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Navigating payment reform

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Todd McQueston
Todd McQueston

Improving quality is the key to surviving payment reform. Here are six ways LTC providers can boost their quality.

The new world of payment reform is upon us and long-term care providers are looking for ways to adapt. CMS is quickly moving away from traditional Medicare reimbursement to a value-based performance model. Before this phase-in period is over, 80 percent or more of payments are going to come from managed care.  

If providers are to survive — and prosper — they need to make some changes. 

First, they need to understand the new reimbursement system that is coming but also prepare themselves to deliver quality care at a lower cost. To do this, more attention must be paid to Quality — undeniably one of biggest contributing factors to performance.

One way LTC providers are adapting is by replacing some of their long-term Medicaid residents with higher paying short-term patients. For one thing, there are fewer long-term patients today as more are being cared for at home. And, as hospitals send more patients home earlier — often with their healing only partially complete — there is a growing opportunity for nursing homes to step in to capture more of these dollars.

A new breed of provider requires more skilled nursing and more information at their fingertips, and gives yet another big reason to focus on quality.

To help navigate this fast-changing river, we have identified six factors that can help providers enhance their quality:

  1. Ensure that your nurses are providing evidence-based care that adheres to current best practices. If providers are to reset the bar on quality they are going to have to use current, evidence-based nursing and medical care. There are many ways to document and share this information but it must be kept current. References that are important to consider include guides to nursing policies and procedures, diseases and symptoms, care plans and core measures, and drugs, to name a few. The good news is that it is now possible to get reference information that is specifically tailored to the LTC setting.
  2. Create a system for sharing these standards so it is easily accessible and applied consistently across your organization. If the goal is to provide consistent, evidence-based care, it is going to be crucial to provide the knowledge and tools to your staff to ensure competency. Fortunately, some of these reference tools have gone digital via online password-protected websites or Apps that can be accessed at the bedside from a PC, tablet or smartphone. Some even offer seamless automated updates and manual updates which gives flexibility while freeing staff from having to do all the updating themselves.  
  3. Include more nursing training and opportunities for continuing education and a way to track it. Learning Management Systems are the norm in most hospitals but not so much in nursing homes. But, there are still ways to bring some of that training to your staff. Look to purchase some online courseware for your facility. Much of this is available online and can help keep your nursing staff up to date. Some programs also give you a way to track the competency of your staff and ensure that they are keeping current.  
  4. Consider ways to improve patient education. Nursing continuing education is important but so is patient education. Resident populations are getting younger, so resident and family education is becoming more important, according to Lisa Anetrini, RN, BSN, MS, Director of Clinical Services, at Ciena Healthcare in Michigan. Ciena nurses can use the printable patient handouts from Lippincott Advisor, an online decision support solution from Wolters Kluwer, she explains. Families of residents also need education about treatment protocols.
  5. Do a full QAPI assessment. Quality Assurance Performance Improvement (QAPI) is a new set of requirements set forth by CMS to help LTC providers drive quality improvement. It is important for providers to teach their staff organization how to implement a Plan-Do-Study-Act quality improvement cycle. Providers can use the QAPI framework to assess their own systems and processes and then compare those results to other statewide and national averages. Take a look at The CMS QAPI Guide: What You Need to Know as a starting point in doing a self-assessment.
  6. Do a root cause analysis to identify source of problems or when things have gone wrong. Consider doing a full root cause analysis to identify the underlying cause of a problem. There are a number of formal tools for conducting a root cause analysis but all assist you in looking at a specific problem that occurred or is reoccurring at a LTC facility and drills down to the fundamental reason why it is happening so it can be corrected and sustained. Check out the website for “Guidance for Performing a Root Cause Analysis (RCA) with Performance Improvement Projects (PIPs)” for tips on completing your own analysis.
Todd is Executive Director with Wolters Kluwer Lippincott Solutions and Donna is Principal of AQAC Consulting, LLC. Todd can be reached at and Donna at

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Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.