1. Smart purchases and successful implementations begin with a roadmap. 

The first step is an evaluation plan that provides a purchaser control of the technology review, according to Jennifer Marso, vice president of strategic communications for Ability. The plan includes internal reviews with staff, product reviews and interdepartmental buy-in.

“It’s important to define requirements and establish a process for how you will evaluate potential vendors and solutions,” adds Janine Savage, RN, RAC-CT, CHC, vice president of product management at PointRight Inc.

For software purchases, Savage recommends “a robust selection methodology that includes an initial solution screening process” that narrows the field to no more than three vendors. 

2. Know the life expectancy of any technology. One  consideration is whether the vendor has a strong capability in managing its product lifecycle so that the product or technology doesn’t quickly become obsolete, Marso adds.

3. Many providers can be stymied about product research, but the evaluation process should help point the way.

The best sources of information are references from other post-acute facilities, as well as live, hands-on evaluation, says Teresa Chase, president of American HealthTech.

“I can’t over-emphasize the difference between a vendor’s spec sheet and how the software actually functions,” Chase says.

Annual software buyer’s guides from industry publications such as McKnight’s Long-Term Care News can be helpful, adds Savage. She also noted the “excellent online technology selection tools” provided by LeadingAge CAST. 

4. Avoid making decisions in a vacuum.

John Ederer, NHA, president of American Data, believes too many software decisions are shaped solely by compliance and reimbursement consideration and instead, should be based on caregivers — “not IT, not other providers nor billing.”

Stakeholders “must include the potential end-users of the software,” adds Chase. “Choose technologically savvy people … both to help in the evaluation and serve as evangelists during onboarding and implementation.”

5. For major IT investments, providers should remember they are not investing only in capital equipment, but the company behind it as well. As Marso points out, “Another question a new software buyer should ask is: Can they grow with me?” That would go far in ensuring the vendor partner sticks around to solve problems “down the road,” she adds.

“Everyone has heard the saying that you don’t marry just a person, you also marry their entire family. The same is true of technology,” Chase says. 

Have an exit strategy if a partner leaves the market, Savage advises.

Providers may want vendors unique to the long-term care space. Charlie Mintz, director of business development for CareServ Technologies LLC, believes such firms better “understand the complexities of the business.”

6. Be patient.

“Buyers need to fully understand the investment of time and resources needed to get this new software up and running,” Marso says. 

7. Newcomers to IT planning invariably learn the importance of integration.

Mintz believes mobile devices make that possible: “A properly configured smartphone can do it all.”

To ease the process, look for solutions that are less stressful.

“With changes in technology, a great business partner will have software that is easy to implement and minimally invasive for IT,” observes Marso.

In a possible sign of what providers might be able to expect regarding Medicaid funding changes, White House senior adviser  Kellyanne Conway said in late January that moving to block grants would “really cut out the fraud, waste and abuse,” and that beneficiaries would “get the help directly.”

Speaking on “Sunday Today,” she said block grants may be a part of President Donald Trump’s overhaul of the Affordable Care Act.

The idea generated protest from some long-term care providers, many of whom rely heavily on Medicaid funding. 

“This ploy is just a lame excuse to block Medicaid,” one
McKnights.com commenter wrote.

There’s a fear among some governors that a move to block grants could be a way to cut funding to states. Gov. Robert Bentley (R-AL), for example, said that if federal officials reduce funding, states should have more ability to change eligibility requirements. 

Seema Verma, President Donald Trump’s nominee to lead the Centers for Medicare & Medicaid Services, said during her Feb. 16 confirmation hearing that tackling healthcare fraud would be a “top priority” should she get the job.

Asked by members of the Senate Finance Committee about how she’d handle the threat of improper payments, Verma said she’d aim to “be on the front end” of identifying fraud, rather than taking a “pay-and-chase” approach.

When asked about federal healthcare regulations, she  vowed to talk openly with providers about their concerns.

Verma’s confirmation vote had not been scheduled as of press time but she was expected to ultimately receive approval, according to various stakeholders. n

Dr. Tom Price recently became Secretary of the Department of Health and Human Services.

Long-term care operators should cast a wary eye for two reasons: Medicaid and Medicare. By all accounts, Price plans to make changes to both programs that might pose an existential threat.

Let’s start with Medicaid. The Trump administration is hoping to save billions of tax dollars by incorporating a block-grant approach to payments. To understand why this shift would be bad for you, please revisit the previous sentence.

Block grants are not being put in place to help you deliver better, more efficient care. They are a budget-trimming tool. In their most basic form, they work like this: The federal government gives states a set amount of dollars for a specific purpose, such as Medicaid. Once the money is gone, it’s gone. You happen to still be in line for payments behind other deserving groups, or those with more political clout? Too bad. You don’t get nearly enough to cover your actual caregiving costs? Tough.

To be sure, many operators have trimmed their Medicaid-payment reliance during the past decade or so. However, Medicaid still remains a major funding source. For many operators, block grants may translate to “Goodbye, Medicaid funding, hello, Mr. Bankruptcy Attorney.”

Then there’s Medicare. If past performance is any indication, the forecast here also is disturbing.

When he was chairman of the House Budget Committee, Price was a frequent supporter of measures that enact beneficiary payment limits. Is there any reason to believe his opinion has changed?

What is going to happen under this scenario when a maxed-out resident enters your facility? As long as you are willing to deliver free care, everything’s fine. That’s not going to be a problem, is it?

Price is an orthopedic surgeon. As such, he surely must be familiar with the Hippocratic oath, which calls on doctors first and foremost to “do no harm.”

Yet he’s going to actively push for “reforms” that may prevent many thousands of people from getting the care they need? Looks like the good doctor may have pledged allegiance elsewhere.  

Frontline workers often are the first to notice dementia patients’ pain and detect changes in their behavior, but a new study finds long-term care and hospice facilities need to do more to include them in end-of-life treatment.

In-depth interviews of 14 British and Irish healthcare workers found they were often frustrated by their exclusion from multidisciplinary team meetings — a signal to some that they were unqualified despite 15 years’ average experience. 

Workers pointed out a series of pain-related signs in those with dementia — physical rigidity, wounds, reluctance to move — that might seem normal to clinicians who see patients less often. Most said being able to access patient information could help them improve pain management.

Researchers found three themes in the interviews: Ability to recognize pain, reporting pain, and desire for formal training in pain monitoring. Healthcare assistants gave more comprehensive reports when they felt valued; negative relationships led to perfunctory reporting. 

Writing in the January issue of BMC Palliative, study authors urged providers to reverse the stigma.

Reviewers of four trials often used to support mandatory flu vaccination policies for long-term care workers say the benefits were overstated. But the lead researcher still says he recommends vaccination for healthcare workers. 

A group of epidemiologists from Canada, Australia and France looked at the math behind the previous randomized control trials and found calculations about patient outcomes, including mortality, were too good to be true.

“The impression that unvaccinated healthcare workers place their patients at great influenza peril is exaggerated,” wrote lead author Gaston De Serres, M.D., Ph.D., professor of epidemiology at Canada’s Laval University. “Instead, the attributable risk and vaccine-preventable fraction both remain unknown and the (number of vaccinations needed) to achieve patient benefit still requires better understanding.” 

Original predictions based on the principle of dilution were high enough that extrapolating them would mean healthcare worker vaccinations could prevent more flu deaths than happen in the entire U.S. each year. The review shows 6,000 to 32,000 hospital workers would need to be vaccinated before a single patient death could be averted.

While De Serres said the flu risk attributed to healthcare workers and the power of vaccine prevention remain unknown, he still recommends health professionals get vaccinated because data do not refute potential positives. 

Some nurses struggle with critical clinical thinking, especially my newer nurses. The clinical orientation process mainly focuses on teaching how to document and reviews core competencies. What can I do to help increase their critical thinking skills? 

One approach that may help you mentor a nurse is creating “teaching moments.” To do this, it is helpful to think of yourself as the “Mentor” and the nurse as the “Mentee.”

Imagine there has been change in a resident’s condition. The nurse approaches you, wondering how to handle the situation. Let’s look at how to make this a teaching moment. 

1. The Nurse “Mentee” presents the information about the resident and the change in the resident’s condition to you.  (You, the Mentor, remain quiet during this phase, allowing the Mentee to do the talking so you can assess her critical thinking skills). 

2. The Mentee tells you what she thinks is going on with the resident and why. She also discusses what the next steps should be in caring for this resident. (Again, the Mentor remains quiet, actively listening). 

3. You ask clarifying questions. You may choose to go with the Mentee to re-assess the resident, or review the resident record for more information with the Mentee.

4. You then provide feedback to the nurse, noting what she has performed well and making suggestions on opportunities for learning. 

This process requires the Mentee to commit to an assessment and plan, forces the Mentor to be quiet and listen, and provides an opportunity to give important feedback — and it turns a clinical situation into a teaching moment. 

Employers may face “significant challenges” in 2017 related to workers bringing class-action lawsuits against them.

That’s according to Seyfarth Shaw LLP, which released its 13th annual Workplace Class Action Litigation Report in mid-January. The research dug into more than 1,300 class-action rulings to identify emerging trends in litigation that employers are likely to face in the coming year.

The report showed that the dynamics of class action lawsuits have been influenced more and more by recent U.S. Supreme Court rulings, including several victories last year that will make class action suits easier to prosecute.

The number of wage- and hour-related class action filings dropped for the first time in more than a decade, but the monetary value of the settlements in those cases “increased significantly,” the report showed. 

Settlement values for cases involving employment discrimination and the Employee Retirement Income Security Act of 1974 decreased over the course of 2016, according to the report.

Seyfarth’s litigation report also found that government enforcement lawsuits, such as those brought by the Department of Labor and the U.S. Equal Employment Opportunity Commission, furthered the “aggressive litigation programs” of the agencies. But both agencies were ultimately limited by the sheer volume of cases handled, the report’s authors said.

Changes in litigation may also occur due to the shift to a Republican White House.

“The U.S. Supreme Court decided several cases in 2016 that favored workers bringing class actions, which in turn portend significant challenges for employers facing these exposures in 2017,” said Gerald L. Maatman Jr., co-chairman of Seyfarth’s Class Action Defense Group and author of the report. 

President Donald Trump’s nominee for Supreme Court Justice recently sided with providers against federal agencies, a fact that should provoke joy in long-term care circles, according to observers.

Judge Neil Gorsuch, now of the U.S. Court of Appeals for the Tenth Circuit, has expressed skepticism in past court rulings over how federal agencies, including the Centers for Medicare & Medicaid Services, interpret their own rules.

In an opinion penned in May 2016 for a case involving CMS’ attempt to recoup Medicare reimbursements from
a home health provider,
Gorsuch wrote that the number of regulations issued by federal agencies “has grown so exuberantly it’s hard to keep up.”

“The Centers for Medicare & Medicaid Services estimates that it issues literally thousands of new or revised guidance documents (not pages) every single year, guidance providers must follow exactingly if they wish to provide healthcare services to the elderly and disabled under Medicare’s umbrella,” Gorsuch wrote.

He goes on to ponder a “strange world” where government agencies are unable to keep up with their own “frenetic lawmaking.”

“Whatever else one might say about our visit to this place, one thing seems to us certain: An agency decision that loses track of its own controlling regulations and applies the wrong rules in order to penalize private citizens can never stand,” he added.

Gorsuch’s thinking is in line with Trump’s promise to reduce the number of rules issued by federal agencies— a move that may bring some ease to the heavily regulated healthcare industry. 

Trump issued an executive order in late January that would require two regulations to be eliminated for every new one introduced. The order also set a cap on the number of rules that can be introduced each year.

Gorsuch was appointed to the 10th Circuit by President George W. Bush. As of press time, his confirmation hearings were expected to begin in mid-March.

Will President Trump’s “repeal and replace” Obamacare campaign pledge impact or modify value-based contracting?

The Affordable Care Act, which President Trump campaigned to “repeal and replace,” will continue to have an impact on the marketplace.

The “replacement” aspect of this campaign pledge is still unclear and being developed and may impact providers and value-based contracting.  Nevertheless, the ACA had three goals that all payors will still seek to implement even after any “repeal” of the ACA.  

The primary goals of ACA were: High-quality of care with strong consumer approval; wellness care models that focus on preventing illness in populations; and lower costs to Medicare or any payor. These goals have caused accountable care organizations to structure themselves to act through “value-based contracting” with their providers, which include hospitals, physicians and organizations providing services to seniors.  These primary goals of the ACA will continue to motivate payors and providers even after any changes to the ACA, regardless of any “replacement” strategy.  

Thus, value-based contracts should remain important in the marketplaces.  Organizations that provide services to seniors should continue to strive toward these ACA goals by focusing on wellness programs that provide quality care yet at lower costs.  

The fact is senior care service organizations must be able to demonstrate to all payors through data and clinical protocols that they further these value-based goals and are aware of other issues affecting providers, (e.g., reducing readmissions of patients back to a hospital).  Payors will continue to provide patients to all providers of care that can improve quality and lower costs.