- Email: [email protected]
Hearing What Our Patients Need and Assuring They Get It
JAMDA 17 (2016) 879e880
JAMDA journal homepage: www.jamda.com
Editorial
Hearing What Our Patients Need and Assuring They Get It Richard G. Stefanacci DO, MGH, MBA, AGSF, CMD * Thomas Jefferson University College of Population Health, Philadelphia, PA
Today’s long-term care and postacute providers are no longer focused on the number of visits per day but instead on the effectiveness of care. With the shift of the Center for Medicare and Medicaid Services (CMS) away from volume-based reimbursement accelerated through the introduction of Medicare Access and Children’s Hospital Insurance Plan (CHIP) Reauthorization Act, providers will increasingly be measured on their value. In fact, the law creates 2 different qualitydriven payment pathways for physicians: alternative payment models and the merit-based incentive payment system. Both of which firmly deliver reimbursements to providers based on outcomes.
Need to Deliver Health The research by Cimarolli and Jung1 in this issue raises opportunities to deliver increased value by focusing beyond acute care or the traditional narrow medical focus. Factors such as hearing and depression, although a part of minimum data set (MDS), are all too often missed from primary care physician’s attention. Her team’s study emphasizes the importance of assessing and addressing hearing difficulties and depression in skilled nursing facility (SNF) residents to optimize utilization of beneficial occupational therapy services and to promote the most optimal independent functioning and quality of life. The improvement of optimal independent function and quality of life not only impacts many of the quality measures that SNF providers are being held accountable for but also the hospitalization rates for frail older adult SNF residents. Hospitalizations are of increasingly greater importance in assessing the value of care provided by SNFs. Besides being accountable for hospitalizations that occur during the SNF stay, SNFs are now accountable for hospitalizations occurring outside their walls. Hospitals are developing preferred postacute networks, which in part, are being based on how well SNFs do in preparing their patients for remaining safe and healthy at home. Tracking admissions that occur 30 days after discharge from the hospital is the same measure being applied to SNFs by tracking hospitalizations occurring 30 days after the SNF discharge; addressing issues such that patients level of preparedness for success at home. This success is based, in no small part, on SNF providers addressing patients’ quality of life issues including hearing deficits and depression.
DOI of original article: http://dx.doi.org/10.1016/j.jamda.2016.06.023 * Address correspondence to Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD, 300 West Maple Ave, Merchantville, NJ 08109. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.jamda.2016.07.001 1525-8610/Ó 2016 AMDA e The Society for Post-Acute and Long-Term Care Medicine.
Beyond Interdisciplinary Care TeamseIntegrated Practice Units This holistic focus requires more hands, minds, and hearts than solely that of the primary care physician. Even the interdisciplinary care team (IDT) common in many SNF may not be enough requiring the expansion of IDTs into integrated practice units. Integrated practice units pull together resources outside of the SNF, such as audiologists and other clinical and nonclinical specialists, into an operational unit to better care for all health needs for SNF residents. Rather than having care silos, where a variety of providers and specialists care for a SNF resident with little or no communication with the IDT, these units are much better positioned to identify issues, such as hearing deficits and depression, and work as a team to address them. Even though there is certainly a great deal to do today with regard to acute care management, especially in terms of antibiotic stewardship and chronic care management, the impact of other factors, such as hearing, seeing, taste, and mental health, will benefit from spotlights such at that shown by the study by Cimarolli and Jung. It is now up to long-term care (LTC) providers to hear the measure. And I am certain our hearing is up to the challenge. Assuring Access to Valued Treatments Part of this challenge includes our active voice in the policy and regulatory debate. Specific to this issue, it includes assuring appropriate access to products and services. Most recently, 2 proposals have been made to decrease the ease of access to antidepressants for LTC patients. The Medicare Payment Advisory Commission released its June Report to Congress.2 The report’s Medicare part D section includes recommendations on eliminating immunosuppressives and antidepressants from protected status on formularies, eliminating or reducing cost-sharing for generic drugs for low-income enrollees, and streamlining the process for formulary changes. This elimination of antidepressants as a protected class will mean that Medicare part D plans can restrict access to a few older generic antidepressants, which may be inactive because of adverse events or lack of efficacy. Further still, CMS has launched another proposal, which will make depression management more challenging as they lump antidepressants with psychoactive medications; limiting use on patients in need of this therapy. The CMS Proposed Rule for the Reform of Requirements for Long-Term Care Facilities (the proposed rule)3 proposes that the definition of “psychotropic drug” be “drugs that affect brain activities associated with mental processes and behavior.” Several classes of specific psych pharmaceuticals are listed as
880
Editorial / JAMDA 17 (2016) 879e880
examples including antidepressants. The concern is that through its proposed significant expansion of psychotropic administration oversight requirements, CMS will not adequately appreciate the appropriate use of evidence-based psychiatric and pharmacologic therapy for nursing facility residents suffering from depression and its impact on quality of life. As the Obama Administration is preparing to leave office, their main focus is the completion of their ambitious regulatory agenda. According to the Office of Information and Regulatory Affairs, we can expect a final rule on the Reform of Requirements for Long-Term Care Facilities to be published in September of this year. The proposed rule was published in July of 2015 and represents a major overhaul of conditions of participation for LTC facilities under the Medicare and Medicaid programs. As LTC providers, we have a responsibility to address medical and other issues impacting our LTC patients’ health. This includes not only making the correct diagnosis and ordering the right
treatment but assuring access to these treatments so that our patients can achieve the highest quality of life possible. In the end, it means hearing what our patients need and assuring they receive it!
References 1. Cimarolli V, Jung S. Intensity of Occupational Therapy Utilization in Nursing Home Residents: The Role of Sensory Impairments. J Am Med Dir Assoc 2016;17. 2. MedPAC. Medicare and the Health Care Delivery System. June 2016. 157-202. Available at: http://medpac.gov/documents/reports/june-2016-report-to-thecongress-medicare-and-the-health-care-delivery-system.pdf. Accessed June 26, 2016. 3. Federal Register. Reform of Requirements for Long-Term Care Facilities (CMS3260-P). March 2015. Available at: https://www.federalregister.gov/articles/ 2015/07/16/2015-17207/medicare-and-medicaid-programs-reform-of-requirementsfor-long-term-care-facilities. Accessed June 20, 2016.
JAMDA journal homepage: www.jamda.com
Editorial
Hearing What Our Patients Need and Assuring They Get It Richard G. Stefanacci DO, MGH, MBA, AGSF, CMD * Thomas Jefferson University College of Population Health, Philadelphia, PA
Today’s long-term care and postacute providers are no longer focused on the number of visits per day but instead on the effectiveness of care. With the shift of the Center for Medicare and Medicaid Services (CMS) away from volume-based reimbursement accelerated through the introduction of Medicare Access and Children’s Hospital Insurance Plan (CHIP) Reauthorization Act, providers will increasingly be measured on their value. In fact, the law creates 2 different qualitydriven payment pathways for physicians: alternative payment models and the merit-based incentive payment system. Both of which firmly deliver reimbursements to providers based on outcomes.
Need to Deliver Health The research by Cimarolli and Jung1 in this issue raises opportunities to deliver increased value by focusing beyond acute care or the traditional narrow medical focus. Factors such as hearing and depression, although a part of minimum data set (MDS), are all too often missed from primary care physician’s attention. Her team’s study emphasizes the importance of assessing and addressing hearing difficulties and depression in skilled nursing facility (SNF) residents to optimize utilization of beneficial occupational therapy services and to promote the most optimal independent functioning and quality of life. The improvement of optimal independent function and quality of life not only impacts many of the quality measures that SNF providers are being held accountable for but also the hospitalization rates for frail older adult SNF residents. Hospitalizations are of increasingly greater importance in assessing the value of care provided by SNFs. Besides being accountable for hospitalizations that occur during the SNF stay, SNFs are now accountable for hospitalizations occurring outside their walls. Hospitals are developing preferred postacute networks, which in part, are being based on how well SNFs do in preparing their patients for remaining safe and healthy at home. Tracking admissions that occur 30 days after discharge from the hospital is the same measure being applied to SNFs by tracking hospitalizations occurring 30 days after the SNF discharge; addressing issues such that patients level of preparedness for success at home. This success is based, in no small part, on SNF providers addressing patients’ quality of life issues including hearing deficits and depression.
DOI of original article: http://dx.doi.org/10.1016/j.jamda.2016.06.023 * Address correspondence to Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD, 300 West Maple Ave, Merchantville, NJ 08109. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.jamda.2016.07.001 1525-8610/Ó 2016 AMDA e The Society for Post-Acute and Long-Term Care Medicine.
Beyond Interdisciplinary Care TeamseIntegrated Practice Units This holistic focus requires more hands, minds, and hearts than solely that of the primary care physician. Even the interdisciplinary care team (IDT) common in many SNF may not be enough requiring the expansion of IDTs into integrated practice units. Integrated practice units pull together resources outside of the SNF, such as audiologists and other clinical and nonclinical specialists, into an operational unit to better care for all health needs for SNF residents. Rather than having care silos, where a variety of providers and specialists care for a SNF resident with little or no communication with the IDT, these units are much better positioned to identify issues, such as hearing deficits and depression, and work as a team to address them. Even though there is certainly a great deal to do today with regard to acute care management, especially in terms of antibiotic stewardship and chronic care management, the impact of other factors, such as hearing, seeing, taste, and mental health, will benefit from spotlights such at that shown by the study by Cimarolli and Jung. It is now up to long-term care (LTC) providers to hear the measure. And I am certain our hearing is up to the challenge. Assuring Access to Valued Treatments Part of this challenge includes our active voice in the policy and regulatory debate. Specific to this issue, it includes assuring appropriate access to products and services. Most recently, 2 proposals have been made to decrease the ease of access to antidepressants for LTC patients. The Medicare Payment Advisory Commission released its June Report to Congress.2 The report’s Medicare part D section includes recommendations on eliminating immunosuppressives and antidepressants from protected status on formularies, eliminating or reducing cost-sharing for generic drugs for low-income enrollees, and streamlining the process for formulary changes. This elimination of antidepressants as a protected class will mean that Medicare part D plans can restrict access to a few older generic antidepressants, which may be inactive because of adverse events or lack of efficacy. Further still, CMS has launched another proposal, which will make depression management more challenging as they lump antidepressants with psychoactive medications; limiting use on patients in need of this therapy. The CMS Proposed Rule for the Reform of Requirements for Long-Term Care Facilities (the proposed rule)3 proposes that the definition of “psychotropic drug” be “drugs that affect brain activities associated with mental processes and behavior.” Several classes of specific psych pharmaceuticals are listed as
880
Editorial / JAMDA 17 (2016) 879e880
examples including antidepressants. The concern is that through its proposed significant expansion of psychotropic administration oversight requirements, CMS will not adequately appreciate the appropriate use of evidence-based psychiatric and pharmacologic therapy for nursing facility residents suffering from depression and its impact on quality of life. As the Obama Administration is preparing to leave office, their main focus is the completion of their ambitious regulatory agenda. According to the Office of Information and Regulatory Affairs, we can expect a final rule on the Reform of Requirements for Long-Term Care Facilities to be published in September of this year. The proposed rule was published in July of 2015 and represents a major overhaul of conditions of participation for LTC facilities under the Medicare and Medicaid programs. As LTC providers, we have a responsibility to address medical and other issues impacting our LTC patients’ health. This includes not only making the correct diagnosis and ordering the right
treatment but assuring access to these treatments so that our patients can achieve the highest quality of life possible. In the end, it means hearing what our patients need and assuring they receive it!
References 1. Cimarolli V, Jung S. Intensity of Occupational Therapy Utilization in Nursing Home Residents: The Role of Sensory Impairments. J Am Med Dir Assoc 2016;17. 2. MedPAC. Medicare and the Health Care Delivery System. June 2016. 157-202. Available at: http://medpac.gov/documents/reports/june-2016-report-to-thecongress-medicare-and-the-health-care-delivery-system.pdf. Accessed June 26, 2016. 3. Federal Register. Reform of Requirements for Long-Term Care Facilities (CMS3260-P). March 2015. Available at: https://www.federalregister.gov/articles/ 2015/07/16/2015-17207/medicare-and-medicaid-programs-reform-of-requirementsfor-long-term-care-facilities. Accessed June 20, 2016.