Posts Tagged ‘RAC Audit preparation’

As the summer draws to a close, it seems as though everyone is already thinking about the holiday season, pushing forward to next year. Hold up – we’re not yet done with this one! There’s plenty still coming down the pike for 2011. Let’s look at your goals – what is there yet to achieve for yourself (and your healthcare organization)? And how are your professional relationships? Have you been able to build and strengthen those?

There are a couple of posts that may help as you continue to work on those 2011 goals. For instance, when it comes to professional relationships, we like one from January about connecting, which included these three tips:

1. Be nice to everyone. Make the effort and never underestimate the value of being nice!
2. Listen to every voice. When we build teams and redesign workflows, our belief is that every voice matters.
3. Bring your ‘A’ game to work – every day.

Now, look at what you planned for this year – not only for your healthcare organization or medical practice, but also for you, personally and professionally. What’s the status? Is it time to revisit those plans and make some course corrections back to where priorities truly lie? Remember these tips from another January post:

Clarify your priorities. It is the first and most essential step to achieving a well-balanced life. Here’s a simple 3-step exercise to use as a tool:

1. Write down your Top 5 priorities. Not what you think your priorities should be, but the ones you want!
2. Next, analyze where you spend the majority of your time. Does it align with your Top 5?
3. Finally, those that don’t align, consider how to eliminate them. After all, if they didn’t make it into the Top 5, perhaps it’s time they go away.

Every choice has a consequence. Each leads us down a particular path.  There’s still time to listen to every voice, including your own. If you need some assistance to complete a few “to do” items, give us a call!

Those three issues popped to the top for ASCs during the CMS/DOH surveys. Today, let’s look at Infection Control and Quality Assessment & Performance Improvement.

Is your ASC Infection Control program in compliance? Your ASC needs to go beyond having solid Infection Control policies and practices in place, you also need an IC officer – a licensed healthcare professional, such as a RN. An effective IC program will replicate guidelines from a nationally recognized one, such as APIC regarding hand hygiene, injection practices, sterilization guidelines and monitoring of environmental and infection control practices. Ongoing training is key to instilling good hygiene habits. Display hand washing posters, wash hands before and after meeting with a patient and use hospital approved germicide cleaners.

Have a program in place? Review the survey to see how well you’d do!

Quality Assessment and Performance Improvement programs require an ongoing effort of data collection, observation, documentation, reporting trends, findings and outcomes to the Governing Body Meetings – all in an ongoing effort to improve patient care services and the quality of that care. Implementing an ASC QAPI program takes time, and for it to work, vigilance. Begin with a specific topic and work through to the end of the current process, note issues, safety concerns, how often they occur, and how often they are in compliance (or not) with the ASC’s policy. Conduct a policy review meeting with staff to report findings and concerns, as well as train (and re-train). Then conduct regular follow-ups. Document the same process, and hold a Review meeting.

The data tells all! Have issues improved, or not?

Next time, Patient Rights – the often unintentionally neglected process. How does yours measure up?

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Is your ASC compliant with CMS? We can get you there!

Communication is the key to unlock team performance and quality outcomes.

It seems a simple enough concept. In healthcare, everyone seems to be talking to each other – patients to doctors, nurses, staff and providers to each other. Yet, despite all the talking, actual communicating doesn’t always occur.

Communication gaps create service quality gaps. In turn, those service limitations lead to patient and staff dissatisfaction and frustration. The improvement and standardization of certain communication strategies can eliminate the costly wastes resulting from bad communication: inefficiency, ineffective and potentially unsafe care, rework, unintended outcomes and a diminished capacity for team performance.

Remember, healthcare systems deliver services. So, if you’re going to measure the quality of healthcare, then you have to go beyond clinical measures, incorporating patient’s perceptions and experiences. Taking this into account, we’ll add two dimensions to the usual five for measuring service quality:

1. Tangibles
2. Reliability
3. Responsiveness
4. Assurance
5. Empathy PLUS
6. Accessibility
7. Communication

Group approaches to the complex issues in healthcare help build cohesiveness. Working as a team allows for creativity, sharing expertise, developing new skills, increasing personal autonomy and influencing decisions. Bonus benefits: job satisfaction and communication improves, mutual respect grows.

If your healthcare organization can build high performance teams, you will naturally evolve to improved quality and outcomes.

Before we can work on the five key areas with 65 quality indicators of an ACO, we must improve our listening skills and really communicate!

by Loy Maslen, RN, MSN, NNP-BC, CPUM

“The single biggest problem in communication is the illusion that it has taken place.” – George Bernard Shaw

ACOs are a type of payment and delivery reform model that begin to tie provider reimbursements to quality metrics (measures of quality indicators) and reductions in the total cost of care (performance and process improvement) for an assigned population of people; i.e. Medicare patients.

These indicators and data derive from 5 Key Areas:

1. Patient and providers’ experience of care (patient and staff satisfaction scores)
2. Care coordination (information sharing across the continuum of care)
3. Patient safety (reporting, analysis and error prevention)
4. Preventive health (treatments to minimize illness and hospital admissions)
5. At risk population, frail and elderly health (using proven care standards to assist with care provision)

The overall quality performance score will be calculated on 65 quality metrics within the 5 defined key areas, equally weighted. CMS will define the quality performance benchmarks based on Medicare Fee-For-Service (FFS), Medicare Advantage or ACO perfomance data over time.

Note that the ACO is eligible for monetary compensation only if it demonstrates to CMS that it has fulfilled the required quality performance elements and achieves the other regulatory performance criteria.

by Loy Maslen, RN, MSN, NNP-BC, CPUM

“Quality is remembered long after the price is forgotten.” —Gucci Family Slogan

I don’t know about you, but if somebody asked me if I provided quality care, I would say “Absolutely!” I suspect every healthcare provider would say the same thing. If they asked me how I know, I might say, “Well…I don’t see many complaints. I get thank you notes. My patients keep coming back and I am very skilled at what I do.”

But what if they then ask, “Do you have data to support your claim of quality care?”

Now I’m a bit less confident in my response, more like, “Can I get back to you on that?”

Healthcare reform is about us “getting back to them on that.” The Center for Medicare and Medicaid Services (CMS) is asking healthcare providers to be accountable for the care we provide. Accountability is the acknowledgment and assumption of responsibility for our actions, products, services, decisions, and policies. That includes administration, governance, and implementation either within the scope of our roles or in our employment positions. It also encompasses the obligation to report, explain and be answerable for any resulting consequences.

While we currently may not have a large panel of Medicare patients, that’s soon to change. As we hear repeatedly, the retirement of the baby boomers affects everything – with a big emphasis on provision of medical care. History also shows us that as Medicare goes, so go the private payers. Now is the time to make quality a habit.

Stay tuned for Accountable Care Organizations (ACO) and quality.

by Loy Maslen, RN, MSN, NNP-BC, CPUM

“Quality is not an act, it is a habit.” — Aristotle

Please join us in welcoming our newest associate, Loy Maslen, NNP-BC, CPUM. She brings over 30 years of diverse healthcare experience to inpatient and outpatient organizations. A TeamSTEPPS™ Master Trainer and VitalSmarts™ Crucial Conversations Master Trainer, Ms. Maslen helps healthcare clients learn effective evidence-based communications with the goal of improving teamwork, and thereby performance outcomes. Her targeted group facilitation assists with development and enhancement of quality programs, quality indicators and data collection that drive improved patient outcomes, as well as satisfy PQRS requirements. Ms. Maslen’s training techniques also show clients how to improve documentation to capture charges that may otherwise face denial in utilization review. 

In addition to significant revenue improvements, her clients gain more efficient workflow systems, greater patient safety and customer service satisfaction. She is able to assess for survey readiness such as NCQA, Joint Commission and AAAHC, identify areas requiring improvement, and work with staff to develop a certification achievement plan.

Ms. Maslen’s past roles range from clinic manager to clinical educator, quality program manager to clinical care management, as well as project management with notable healthcare organizations such as Evergreen Healthcare, Valley Medical Center and Qualis Health. Her highly successful “lean thinking” facilitation for rapid process improvement projects draws on extensive experience with state and national regulatory agencies, as well as the Washington State Medical Home Collaborative.

She holds the firm belief that an Accountable Care Organization (ACO) begins with partnerships between patient, family, providers and staff, applying standard structure and process to drive improved quality outcomes while simultaneously decreasing costs and eliminating waste. Ms. Maslen, a passionate teamwork advocate, sees human creativity, clear communication and effective training to be essential for comprehensive patient-centered care that is accessible and coordinated, while also supportive of physician leadership and staff.

In addition to an MSN, Ms. Maslen is a Board Certified Neonatal Nurse Practitioner and Certified Professional Utilization Manager, as well as holding certifications in Advanced Cardiac Life support, Basic Life Support, Pediatric Advanced Life Support and Neonatal Resuscitation.

Then you’ll enjoy “meeting” our newest associate, Loy Maslen, who brings years of quality process improvement work with her. She has led advances in operational work flow efficiencies resulting in significant revenue generation, elimination of wasteful unnecessary processes, enhancement of staff ratios through team building, skill set standardization with competency validations, minimization of organization risk, and improved patient and staff satisfaction.* Our next few blogs will be more technical in nature as we share some of her background, tools and outcomes.

We have enjoyed for the greater part of the past twelve months sharing with you our stories of launching DNA, our marketing approaches, some case studies, “platinum” customer service guidance, our personal and professional challenges and our tactics in overcoming adversity.

*Update: We welcome Loy as Dee Collins, RN, retires. Dee retired in September this year and is enjoying painting, volunteer work and playing with her grandchildren!

We live in an exciting time. Healthcare comprises trillions of dollars of the annual budget. Well, that’s not exciting, but the fact that the Government recognizes (no matter which side of the aisle) that we have to eliminate waste, is! We can keep trying to lower reimbursement, come up with innovative ways such as the Medical Home Initiative (more on this in a later blog), but ultimately it lies with every hospital and clinic to look at the way their work gets done on a daily, and sometimes minute-by-minute, basis.

Decrease Healthcare Organization Costs by 20%
Every healthcare organization can do it. There’s low-hanging fruit dangling savings everywhere: staffing ratios, benefits and supplies. Then there is what we call “gravy” savings, such as:

• Maintenance agreements (are you paying for things that might go wrong?)
• Is the lobby aquarium really worth $6,000 a year to maintain (plus replacing expensive fish found floating)?
• Do you really need to buy all the break room supplies?

Cutting these expenses can help offset increases in a couple of your most costly categories: malpractice insurance and employee benefits. Next, you’ll want to conduct a due diligence review on cash flow accuracies, reconciliation and safeguards against theft.

Though these initiatives seem obvious to Barbara and me, we understand why internal practice reviews don’t happen more often. It’s because when you’re doing the work, you don’t usually have the time to step outside of it to examine how it is that you’re working. If you’re a provider whose income is going down, you’re not going to want to pay overtime for employees to brainstorm. That’s unfortunate, too. So often, we’ve found that staffs are unaware of what others are doing. That ignorance is creating a natural outcome of duplicative work.

As the pressure increases from CMS and Congress to pass on the financial rewards for quality outcome measures, performance report cards and patient satisfaction, we think that Derry, Nolan & Associates is in a ripe position to help those organizations that finally realize they can’t ignore these trends, if they want to survive.

Unfortunately, another trend is the “quick and easy” decision to become employees of larger organizations and let someone else worry about the quality assurance programs, marketing, accounts receivable and accounts payable! Speaking candidly, whether you’re an independent group or a large integrated one, the same types of improvement efforts will need to prevail.

One reason Barbara and I work so hard is our hope of leaving a legacy to other healthcare and medical practice consultants who will carry on our work. This feeling resonates from our spirits… we want to win, take our “A” game to clients. It’s the most satisfying of all the reasons we work.

The flip side is that often we have had to fortify our spirits to get through adversity, setbacks and delays. In the midst of these difficulties, we don our mental armor and get stronger. (That isn’t to say that we don’t have our moments after the consultation ends!)

Three common obstacles we have encountered:

1. Weak teams—some members just have to go
2. Recalcitrant Providers—“we’ve been doing this for 35 years… who are you”
3. Bureaucratic Processes—”we will have to take that to committee”

Because many of our medical practice consulting projects involve team-building, we have to guide and work with the people we inherit. Some are weak links, not engaged in the process of change, or worse, down-right instigators. We have learned (the hard way) to eliminate these employees as quickly as possible, so the team can move ahead with change implementation.

We have far more challenges with older physicians (our age!) than the generation Xers, who almost always welcome change, along with technology advancements. As you may have guessed, most of our resistant encounters have come from taking “seasoned” providers kicking and screaming to an electronic health record.

Finally, the layers of committees and politics can be very frustrating. We’ll think we have a project based on the enthusiasm of our contact, only to find that they have decided to do it themselves with internal resources. Many times we eventually get called in because there really weren’t the internal resources, process redesign knowledge or team objectivity to pull it off.

Despite these challenges, eight years later, we are still in business. We have learned to be patient, politically correct (took us a few times to get that right) and always look for opportunities to win our client’s respect.

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“If you’re going through hell, keep going!” – Winston Churchill

The term “networking” sometimes carries a negative connotation due to professional connections being used to get in the door or sell a product. But when Barbara and I made the decision in 2003 to start our own firm, we “networked” with everyone we knew! We met with colleagues of many years who worked in the medical field, taking them out for meals (I gained twelve pounds during our launch!).

Thinking of natural, logical business connections a physician would have, we met with several principals of larger healthcare-focused legal and accounting firms. After all, if you’re in financial difficulty, your CPA and attorney will know!

Then we hit the professional associations – Washington State Medical Association and the Medical Societies. We selectively advertised – remember this was pre-Facebook and LinkedIn – with Washington State Medical Group Management, Medical Group Management, provider directories, resource guides and associated websites. We worked the speaker circuit, volunteering our expertise and presenting at any healthcare function to which we were invited.

Within 90 days, the phone began to ring and it hasn’t stopped since.

Based on that success, we decided our approach to marketing, building rapport and connecting with our clients would be based on three key ingredients:

1. Be nice to everyone. Make the effort and never underestimate the value of being nice! For instance, last night we dined with a VP from MultiCare who has become a good friend to both of us.
2. Listen to every voice. When we build teams and redesign workflows, our belief is that every voice matters.
3. Bring your ‘A’ game to work – every day.

Embodying these three, simple approaches have helped us easily outweigh and outmaneuver work stress. So nurture your relationships with your colleagues. Be proud of your accomplishments, tooting your own horn in a humble way!

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“The greatest ability in business is to get along with others and to influence their actions.” – John Hancock

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Derry, Nolan & Associates’ healthcare and medical practice consultants can help your healthcare organization – medical practice, clinic or integrated healthcare system – with leadership recruitment, interim management, on-boarding and customer service training.