Listen in to the last podcast series of 2020!! Based on data collected this year on the percent of rehab goals met, we've created an audit tool to understand WHY don't we meet the goals? Through the end of December, join the QRM Quality Team to help answer this question as we deep dive quality improvement opportunities related to our audit findings.

The dining room is a natural environment for identifying long-term care resident needs in real time. There's no better place to easily explore and examine activities of daily living in action! And since all IDT members play a role in dining room support, this is an area where we all can share perspective to address resident needs.

If you remember Grand Rounds, check this one out! We may not “round” anymore but we still collaborate to determine individual patient needs.

Join QRM's CMI expert Rita Ramos for a discussion on how to use case mix index weights to drive LTC programming initiatives. What does CMI tell you and how can you use this information to individualize care plans and allocate appropriate resources for your LTC patient population? Check out this episode to find out!

Part 2 of our LTC Quality Improvement and Clinical Programming series

Tune in for a review of the nursing home compare publicly reported long-stay quality measures used to help consumer make informed decisions about health care providers. Today we dig into the long-stay QMs used to calculate the 5 star Quality Domain

Introduction to a new podcast series: Long-Term Care quality improvement and clinical programming. In the next 5 episodes, we will navigate the new Care Compare website and analyze Nursing Home Compare 5 star quality measures specific to long-stay residents. We will discuss CMI and what your weighted Case Mix Index means, how it differs by state, and how to analyze monthly CMI trends to address LTC patient needs. The final 2 episodes in this series will be dedicated to LTC patient identification using an interdisciplinary Grand Rounds process and LTC clinical programs to consider in-room and in a COVID safe group setting.

Please check out your Care Compare 5 Star Quality Measures before next week's episode at:
https://www.medicare.gov/care-compare/

Reach out to the Buzz Podcast team at:
[email protected]

During today's episode, QRM's VP of Medical Review Ashley Duggan shares 3 potential audit & denial risk areas her team has identified related to COVID.

Resources discussed in today's episode:

Let's Get to the Point: Coding and Documenting to Capture Isolation

Given the current COVID-19 Public Health Emergency, providers have incorporated isolation into resident care to minimize infection transmission. While isolation may be essential to resident safety, it may not always meet the RAI Manual criteria for claiming on the MDS. Per the RAI Manual, there are 4 specific criteria that must be met in order to claim isolation - criteria that have not changed with onset of the current Public Health Emergency.


Code for “single room isolation” only when all of the following conditions are met:

1. The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact, airborne or droplet transmission.

2. Precautions are over and above standard precautions. That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect.

3. The resident is in a room alone because of active infection and cannot have a roommate. This means that the resident must be in the room alone and not cohorted with a roommate regardless of whether the roommate has a similar active infection that requires isolation.

4. The resident must remain in his/her room. This requires that all services be brought to the resident (e.g. rehabilitation, activities, dining, etc.).

The RAI Manual also reminds us that specific examples of when the isolation criterion would not apply include urinary tract infections, encapsulated pneumonia and wound infections.

When conducting clinical audit, the following are frequently overlooked areas that may contribute to lack of proper claiming of isolation:

• MDS Section G coding of walking in corridor and locomotion off the unit
• Lack of lab results to substantiate active infection above/beyond standard precautions
• Lack of documentation that all services were received in the resident’s room, including meals, therapy and showers/weights
• Lack of documentation of a private room on a daily basis

The Point Is: Educate and prepare facility teams to document to capture isolation for accurate reimbursement

From the QRM office of Medical Review & Compliance | Author: Ashley Duggan, OTR, RAC-CT, Vice President

Our COVID Clinical Practice Series continues with a review of the functional impact of COVID and strategies you can utilize to improve functional outcomes following the dramatic decline our industry experienced in March 2020

Our guest Rita is back on the pod to give our audience infection control strategies to implement before, during, and after resident interactions. She discusses why having an infection control plan before any resident activity is so important and how to incorporate infection control education into your activities to promote adherence - "this is MY dance space, and this is YOUR dance space"!!

Resources discussed during this episode:

Phase reopening guidelines: https://www.cms.gov/files/document/qso-20-30-nh.pdf

CDC guidelines for Optimizing PPE: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

Quick reference for Optimizing PPE: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/strategies-optimize-ppe-shortages.html

Joining the pod for the next 2 episodes is QRM's new team member Rita Ramos, SLP and Quality Clinical Specialist. In this episode, Rita discusses the negative impacts of social distancing and isolation on the 3 D's: Depression, Delirium, Dementia and offers strategies to safely bring residents back together for carefully planned, choreographed social activities.

Resources discussed in this episode:

https://www.cms.gov/files/document/qso-20-30-nh.pdf