quarterly

Transcription

quarterly

W H AT ’ S I N S I D E
2
AANAC Speaks
10
Q+A
11
Workshop Schedule
13
What’s New in AANAConnect
14
What You Need to Know
16
New C-NEs and RAC-CT®s
SUMMER 2012
LTC QUARTERLY
SPEC
IA
EDITI L
ON
CMS Posts Revised Five-Star
Nursing Home Quality Rating System
Judi Kulus, lnha, rn, mat, rac-mt, Vice President of Curriculum Development, AANAC
There are a few things that have become certain in long-term care: annual
survey, Quality Measures (QMs), and five-star quality ratings. The nursing
home annual licensing and certification survey process is in the middle of being
transformed from the traditional survey methodology to the Quality Indicator
Survey (QIS) process. Quality Measures have been reworked using the MDS 3.0 data.
continued on page 4
Harness the Power of Your Team
Betty Frandsen, rn, nha, mha, c-ne
AANAC
400 S. Colorado Blvd., Suite 600
Denver, Colorado 80246
Phone 800.768.1880
Fax 303.758.3588
1
© 2012 AANAC. No part of this publication may
be reproduced without written permission
from AANAC. The information presented is
informative and does not constitute direct legal
or regulatory advice.
Every nursing department is composed of individuals serving in the variety of roles
required to meet residents’ needs. The fact that there are RNs, LPNs, and CNAs whose
names appear together on a schedule, and who are assigned to work in a particular area
of the nursing home, does not mean that this group functions as a team. Nursing staff
can be fragmented and headed in different directions, or they can have a defined focus
continued on page 7
AANAC
SPEAKS
AANAC Members
Are Represented in
Washington, DC
When it comes to legislation
impacting health care, the atmosphere
on Capitol Hill was described as more
polarized and tense than it has been in
years. This was a common theme heard
by members of the AANAC board and
staff as they visited their respective
states’ senators and representatives
during the annual American Health
Care Association (AHCA) congressional
briefing. The explanation for this
atmosphere is election-year positioning
and the difficulty at this time for our
elected officials to find common ground.
inform them about the needs of the
elderly. Regardless of whether we visited
the office of an elected Democrat or
Republican, the AANAC representatives
were welcomed warmly and we were
assured of the member’s commitment to
legislation that cares for our elderly.
Ten AANAC board members and
staff visited over thirty members of
Congress from nine states, asking these
representatives to support the following
key issues:
• Address Nurse and Critical
Caregiver Shortages. Amend the
Nurse Reinvestment Act to include
educational and financial assistance
for caregivers in all health care
settings, establish a national nursing
database, and enhance the number of
nurse educators.
During our visit to Washington, we
• Support Stable Medicare Funding
joined hundreds of nursing home
Necessary for Quality Care. Stable
and assisted living professionals who
Medicare funding is essential to
gathered to receive information on
protect seniors’ access to quality longlegislation impacting long-term and postterm and post‐acute care.
acute care providers and to personally
meet our members of Congress to
2
• Update the Medication Law to
Match Current Patient Needs. Revise
the Controlled Substances Act of
1970 (CSA) to recognize that the longterm care nurse acts as “an agent
of the prescriber” in documenting,
transmitting, and communicating
orders for controlled substances to
the pharmacy.
• Sponsor the Improving Access to
Medicare Coverage Act of 2012.
Since extended hospital observation
stays constrain Medicare beneficiaries’
access to skilled nursing facility
services, ensure observation stays
count toward the required three-day
stay by cosponsoring the Improving
Access to Medicare Coverage Act of
2012 (H.R. 1543/S. 818).
As an AANAC member, you are
encouraged to read the Issue Briefs that
were discussed with our representatives
and take a moment to send them to your
senator and representative. If we all take
a small step in letting our voices be heard,
it will add up to a resounding thunder.
continued on page 3
A A N AC LT C L E A D E R 7. 2 4 . 2 012
AANAC Members Are Represented in Washington, DC, continued from page 2
Here are some of our personal experiences:
This week I had the pleasure of
The junior senator from Illinois is Mark
representing AANAC on Capitol Hill by
visiting the offices of Colorado state senators
Mark Udall and Michael Bennett, as well as
Mike Coffman, my state representative. While
I didn't meet my senators or representative
personally, I am hoping the visits may assist
in arranging a personal visit to my long-term
care community back home. I intend to visit
each local office to invite them personally to
visit our residents, families, and staff. If, in fact,
a visit occurs, I will let you know. I continue to
think it is important that we actively look for
ways to educate our politicians, talk about the
nursing shortage, and promote favorable
long-term care legislation.
Kirk (52), who suffered a stroke in January of
this year and who remains in a rehab facility
to this day. When I went to meet with his
staff, I knew the concerns that I was to share
with them would be very close to home. The
issues we face daily in our long-term care
industry (funding/staffing/reputation) are
ones Senator Kirk is actually experiencing,
and his staff feel that when he returns he will
be able to advocate for our industry with a
strong and credible voice. Our thoughts and
prayers remain with him as he slowly recovers
from this debilitating stroke, and his staff are
heartened by his recovery and strength.
On a personal note, this was my first
Ruth Minnema, rn, ma, nha, rac- ct,
time “inside” the Capitol and the history
Board Chair
that permeated the building
filled me with a sense of
awe. The staff at the Senate
offices that I visited (Senator
Kirk, Senator Durbin, and
Representative Biggert) were
all knowledgeable, intelligent,
and open to discussing the
issues that we face in our
industry. I felt heartened by
actually seeing the “business”
of government instead of
reading about it or seeing
it on the news. The biggest
challenge each office stated
was how to manage the baby
boomer demand for services
ne Powell, Ruth Minnema, Carol
and how we as a nation are
Left to right: Peter Arbuthnot, Joan
Macken, Gail Harris, Susan Duong
Maher, Diana Sturdevant, Patrice
going to pay for that. We all
share their concern(s)! I left with a renewed
When I was in Washington for the
sense that we as individuals can make a
congressional visits, I had the privilege of
difference, but we need to “do something,
meeting with my senators and congressman
however small.”
from the great state of Mississippi. I met with
Patrice E. Macken, mba, rhia, lnha, rac- ct,
Congressman Gregg Harper, his legislative
Board
Member
assistant, and the special assistants to
Senators Roger Wicker and Thad Cochran.
Once again, this year's visit to
The meetings were positive and they all
Washington, DC, was fruitful. Being from
indicated that they would keep me as a
California, I visited the offices of Senators
reference should they have questions about
Dianne Feinstein and Barbara Boxer, as
SNF issues. It was a privilege to represent the
well as House Representative Zoe Lofgren
members of AANAC to these national leaders. from California's 16th District. Of special
Peter Arbuthnot, aa, ba, rac- ct,
Board Member
3
note from my meetings was the reaction of
Representative Lofgren. She expressed a great
deal of interest and asked a lot of questions.
During our meeting, I was impressed with
how much genuine concern she expressed
about how all these issues affect the plight
of our elderly and disabled populations. I
was happy to hear that she had some
knowledge of most of the issues I discussed
with her. She shared with me that there
is still a nursing shortage in some parts of
our country. She was most concerned with
the acute care hospitals' use and over-use
of "observation" stays and she immediately
asked her legislative counsel, Melody Reis, to
obtain more information on the matter. As
for the Controlled Substance Act, she said
she will also delve more into this issue. It's
important to her that our residents do not
suffer needlessly due to our inability to obtain
pain medication for them in a timely manner.
She knows the importance of having access
to pain medications. She shared that she had
experience with pain-control issues when
her father was under hospice care. Lastly,
Representative Lofgren expressed support for
our call for stable Medicare funding, and she is
active in voting for affordable access to medical
care, as well as for providers to have the funds
needed to provide quality medical care.
Susan Duong, rn, bsn, bs, nha, c-ne, rac- ct,
Board Member
During my visit to Washington, it
was an honor to meet with a variety
of representatives and staff including:
Congressman John Thune and staff member
Jayne Lucas; Congressman Tim Johnson
and staff member Ashley Raspor as well
as Congresswoman Kristie Noem and staff
member Andrew Christianson. During
these visits we discussed the three initiatives
brought forward by AANAC, but more
importantly our organization itself and the
knowledge and experience these almost
14,000 members can be as a resource to any
of the congressional offices. I left information
with each and invited all of these offices to
contact AANAC for “real life” solutions
and look forward to continued collaboration
between these important figureheads and our
members as we shape long-term care together.
Joanne Powell, nha, rhia, Board Member
●
A A N AC LT C L E A D E R 7. 2 4 . 2 012
Revised Five-Star Rating System, continued from page 1
annual health inspections and
complaint investigations. This domain
uses the number, scope, and severity
of deficiencies that were identified
during the three most recent annual
inspection surveys. It also calculates
the substantiated findings from the
most recent 36 months of complaint
investigations. If a facility requires more
than one revisit by the health inspectors
to prove that a deficiency is corrected,
then more points are added to the score,
pushing the rating down. Here are
some highlights from the user’s guide
regarding this domain:
• The system calculates the rating
so that the top 10% of performing
facilities in each state receive a
five-star rating.
• The middle 70% of facilities receive
a rating of two, three, or four stars,
with an equal number (approximately
23.33%) in each rating category.
• The bottom 20% (with the highest
score) receive a one-star rating.
With the MDS 3.0 QM data, the Five-Star
Nursing Home Quality Rating System
has been revised on Nursing Home
Compare. This five-star system is a set
of quality “star” ratings for each facility,
on a scale of 1 to 5.
The newly posted, revised manual
states that “the primary goal of this
rating system is to provide residents
and their families with an easy way to
understand assessment of nursing home
quality, making meaningful distinctions
between high and low performing
nursing homes” (Design for Nursing
Home Compare Five-Star Quality Rating
System: Technical Users’ Guide, July 2012, p.
2). The Nursing Home Compare reporting
site is a place where consumers can go
to evaluate their local nursing homes in
order to make more informed choices
about their care and service providers.
The five-star rating system is composed
of three domains: Health Inspections,
Staffing, and Quality Measures. Since
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the MDS 3.0 began, the Quality Measure
domain of the five-star rating system has
been in “freeze frame” with MDS 2.0 data.
The other two domains have continued to
be used to calculate facility ratings. Now
that CMS has published the updated, July
2012 Five-Star Nursing Home Quality
• In order to control for variation
of the survey process in different
states, the Health Inspection domain
is calculated using the relative
performance of facilities within a state.
• The cut points are recalibrated each
month so that the distribution of star
ratings within states remains relatively
Facility staff can once again fully and knowledgeably participate in
quality assurance planning that works toward obtaining and maintaining
a five-star rating.
Rating System manual, facility staff can
once again fully and knowledgeably
participate in quality assurance planning
that works toward obtaining and
maintaining a five-star rating.
Five-Star Health
Inspection Domain
The Health Inspection domain is
a measure that is based on
substantiated deficiencies from
constant over time, in an effort to
reduce the likelihood that the
rating process affects the Health
Inspection outcomes.
• A facility’s rating will not change
from month to month without new
survey information from the facility,
regardless of changes in the statewide
distribution due to new surveys in
other facilities.
continued on page 5
A A N AC LT C L E A D E R 7. 2 4 . 2 012
Five-Star Staffing Domain
utilizing the facility’s reported hours,
dividing them by the expected hours,
and then multiplying by a national
average score posted by CMS. The
result of this calculation is “adjusted
hours,” which are then used to set the
Staffing star. In order to receive a
five-star rating, facilities need to achieve
at least 4.418 hours per resident day
of total nurse staffing and a minimum
of 0.710 hours per resident day of
registered nursing hours.
The CMS staffing studies identified in
the user’s manual found that there is “a
clear association between nurse staffing
ratios and nursing home quality of care.”
The studies determined that there is a
specific staff-to-resident threshold below
which residents are at a substantially
greater risk for quality problems. The
goal of this rating is to encourage facility
leaders to provide adequate staffing
levels because of “considerable evidence
of a relationship between nursing home
staffing levels, staffing stability, and
resident outcomes.”
Five-Star Quality
Measure Domain
The staffing measure domain uses two
separate but equally weighted measures
to calculate the facility’s rating. They are
(1) total registered nursing hours and (2)
total nursing hours (including registered
nurses, licensed practical nurses, and
nurse aides), both on a per-resident-day
basis. The rating system is calculated by
There are 9 MDS-based Quality Measures
that are used to calculate the Quality
Measure domain. They include 2 shortstay measures and 7 long-stay measures.
Facility ratings for the Quality Measures
are based on a subset of the 18 QMs that
are currently posted on the Nursing
Home Compare website. These include:
Short-Stay Residents:
• Percent of residents with pressure
ulcers (sores) that are new or worsened
• Percent of residents who self-report
moderate to severe pain
Long-Stay Residents:
• Percent of residents whose
need for help with activities of
daily living has increased
• Percent of high-risk residents
with pressure sores
• Percent of residents who
have/had a catheter inserted
and left in their bladder
• Percent of residents who were
physically restrained
• Percent of residents with a
urinary tract infection
• Percent of residents who
self-report moderate to severe pain
• Percent of residents experiencing
one or more falls with major injury
Each of the nine QMs is weighted equally
and facilities are awarded points for each
one, based on a score of 1 to 100. A perfect
score for all nine QMs would be 900 and
the worst score would be a 9. The scoring
for all of the QMs is based on national
percentile ranking, with the exception of
the ADL measure, which is based on state
ranking. The reason for the difference in
the ADL QM scoring is compensation for
variability in state case mix policies.
Ratings for the QM domain are
calculated using the three most recent
quarters for which data is available.
By using assessment data from three
quarters, CMS hopes to increase the
stability of estimates and reduce the
impact of missing data.
continued on page 6
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A A N AC LT C L E A D E R 7. 2 4 . 2 012
Overall Nursing Home Rating
(Composite Measure)
In order to determine the overall
five-star rating for a facility, the system
follows these five steps:
• Step 1: Start with the Health
Inspection five-star rating.
• Step 2: Add one star to the Step 1
result if Staffing rating is four or five
stars and greater than the Health
Inspection rating; subtract one star
if Staffing is one star. The overall
rating cannot be more than five stars
or less than one star.
result if Quality Measure rating is
five stars; subtract one star if Quality
Measure rating is one star. The overall
• Step 4: If the Health Inspection rating
is one star, then the overall quality
rating cannot be upgraded by more
than one star based on the Staffing
and Quality Measure ratings.
• Step 5: If the nursing home is a
Special Focus Facility (SFF) that has
not graduated, the maximum overall
quality rating is three stars.
A facility’s overall rating will be adjusted
anytime health inspection survey
information for a standard survey or
Managing Your Five-Star Rating
If you haven’t already gone to Nursing
Home Compare and reviewed your
facility’s five-star rating, now would be
a good time to do so. Take a look at your
overall star rating and the individual
A facility’s overall rating will be adjusted anytime health inspection survey
information for a standard survey or a complaint investigation is added to
the database.
a complaint investigation is added to
the database. The Staffing measure
is updated approximately annually
based on when the standard survey is
conducted and which quarter is used to
calculate the Staffing measure. Updates
to the QMs are posted mid-month in
January, April, July, and October. At the
same time, the scoring for the QMs is
recalculated and changes can impact the
facility’s rating.
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stars assigned for the Health Inspection,
Staffing, and Quality Measure domains.
While you’re at it, look at the ratings
for your competitor down the street.
Then begin a plan to be proactive about
improving or maintaining your five-star
system rating.
quality assurance committee process.
Approaching it as a team will increase
awareness and foster creative solutions
to improve your five-star rating.
Sources:
American Association of Nurse Assessment
Coordination. (2011). The Five-Star Quality
Rating System. Denver, CO: Rena Shephard,
mha , rn, rac-mt, c-ne.
Centers for Medicare & Medicaid Services. (2012,
July). Design for Nursing Home Compare Five-Star
Quality Rating System. Available at: http://www.
aanac.org/docs/reference-documents/usersguide.
pdf?sfvrsn=0 and at http://www.cms.hhs.gov/Cert
ificationandComplianc/Downloads/usersguide.pdf.
Kramer, A. M., & Fish, R. (2001, Winter). “The
relationship between nurse staffing levels and the
quality of nursing home care.” In Abt Associates,
Inc., Appropriateness of minimum nurse staffing
ratios in nursing homes: Phase II final report (chap. 2).
●
Every facility issue that negatively
impacts your five-star rating represents
potential underlying process problems
and needs a thorough root-cause analysis.
Be systematic about weaving quality-ofcare issues, staffing challenges, and MDS
accuracy problems into your continuous
A A N AC LT C L E A D E R 7. 2 4 . 2 012
Harness the Power of Your Team, continued from page 1
and work together toward common goals.
The level of success achieved is frequently
based on the strength or weakness of the
nurse leader and this leader’s ability to
inspire others.
One of the most important realizations
that can be grasped by a nurse leader
is that no one person can achieve
significant outcomes alone. Behind
every successful person is a team of
individuals who support their leader
and pave the way for success through
combined efforts. A leader who makes
all the decisions may be perceived as a
dictator who does not value the team
members’ experience or ideas. Although
this type of leadership displays the
leader’s strengths, it also exposes
weaknesses that would be minimized
in a team atmosphere.
Nursing staff achieve more when
the department functions as a team.
According to inspirational speaker John
C. Maxwell, leaders who fail to grasp
this fact are often hampered by ego,
insecurity, or temperament.
• Ego—Most leaders don’t enjoy
admitting to their staff that there
are things they cannot do or don’t
understand. Often they try to do all
things, yet they may not be doing
them well. Failing to delegate and
taking on more than is reasonable
results in a juggling act in which some
things are going to be dropped.
Kerry Wells of INJOY says, “Spinning
more plates doesn’t increase your
talent—it increases your likelihood
of dropping a plate.”
continued on page 8
IT’S HERE!
FIVE-STAR FOR MDS 3.0
How much do you know
about the new rating system?
Are you prepared to excel in the three specific areas of focus?
How exactly does your coding accuracy inﬂuence final rating?
If you have questions like
these—we invite you to join
Rena R. Shephard on August
2nd at 2 pm EDT (1 pm CDT, 12
noon MDT and 11 am PDT) to get
easy-to-understand answers that
will prepare you to give yourself
and your facility a “high five.”
7
You’ll be able to:
•Describehowsurveyresultsimpactyourrating.
•ReviewtheroleofQMs.
•Describehowtheratingforstafﬁngiscomputed.
•ProactivelyinstituteQAactivitiestoenhanceyourrating.
Register today
at www.aanac.org/webinars
A A N AC LT C L E A D E R 7. 2 4 . 2 012
• Insecurity—When a leader feels
threatened by others, he or she is less
likely to draw on the strength of the
team. Insecurity is often behind the
failure to foster a team atmosphere.
We have all known people who won’t
hire individuals they perceive as very
capable because they fear being
overshadowed. Only leaders who are
secure in their skills and knowledge
will empower others. Leaders who fail
to build teams may want to maintain
control of everything, or may fear
being replaced by someone they
perceive as more capable. President
Woodrow Wilson would offer this
advice to insecure leaders: “We
should not only use all the brains we
have, but all that we can borrow.”
• Temperament—There are people
who never think of asking others
for help. Their personalities may
not be very outgoing, or they simply
don’t think in terms of team building
and participation. If they try to do
everything on their own, they limit
their own potential.
independent people to creating team
players? Everything starts with creating
a vision and working together toward a
goal. We need to point our staff toward
a meaningful target if we expect them
to achieve a goal. We must first see the
vision of what we want the team to
A nurse leader is charged with painting the big picture for his or her staff,
making sure the right people are in the nursing roles, and modeling the
behavior that is desired of others.
A team is not just a group of people who
are directed by one leader. Every person
on the team has a role to play, and these
combined roles contribute to the overall
big picture. It is the responsibility of
the nurse leader to help others grasp
the big picture by continually keeping
in the forefront a vision of where the
team needs to go. How does a nurse
leader shift from leading a group of
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AFTER TWO YEARS.
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achieve in order to help everyone else
see it. A nurse leader is charged with
painting the big picture for his or her
staff, making sure the right people are
in the nursing roles, and modeling the
behavior that is desired of others.
continued on page 9
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A A N AC LT C L E A D E R 7. 2 4 . 2 012
Assess to determine what kind of attitude
the members of your team have when
it comes to the big picture. Do they see
outcomes that benefit them individually,
or are they committed to doing whatever
it takes for the team to succeed? As
a nurse leader, determine to model a
willingness to achieve the big picture
rather than to serve self. Motivate team
members by sharing the vision with
enthusiasm, and recognize those who
come on board and work with others
toward the desired goal.
When we think about the process of
completing the MDS 3.0, we see that
various team members complete sections
that are appropriate to their set of skills
and knowledge. It takes the expertise of
a team to gather the data that is used to
build an individualized care plan and
maximize a resident’s potential. If only
one person were to take responsibility for
9
completing all sections and interviews
that are part of the MDS, the outcome
would be weak, important perspectives
would be missed, and important
elements would be missing from the
resident’s care plan. Just as it takes a
team to properly complete the MDS
and develop a meaningful care plan, it
takes the whole nursing team to achieve
positive outcomes for all residents.
Nurse leaders who want to develop a
strong and effective department must
realize the importance of drawing on
the strengths of each member of the
nursing staff. A winning team can
be built only through a shared vision
and acknowledgement of each team
member’s contribution. Start looking
today to discover the specific strengths
possessed by each of your team members,
and draw on those strengths to harness
the power of the nursing team. ●
A A N AC LT C L E A D E R 7. 2 4 . 2 012
To Whom
Does the MDS
Nurse Report?
Do your MDS teams
report to Nursing or
Finance or some other
organization within
your facility? Would
anyone care to share
your thoughts?
What are the benefits
of one over the other?
I’m assuming that
traditionally it’s
always been Nursing,
but I was wondering
if anyone else has
broken that mold and
what the benefits are
of doing so.
I am an independent consultant,
so I am not in one facility, but my
business is MDS consulting, and
I always recommend that MDS
repor t to the administrator.
Judy Wilhide Brandt, rn, c-ne, rac-mt
(judy.wilhide@judywilhide.com)
Q+A
The MDS Connection community thread on
this question also included these notable comments:
Delores wrote: Although the MDS is a resident assessment tool, it is the direct
link to reimbursement, therefore how can the final report-ability be other than
to the administrator? In my experience, assigning report-ability for various
departments to the DON is not effective. Some acute care hospitals have changed
the title to VP of Nursing or something similar to side-step this issue. Just pile
it on the DON.
Eva wrote: Definitely the administrator. RNAC needs to be able to be at the level
of the other department heads, so he/she can coordinate all the departments
equally. The RNAC needs to be able to coordinate care from all departments as
well as be sure reimbursement is in line.
Judith wrote: I would also like to suggest that the MDS department should
report to the administrator, with a copy of results to the DON through the
administrator. The MDS should also be its own department, rather than a
division under Nursing. MDS plays a direct role in financial compensation
as well as maintenance or improvement in the provision of nursing care.
Kristi wrote: A few months ago I negotiated to have the MDS made its own
department at my facility. It’s very difficult to have it under a different
department because there are so many hands involved (therapy, social work,
nursing, billing, dietary). This way, I also am able to feel as though I am on a
level playing field with other department heads when trying to get what I
need or want, and I also am able to have more say when it comes to the process.
It has been working pretty well so far!
Karen wrote: As long as I have been an MDS Coordinator I have reported to my
DON. She is very supportive of me when I need help to have the other IDT team
members get their portions of the MDS completed timely. This doesn’t happen
very often. We work well as a team.
Qualifying for Short Stay
I have a resident who was admitted
June 26 on Medicare A, on PT and OT.
She was hospitalized on July 9 and
returned July 11. I did a Discharge
10
return anticipated and a Reentry.
Does she qualify for a short stay? Do
we do a 5-Day Readmission combined
with SOT? Since she was here on
Med A June 26, it wouldn’t be day 8
or earlier unless you don’t count the
previous stay. She was discharged
home on July 14. Thank you for all
your help.
continued on page 14
A A N AC LT C L E A D E R 7. 2 4 . 2 012
AANAC 2012
UPCOMING WORKSHOPS
TRAINING PARTNER
MASTER TEACHER
DATES
CITY/STATE
MDS 3.0 RAC-CT CERTIFICATION WORKSHOPS | 3-DAY
Harmony Healthcare International
Jennifer Pettis
July 31 – Aug 2
Napa, CA
Pathway Health Services, Inc.
Cynthia Perrault
July 31 – Aug 2
Nashville, TN
LeadingAge Kansas
Ron Orth
Aug 1 – 3
Wichita, KS
Jennifer Pettis
Aug 7 – 9
Glendale, AZ
Colorado Health Care Association
Rena Shephard
Aug 7 – 9
Denver, CO
Ohio Health Care Association
Robin Hillier
Aug 7 – 9
Columbus, OH
Judi Kulus
Aug 7 – 9
Brookfield, WI
Renay Corrigan
Aug 13 – 15
Portland, ME
Hill Educational Services, Inc.
Carol Hill
Aug 20 – 22
Florence, AL
Jennifer Pettis
Aug 21 – 23
Topsfield, MA
LeaderStat
Lisa Hohlbein
Aug 21 – 23
Kansas City, MO
Renay Corrigan
Aug 27 – 29
Bloomfield, NJ
Cynthia Perrault
Sep 11 – 13
Charleston, SC
Leaderstat
Lisa Hohlbein
Sep 11 – 13
Baltimore, MD
Judi Kulus
Sep 18 – 20
White Bear Lake, MN
MDS 3.0 RAC-CT RE-CERTIFICATION WORKSHOPS | 1-DAY
LeadingAge Ohio
Jane Belt
July 25
Columbus, OH
Life Services Network
Ron Orth
July 25
Springfield, IL
Ron Orth
July 26
Woodridge, IL
Ron Orth
Aug 7
Rockford, IL
North Dakota Long-Term Care Association
Ron Orth
Aug 9
Bismarck, ND
LeadingAge NY
Sandy Biggi
Aug 10
Latham, NY
Hill Educational Services, Inc.
Carol Hill
Aug 27
Fultondale, AL
Jennifer Pettis
Aug 7 – 9
Muncy, PA
Judy Wilhide
Aug 15 – 17
Springfield, IL
MEDICARE UNIVERSITY WORKSHOPS
The workshop schedule is subject to change and is updated regularly. To see a full AANAC Training Partner workshop schedule, visit aanac.org/workshops
11
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What’s new in
New Tutorial Videos
are Now Available
We want to make using AANAConnect as easy as possible.
To help you learn about the benefits your member community
offers, we’ve created a series of short “how-to” videos. From
updating your profile to using advanced search to find
the information you need, these videos provide a visual
navigation of the featured tool or resource and are all four
minutes or less.
Here’s what we cover:
• My Profile: Learn how to maintain your profile
information through AANAC.org, update and
upload a photograph of yourself, and modify your
privacy settings.
• Communities: View the many communities available
and take an in-depth look at our most popular
community—MDS Connection.
• Discussion Postings: Use the quick community links
in discussion postings and email digests. Modify your
signature and search for specific postings.
• Joining a Community: Make sense of subscription
options, set up different email delivery addresses and
get involved in multiple communities.
• Member Directory: Dive deep into the Member
Directory feature using various functions like MDS
software provider, group membership, “likeness”
and much more.
• My Contacts: Expand your professional network
using mutual contacts and simple search techniques.
Also covers the Inbox.
• Posting a Message: Learn how to respond directly
to postings through the discussion groups or
conveniently from your email.
• Resource Libraries: Upload documents to the
community libraries or search for the samples you
need to get the job done.
Enjoy the power of your professional community.
We’d invite you grab some popcorn, but the videos
aren’t that long. (Well, unless you just love popcorn.
Then grab it anyway!)
Active Discussions this
week on AANAConnect:
LTC Network:
Thread Subject:
Overnight passes when
on Medicare
Posted by: Kim Lies
We have a gentleman
who is on Medicare. Ho
wever,
family keeps coming
and getting him for pa
ss and he is
gone from 6 pm until
1am. He has now had
4 times of
this and I’m not sure ho
w to handle this? I’m cer
tain it is
a red flag to Medicare
that he doesn’t need ski
lled care
since he is constantly
leaving. Do we discharg
e him from
Medicare? (He just ha
d knee surgery) Or ca
n we say he
cannot leave? Also, ho
w do all of these overni
ght passes
when on Medicare aff
ect his MDS schedule
?
Have you experienced
a similar situation as the
one
facing Kim? Click on the
thread subject above an
d be
one of the first to provid
e her with an idea of ho
w
to
handle this scenario.
n:
MDS Connectio
es
RUG score averag
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Thread
McDavid
Posted by: Mark
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Click here to view. ●
13
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Q + A, continued from page 10
What You
Need to Know
Check out these latest updates from the
“Need to Know” section of the AANAC
homepage and find the information you
need to get the job done right.
Five Star Technical Users Guide
UPDATED
July 12 SNF/LTC Open Door Forum:
Agenda and Call-in Info
OIG Slams Assessment / Care Planning
for Atypical Antipsychotics UPDATED
Medicare Tip
If a Medicare resident admits to
your facility with the expectation
that he will remain overnight but
is discharged or is transferred to
a nonparticipating provider or a
nonparticipating distinct part of
the same provider or dies before
midnight of the same day, the day
can be billed for reimbursement.
Judi Kulus, nha, rn, mat, rac-mt, c-ne
(jkulus@aanac.org)
Treatment of
Members Policy
AANAC has posted the
Treatment of Members Policy
on the website. If you need to
access it, please click here.
Get Answers Now
When you need answers fast, the
best place to start is AANAConnect.
We have thousands of member
questions that have already been
answered by our experts who
moderate the communities 24/7.
Just type your topic into the search
box to see the discussions, tools and
peer-submitted resources that may
be just what you’re looking for.
14
The first stay was not a short stay since she was in the facility more than
eight days. However, the readmission stay may qualify since the resident was
discharged less than eight days since readmission.
Carol Maher, rn-bc, rac-mt (cmaher0121@earthlink.net)
Office of Inspector General Audits
One of our facilities received a letter from the OIG requesting the full
medical record of a resident, stating the Office of Evaluations and
Inspections was conducting a random review of safety and quality of care
to post-acute Medicare beneficiaries. Has anyone else received one of these?
Also, at the risk of seeming cynical, I want to know if these are just what
they say they are. Thank you.
Yes. I have been a nurse that reviewed charts for those folks. They ask for charts
and send them to medical professionals to supper the OIG work plan. They
compile the results and publish studies, like the one on psychotropic drugs that
got so much attention. You can read about them on the HHS OIG webpage.
Give any government request the utmost priority. When I was reading
charts for them, if I found something that clearly needed to be dealt
with (such as quality or overpayment), they forwarded the chart to the
appropriate authority for follow-up.
You can also call the POC number on the letter and they will explain it to you.
Give any government request the utmost priority. When I was reading charts for
them, if I found something that clearly needed to be dealt with (such as quality
or overpayment), they forwarded the chart to the appropriate authority for
follow-up. They can take back overpayments or investigate anything that needs
investigating, even though the reason for the chart request is a study.
Judy Wilhide Brandt, rn, c-ne, rac-mt (judy.wilhide@judywilhide.com)
Individual and Group Therapy
I have a therapist that wants to see a Medicare Part A patient and a
Medicare Part B patient at the same time and bill individual minutes
for the Part A patient and group minutes for the Part B. I am being told
that this is acceptable according the rehab policy, which states that a
therapist can see a Part A and Part B for two different activities and
bill group for B and individual for the A on the MDS. This is not how I
understand it. Can someone please explain how this can be done and
whether this is acceptable?
Federal MDS regulations indicate individual therapy is one resident working
with one therapist.
For Part A Medicare, when two residents are working on different activities
together it is considered concurrent. Part B does not recognize concurrent
therapy, so when a Part B resident is working with another resident it is
considered group for that Part B resident. The reference for this is the RAI User’s
Manual, chapter 3, page O-16.
Carol Hill, rn, cdp, c-ne, rac-mt
A A N AC LT C L E A D E R 7. 2 4 . 2 012
AANAC
Board of Directors
Carol Siem msn, rn, bc, gnp
Chair
Ruth Minnema rn, ma, c-ne, rac-ct
Vice Chair
Carol Maher rn-bc, rac- ct
Secretary
Peter Arbuthnot aa, ba, rac- ct
Treasurer
Susan Duong, rn, bsn, nha, rac- ct, c-ne
Patrice E Macken, mba, rhia, lnha, rac- ct
Gail Harris, rn, bsn, rac- ct, c-ne
Joanne Powell nha, rhia
Diana Sturdevant ms, gcns-bc
Assessment Not Used for Payment
One of my residents was ill and on medical hold for therapy, resulting in
only four treatment sessions and a decline in RUG level on her COT date.
Her COT observation date coincides with her 30-Day assessment for day 29.
Since the days coincide and her rate would decrease, I wouldn’t need to do
the COT, just a 30-Day, and my rate would change on day 31. On my next
COT observation date, or day 36, the rate would go up, so I would do a COT.
My question is: In this scenario, the 30-Day assessment wouldn’t be used
for billing, since the COT on day 36 would pay from day 31, so do I have to
do the COT for day 29?
No, you don’t have to complete the COT. In this situation, there is no gap where
an assessment that is “used for payment” is not available to bill on. The “used for
payment” policy applies only if the resident is discharged from Part A before the
beginning of the payment window for the respective assessment.
Ronald A. Orth, rn, nha, cpc, rac-mt (raorth@clinicalreimbursement.com)
AANAC
Expert Panel
AANAC is pleased to introduce you to our
panel of volunteer reviewers who represent
the best and the brightest in our field:
Jennifer Pettis rn, wcc, rac-mt, c-ne
Chair, Harmony Healthcare International
Topsfield, MA
Betty Frandsen rn, nha, mha, c-ne
Nichols, NY
Robin L. Hillier cpa, stna, lnha, rac-mt
President, RLH Consulting
Becky LaBarge rn, rac-mt
Vice President, Clinical Reimbursement
The Tutera Group
Deb Myhre rn, c-ne, rac-mt
Nurse Consultant, Continuum Health
Care Services
Ron Orth rn, nha, rac-mt
Clinical Reimbursement
Solutions, LLC, Milwaukee, WI
Andrea Otis-Higgins
rn, mlnha , cdona , clnc, rac-mt
CEO, Administrator, St. Andre Healthcare
Biddeford, ME
Rena R. Shephard mha, rn, rac-mt, c-ne
AANAC Executive Editor
President, RRS Healthcare,
Consulting Services, San Diego, CA
Judy Wilhide Brandt rn, rac-mt, c-ne
Regional MDS/Medicare
Consultant President, Judy Wilhide
MDS Consulting, Inc.
Consistent Staffing
I attended recent training and there seemed to be a big push for consistent
staffing. I am curious whether anyone has recently switched to consistent
staffing, how big is your building, and are there any ups/downs, pros/cons you
would be willing to share.
Consistent staffing has been the standard for awhile. If you Google “consistent
staffing nursing homes,” you will get links to some important and informative
documentation about this. David Farrell is one of the nationally recognized
15
A A N AC LT C L E A D E R 7. 2 4 . 2 012
LOOK AT WHAT YOUR COLLEAGUES
HAVE BEEN UP TO!
C-NE Recipients
March 16 – July 19, 2012
MDS 3.0 RAC-CT®
Recipients
March 16 – July 19, 2012
Tamela Aaron
Lori Allred
Grace Ashu
Kimberly
Abdulghani
Kandy Alters
Martin Aunon
Catherine
Anderson
Kemitashi Austin
Mercy Abunaw
Diana Adams
Barbara Anderson
Lori Adams
Kim Andrews
Nancy Adams
Lily Anne
Angeles-McGill
Monica Adams
Adeyinka
Adebayo
Ron Anglo
Jody Angus
Hasmin
Affo-Worou
Jacqueline
Anongos
Bose Ajayi
Elaine Applin
Jenny Akers
Malcolm Aquino
Deborah Alabran
Marlene Aquino
Margaret Alade
Marites Arbolario
Diana Alderman
Cheryl Archibald
Donna Alexander
Malissa Armstrong
Jennifer Alexander
Kayl Armstrong
Catherine Alfonso
Sherrie Arp
Nenita Alfonso
Sheila Arroyo
Linda Alford
Jillian Arvelo
Catherine Alloway
Margie Ashby
Ruth Avila
Aleida Avila
Daramola Ayoade
Brenda Aznar
Nora Badway
Ron Anglo
Jason Gedney
Judi Kulus
Valsamma Babu
Deborah Green
Lisa Leonard
Leigh Bebber
Jill Greenhoe
Carrie Lukins
Connie Black
Chris Hanson
Mary McBeath
Doreatha Chase
Deborah Kania
Jeanne Mendoza
Sandra Edmonds
Nelia Kennedy
Karen Parenti
Lorraine Fabry
Mary Klinger
Suzanne Russell
Alicia Bauer
Regina Bishop
Jo Ann Brunson
Diane Baum
Connie Black
Evelyn Bryant
Kay Campbell
Dusty Baxter
Misty Blackburn
Debra Buchanan
Aisha Canty
Sherry Beal
Inesha Blackwell
Angie
Budnick-Brissette
Robert Carbonilla
Shelly Beary
Donna Blair
Londa Beck
Marilyn Blakeley
Marie Bedford
Deborah Blaschko
Connie Beerbower
Ofella Blewitt
Leah Belimac
Cheryl Bliefernich
Elizabeth Bell
Pamela Blohm
Veronica Bellman
Joyce Blount
Leakie Bell-Wilson
Julita Bocado
Hazel Bennethum
Akinfaye Bolanle
Janet Bennett
Mary Boles
Jose Miguel Buhay
Mary Ann Burdett
Phyllis Burger
Apryl Burgess
Rachel Burgos
Lariza Burgos
Brenda Burk
Dennis Burke
Rebecca Burrus
Bernardina
Baes-Abayev
Nancy Bensen
Vicki Bollenbacher
Maureen Baker
Mary Beth Berda
Shelia Bolwahnn
Linda Baker
Karen Beres
Shereen Banarsee
Ami Bernard
Ann Bowman
Sherrie Banas
Donna Bernard
Rhonda Barajas
Holly Bernhardt
Kasey
Brandenburger
Honesto Cacho
Diane Barbera
Miriam Berry
Rhonda Brennan
Arlene Cagampang
Stephanie Barkey
Dawna Berry
Kimberley Brien
Susan Cagnon
Ashley Barnhart
Maricelle Bertumen
Heidi Brown
Lisa Barnhart
Janice Berube
Brandi
Caldwell-Petrus
Joy Barr
Rose Marie
Bien-Aime
Claire Barry
Feliscity Bassett
Cheryl Billman
Pearl Binka
Nicole Bowers
Tiffany Brown
Teresa Brown
Michele Brown
Suzan Brown
Stacey Brown
Kathleen Butler
Kathy Butler
Pam Byam
Gina Byrge
George Cabrera
Kathleen Calhoun
Jan Callanta
Kathleen Caluag
Diana Cameron
Michelle
Shoemaker
Ewa Swiatek
Laurie Terning
Sherry Trumpower
Wendy Wilson
Wanda Wyse
Kimberly Campbell
Cheryl Cardwell
Donna Carlone
Kristina Carlson
Sonya Carollo
Diana Carpenter
Karen Carr
Lisa Carson
Angela Carter
Angela Carter
Grace Castillo
Leanne Ceccarini
Jeanne Celestino
Gretchen Chapman
Mary Chapple
Kathryn Chatman
Sandy Cheatham
Chiu Chen Chen
Rose Chen
Carla Chesbrough
Florence Choge
Latwinnie
Chokureva
Michael
Christopherson
16
A A N AC LT C L E A D E R 1.10 . 2 012
Colleague Achievements, continued from page 16
Josephine Chu
Amie Dautremont
Louie Duque
Alesandre Fowlks
Lori Chuisano
Bethany Davenport
Laurie Duran
Kathleen Fraire
Ma. Paulita Ciriaco
Vanessa Dyal
Lisa Frazier
Kristina Clark
Bruce Davidson
Rosella Ealy
Cindy Frazier
Sharon Clark
Lisa Davis
LuzElena Eaton
Ruth Frebowitz
Tania Cleaver
Crystal Davis
Adeluisa Edano
Terri Frederick
Caitlin Cohen
Denise Davolt
Patricia Eddy
Marilyn Frederick
Kimberly Cole
Melvin Joseph
De Guia
Sandra Edmonds
Amy Fridley
Bridget Edwards
Ashley Fritts
Cathie Coleman
Carol Collier
Crystal Collins
Jaime Comerford
Fe Condeno-Lontoc
Dawn Conley
Debra Conrick
Nancy Cook
Janae Cook
Misty Cook
Karen Coppernoll
Deborah Corado
Anastasia Cormier
Ashley Corner
Mark Cosmiano
Rebecca Coston
Shannon
Countryman
Charlotte
Covington
Larissa Deblanc
Michelle Del Valle
Clarice Dela Cruz
Lagrimas DeLeon
Imelda Delimeos
Maria Delson
Martha Dempsey
Dennise
Derby-Bemis
Leeah Develez
Sujey Diaz
Pamela Dick
Joan Dillon
Abegail Dimacali
Margaret Dini
Annika Dinovi
Sherry Dobbs
Gina Docteur
Marcelita Doherty
Nancy Cowan
Carol Dollar
Janice Craig
Maricar Domingo
Constance
Cronacher
Robin Donahue
Susan Donella
Chrystina Edwards
Carlet Fromm
Donna Edwards
Su-hwei Fu
Cheryl Ehrlich
Gina Galang
Deloris Ellibee
Denise Gallagher
Peggy Ellis
Emilie Galyon
Sandra Elswick
Tamika Ganzy
William Engerson
MaryAnn Garcia
George Enongene
Elaine Garcia
Askale Enyew
Juliet Garvin
Laurie Erhardt
Virginia Garza
Honey Erolan
Jacqueline
Gayle-Brown
Jacqueline Esack
Stephanie
Escamilla
Heidi Escobar
Morgane Etienne
Brooke Evans
Patricia Falvey
Zexu Fang
Carol Farnsworth
Marvis Farris
Deborah Fein
Ellen Donovan
Sister Deirdre
Ferguson
Fe Dosado
Kimberly Ferree
Gail Dosey
Heather Ferrell
Veronica Douglass
Marietta Fertig
Rebecca Dowell
Galyna Fishman
Carrie Drake
Laurie Fitzloff
Colleen Drake
Christine Flaurr
Sabrina Fleming
Deborah Curtis
Maureen
Drouillard
Sherri Dabiew
Kelli Duckett
Donna Daffron
Debra Duff
Bethani Dandois
Mary Joy Duller
Edward Daniels
Paula Duncan
Judith Dantonio
Kerry Dunning
Konnie Cross
Cynthia Crumb
Michelle Cruz
Sherry Cruz- Flores
Donna Cuadra
Rosemarie Cuadro
Jennifer Cuaycong
Amy Cullen
17
Regina Davidson
Marcela Flores
Rita Flynn
Lisa Folson
Denise Ford
Deborah Foster
Rose
Gazzerro-Langford
Mia Gehm
Andrea Gele
Tammy Genagon
Tina Ghorley
Sandra Giafardino
Vicki Gidley
Annette
Gielchinsky
Janice Giessinger
Michelle Gillard
Viviane Gilles
Millicent Gillis
Margaret Gillroy
Brenda Gilmore
Marilyn Glassco
Nadira Godbout
Monica Goetzinger
Maureen
Golas-Markure
Stephanie
Gonsalves
Michelle Gonya
Maria Ana
Gonzales
Monique Gonzales
Valerie Gonzalez
Johana Gonzalez
Chastidy Goodwin
Denise Gorrie
Phyllis Graham
Melissa Graybill
Edna Green
Angela Greene
Debora Greene
Jane Ellen Gregson
Katherine Griffin
Karin Hanna
Mary Hite
Chris Hanson
Ann Hobson
Roderick Harper
Jennifer Hodges
Janice Harris
Patricia Hoffman
Melinda Harrison
Debra Hoffman
Lindsey Hart
Donna Hohm
Carmisha Harvey
Linda Hoisington
Linda Hatter
Cynthia Holden
Martha Haugen
Diane Holzberg
Pamela Hawkins
Beverly Holzer
Mary Hawn
Edy Homan
Bonita Hayes
Sheryl Hopson
Shirley Hayes
Tashina Hornaday
Laura Hayth
Brandy Hostetter
Pavlina Head
Paulette Hoyle
Paulyn Headley
Melissa Hudek
Joann Heath
Kathleen Hughes
Noelle Heery
Karen Hulsebosch
Christie Heese
Suellen Hunsinger
Jennifer Heimann
Linda Hunt
Patricia Grilli
Jolene Hein
Paula Hunt
Laci Gritton
Jeanette Heitzler
Tammara Hunter
Eileen Grubbs
Terry Hellman
Robin Husman
Jennifer Grube
Jackie Helms
Freda Iaizzi
James Gruebner
Christine Hemphill
Uduak Ibanga
Kathy Gruel
Connie Hemphill
Maureen Imperato
Grace
Indrakusuma
Shannon Griffin
Josephine Griffin
H. Patricia
Griffiths
Gale Grunert
Cathy Henderson
Mary Grace
Guanzon
Debra Hennen
Julie Guiler
Elvira Hernandez
Suzanne Guimond
Christal Hertzog
Lilian Guinto
Darunee Gust
Madonna
Heshelman
Juanita Gutierrez
Valerie Hesse
Chijioke Izuka
Gregory Guymon
Susan
Hickson-Painter
Janet Jackson
Nancy Haas
Sandra Hacker
Lorinda Hagstrom
Kathleen Haider
Dorothea Hairston
Pamela Hajewski
Beverly Golmon
Cristina Hall
Jeannette Gonder
Angela Hamer
Michele Gonsalves
Patricia Hamilton
Beverly Hand
Cyndi Hensarling
Amy Higgins
Lindsay Hight
Donna Hill
Sandra Hill-Harris
Patricia Hillman
Ramona Hinds
Wendy Hinkle
Rebecca Hinojoza
Angela Hise
Karen Irthum
Dionne Isadore
Katrina Isakoff
Annie Iskenderian
Rossana Itchon
Tiffany Jaklevich
Najma Jamal
Dana James
Kaelin Jansen
Erica Jasperson
Linda Jensen
Diane Jensen
Dana Jimenez
Cerrisa John
Barbara Johnson
A A N AC LT C L E A D E R 1.10 . 2 012
Betty Johnson
Julie Kutz
Jack Loer
Valarie Mauro
Stephanie Mitchell
Marnie Nieves
Patti Johnson
Joyce LaCroix
Marie Logsdon
Kim Maxson
Elaine Niewind
Cathy Johnson
Aleine Jubelle
Lacuna
Editha LoMonaco
Naide Mazzochi
Tujuana
Mitchell-Simon
Barbara Johnson
Mary Johnson
Kathryn Johnson
Sandra Johnson
Diane Johnson
Robyn Jones
Sherri Jones
Shukriyyah Jones
Donna Jones
Susan Jones
Gwendolyn Jones
Tanya Jordan
Paula Josephs
Lilly Juarez
Jennifer Kaczmarek
Moses Kamande
Leanna Kane
Moses Karanja
Victoria Karpman
Wenxin Karshis
Margaret Keck
Sarah Kelley
Theresa Kelley
Christina Kelley
Stacy Kelly
Earl Kendall
Jill Kennell
Amy Keown
Kellin Keyfauver
Jim King
Victoria Kinsman
Tracy Klenda
Jan Kliethermes
Beatrice Klingel
Brenda Kloster
Cynthia Knauft
Kathleen Kolodge
Colette Kon
Aminata Kone
Aimee Kroeger
18
Donna Lagueux
Beth Lambros
Linda Lamson
Lisa Lanausse
Sherry Landis
Dawn Landis
Hollis Landskron
Patrick Langat
Helen Langford
Connie Langlois
Veronica Lanigan
Andrea Long
Glory Mbakwe
Kristy Long
Catherine Mbugua
Rowena Long
Elizabeth
McAdams
Rosina Lott
Leanne Love
Susan Lubeck
Lupita Lucio
Martha Lugo
Carrie Lukins
Mary Lunzer
Deborah Lysik
Anita Lanoue
Archanaceline
Macloen
John Lao
Reneena Maglunog
Jennifer McAfee
Kelly McArthur
Brenda McCabe
Lori McClenning
Barbara McCurry
Amelia McDonald
Constance
McEldowney
Amber Mitchum
Corinne Monahan
Heather Monge
Teresita Monsada
Maureen
Montanaro
Karen Montgomery
Sara Moody
Robert Moore
Angela Moore
Lorie Moore
Evelyn Morgan
Pamela McGuire
Emily Morgan
Candace McKee
Jeri-Ayn Morley
Erin McLagan
Larissa Moroz
Denise McNamara
Darlene Morris
Norma Mears
Cindy Morris
Cynthia Mains
Lydia Medders
Sofia Moya
Lenita Mallorca
Aden Medhane
Aimee Mullins
Reginald Mamaril
Taunya Medler
Rachel Murawski
Elaine Laufer
Kathy Manalang
Hilda Mejias
Trevor Lavergne
Gail Charmaine
Manapat
Jeanne Mendoza
Claudine
Murdaugh
Jennifer Larner
Anne Larson
Lynda Larson
Elisa Larson
Christine
Latondress
Denise Lavon
Terri Lawall
Lynda Lawrence
Kimberly Layfield
Danielle Leahey
Theresa Learst
Keri Lease
Monica Ledford
Joung Hwa Lee
Virgillio Legaspi
Susan Mahaffey
Melonie
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VanDerSloot
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19
Jennifer Ryals
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Wormington
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Yocheved Zentman
Mary Lou Zepeda
Glorificacion Zerna
Patricia Zibelli
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A A N AC LT C L E A D E R 1.10 . 2 012
MDS 3.0 RAC-CT®
Recertifications
March 16 – July 19, 2012
Edna Adams
Brenda Brooks
Teri DeGraw
Phyllis Adams
Stephanie
Broussard
Lisa Delano
Marie Andree
Adolphe
Diana Aduna
Rosemary Brown
Cheryl Ahlberg
Tiare Brown
Karen Ahlers
Karan Bulvin
Omana Alex
Michele
Busenlehner
Linda Allen
Penny Allison
Jerry Amerman
Debbie Arthur
Tonya Ashford
Mary Askegren
Marie Gabrielle
Avril
Jennifer Butt
Nancy Calizar
Katina Campbell
Richard Cannon
Arlyn Carbonel
Bonnie Carrillon
John Carter
Judy Bair
Eimee Casal
Musa Baldeh
Elaine Casey
Elizabeth Baldwin
Alice Chambers
Kristin Bangert
Kathy Champion
Kathy Barger
Janette Chase
Tina Bark
Susan Chester
Anne Bartlett
Anita Cheung
Diana Basko
Betty Chilson
Susan Battaglia
Robin Christman
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Heather Boehlke
Rito Nelson Daan
Coletta Bontrager
Pamela Darling
Melinda Boucaud
Elizabeth Darnell
Barbara Bowes
Cyndi Davis
Judy Boyd
20
Deborah Brown
Erica Davis
Jeanne Boyle
Kristina Davis
Linda Brooke
Victoria Dedrick
Linda Demme
Donna Deneen
Ann Deziel
April Diaz
Stacy Dikeman
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Jo Ann Dobbs
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Jeanne Dunker
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Mychajlowskyj
Donald Lowe
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Macatangay
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Mojdeh Rutigliano
Catherine Sack
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Villavicencio
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Kathy Waiters
Sandra Wyman
Janice Wallace
Carol Yako
Susan Wallace
Patricia Yanoski
Heather Ware
Janice Yotty
Michelle Warlick
Mary Zorn
●
experts on this topic. This link takes
you to a piece he wrote on this in 2006:
http://www.theconsumervoice.org/sites/
default/files/advocate/policy-resources/
Auld,Rosenthal-1of4-Concurrent(Consist
entAssignment).pdf.
This one is from the Advancing
Excellence campaign—very helpful:
http://www.nhqualitycampaign.org/files/
impguides/2_ConsistentAssignment_
TAW_Guide.pdf.
Rena R. Shephard, mha, rn, rac-mt, c-ne
(RRS2000@aol.com)
My Facility’s
New Five-Star Rating
I guess I don’t understand this fivestar system at all. I just reviewed my
facility’s five-star breakdown. The
way I am reading into it, we should
be rated as a five-star building but our
21
total review stars read as a four-star.
The breakdown is:
inspection rating; subtract one star if
staffing is one star. The overall rating
cannot be more than five stars or less
than one star.
• Health inspection: 4 stars
• QM: 4 stars
• Staffing: 4 stars
• RN staffing: 4 stars
With these numbers, shouldn’t we be
a five-star? Can someone please explain
this to me? My administrator doesn’t
get it either. Thank you so much.
Here are the steps for determining
your five-star rating. Notice that for the
staffing rating, you would not get to
add a star since it is not greater than the
health inspection rating.
• Step 1: Start with the health
inspection five-star rating.
result if staffing rating is four or five
stars and greater than the health
result if Quality Measure rating is
five stars; subtract one star if Quality
Measure rating is one star. The overall
• Step 4: If the health inspection rating
is one star, then the overall quality
rating cannot be upgraded by more
than one star based on the staffing
and Quality Measure ratings.
• Step 5: If the nursing home is a
Special Focus Facility (SFF) that has
not graduated, the maximum overall
quality rating is three stars.
Ronald A. Orth, rn, nha, cpc, rac-mt
(raorth@clinicalreimbursement.com)
●
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2012 AANAC.
part of this
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AANAC.
22
13
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legal or regulatory
advice.
© 2011 AANAC.
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