facility Assessment

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Jan 19, 2018

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Edited by Kris Mastrangelo


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

Interview with Judi Kulus, Vice President of Curriculum Development at AANAC

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Judi Kulus, the Vice President of Curriculum Development at the American Association of Nurse Assessment Coordination (AANAC), in the 2017 AHCA Provider Lounge.  Judi discusses the need for facilities to analyze patient populations for the facility assessment.    Only through a thorough understanding of their patient population can a provider determine the appropriate staffing levels and competencies needed for their facility.  (Audio transcription below).



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Transcribed Audio:

Kris Mastrangelo: Good afternoon and welcome to the Provider Lounge. We're at the 68th AHCA/NCAL Annual Convention in Las Vegas, Nevada. Today we have Judy Kulus with us - the Vice President of Curriculum Development from AANAC and the American Association of Directors of Nurses. Thanks so much for coming.

Judi Kulus: Thanks for having me.

Kris: We are super eager to hear what your thoughts are on all the changes that are occurring and what's keeping you up at night. What's on your mind? What do you have for us?

Judi: Well what I thought I'd share today is just you know some of my concerns over there's so much change coming at us so quickly. The deadlines for the Phase Two potential new payment system next year and I think what we're seeing is just an uptick of the need for transparency in our operations. When you think about the new data that just came out recently with our utilization and that comes out all the time. You've got our ratings on five-star, all the quality measures, survey data that's being posted and we just need to know what we're doing in our facilities day in and day out and transparency is something that we have to do but we need to know what our ratings are. That's a big challenge to be transparent enough and not too transparent to you know protect our operations and what is happening.

Kris: Okay, there's a very good point though. You know the transparency is critical for the staff members to understand what's going on. The transparency is critical for the consumer, but on the other hand some transparency may be too much information or too much.

Judi: Right. So, one of the things that we're seeing with the facility wide assessment report that's coming November 28th is that we have to analyze our resident population. We have to look at their diagnosis, their conditions, their ADLs and their cultural needs, there may be religious needs and analyze that and to look for staffing competencies and how to staff our units right. So, there's some level of transparency that we're going to be producing when we look at all of that and frankly it's an important process and I know we're hearing how do we do that facility-wide assessment and as I looked at the interpretive guidelines and looked at what was in the interpretive guidelines the facility wide assessment is mentioned over 90 times in 14 of the 22 sections and it will be mentioned in multiple tags. So, what they're going to look at within the new survey process is what did you do if you had an adverse event or an adverse thing happen in the survey process and then was it addressed in the facility-wide assessment. So, getting back to transparency is looking at who we are as an organization, managing who we are, knowing who we are, looking at our data and then processing it effectively to staff and for our competence and documenting that for the facility assessment that goes out but again, there's a concern of how much information do we share. So, we have to do this process but then we want to be sensitive to what we say we need and are we doing what we say we need.

Kris: Right and I think that for the providers we call it define and refine. Define what your facility has for a population. One of the conundrums occurs when they think that the data can be extracted from a UB-04, but if your UB-04 doesn't properly reflect the diagnosis then you're going to be thinking about competencies in a patient mix that may not be reflective of what you really have. So, it goes deeper to that but I think a very key point that you're bringing up is that upon completion of the facility assessment that's just not a binder on the shelf, it's a working tool via the regulatory process and the survey process and that refinements need to be made. But the biggest the biggest takeaway is that they define the patient population but yet you have to have competencies so that the nurses, all the staff, with this defined categorization of patients - who do you have, orthopedic, respiratory, ventilator - what is it and they have to be trained to care for and then the staffing beyond it. So very, very good point.

Judi: So, at AADNS, our DONs, our members have been really asking for resources and support for the facility-wide assessment. We have created a tool. It's a software tool that allows you to select your diagnosis for your building and then work the process of selecting your competencies, policies and procedures you need, what contracts, what specialists and walk you through that process and then it allows you to print a report for the surveyor. I mention that because it's all about transparency in terms of who we are, what we need to do and making sure that we dot our I’s and cross our T’s to know that we've addressed the important aspects of what we do.

Kris: Yeah, it's a big deal, the facility assessment. It’s not just the binder on the shelf, right? It's defining what they are and we're seeing it across the country. They're coming up with their first round and their first drafts and asking is this the patient we really serve and furthermore, if it is how will that patient population work in the new payment system because they may not want to keep that patient population or they may want to refine it. So, excellent information one other comment you said before when we talked about transparency, data.

Judi: When I think technology, you know I mentioned we got a tool or a resource but we have so much information coming at us. We've got our MDS data, we have our quality measures we have other reports we're gathering for the new survey process and I think managing our technology in our building, our electronic health records and the pharmacy reports. Now the Requirements of Participation do not require us to have certain technology to comply but when you look at the requirements of what has to be transferred with the resident when you discharge them the list is so long, how do you do that if you can't pull things out of the electronic health record efficiently? And managing your data to select what you need to establish for a QAPI PIP, right? So, big data is a huge issue and I think when we're not techies and we're care delivery, I mean technology sort of can rule us over us controlling our technology, our data and I think a lot of effort needs to go into managing our data, managing our outcomes and knowing where we're at. Not just the historical data because QMs are outdated, MDS data can be outdated, but real-time data so that we can manage our 5-star ratings, manage our QMs. Now I know this is something we all know that we have to do but how do we get to that and taking efforts to really choose some really good technologies.

Kris: We have to distill and synthesize and simplify the whole process. Thank you so much Judy from coming today. We look forward to seeing you again. Thank you so much.

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Tags: Facility Assessment

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