Providers must ramp-up staff competency, fortify partnerships to reduce readmissions, expert says

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Susan LaGrange
Susan LaGrange

LAKE BUENA VISTA, FL — Providers must take a long look at their staff members' competencies and how they communicate with acute-care partners to survive amid a regulatory environment that's constantly ramping up pressure to improve quality, an expert said Monday.

Looming incentive payments should be driving providers to assess the factors that play into readmissions sooner than later, Susan LaGrange, RN, BSN, NHA, CDONA, FACDONA, CIMT, a consultant with Pathway Health, told attendees at National Association of Directors of Nursing Administration's annual conference.

Under the Centers for Medicare & Medicaid Services' value-based purchasing program for skilled nursing facilities, 2% of Medicare payments will be withheld from providers beginning in fiscal 2018 in order to fund incentive payments tied to quality measures such as 30-day readmissions.

“Two percent sounds like a very low amount of money but it really is not,” LaGrange said. “At a time when we need every penny we have, we're really going to have to take a look at our systems.”

Providers also should be focusing on their nursing staff's clinical competencies, and making sure the right people are matched with the right roles. Nurses' assessment and care planning skills might have to be sharpened through additional education, LaGrange advised.

“I believe people come to work wanting to do a good job, but we really need to maximize our employees' best assets and put them in the right place,” she said.

LaGrange also stressed the importance of engaging key players, such as nurse practitioners, pharmacy consultants and vendors, to help boost facilities' systems and employees' skills.

That engagement can also go far in developing strategic partnerships with acute-care providers, LaGrange said. Meetings with hospitals should focus on communication and collaboration, and providers should come prepared with data to show that they provide quality care and are ready to work together on care transitions.

“None of us can go to hospitals today and say, ‘We're a good facility,' like we used to,” LaGrange said. “People want to say, ‘Show me the money.' They want the data.”

LaGrange's tips to providers to help work on their hospital readmission rates included:

  • Fully understand data, such as rehospitalization rates and quality measures
  • Build a performance improvement team that includes social workers, discharge planners, and certified nursing assistants. “If we don't include [frontline staff], we don't know what's really happening.”
  • Conduct root cause analysis of readmissions to pinpoint opportunities for improvement
  • Stay open to technological advancements, such as telehealth
  • Communicate with families about readmission choices and the level of care achievable in the skilled nursing facility

“If we're not where we want to be, that doesn't mean it's all over for us. It means let's get ourselves in place, let's get our ducks in a row, let's get out staff trained, let's get our numbers up there,” LaGrange said. “Let's really move to show that we are a competitor and we can provide that quality in our marketplace.”

Around 300 nurse leaders are participating in NADONA's 30th annual conference this week. The conference and exhibition continues through Wednesday at Walt Disney World's Coronado Springs Resort.