- Email: [email protected]
Provider partnerships improve geriatric care across the continuum
Geriatric Nursing xx (2016) 1e2
Contents lists available at ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
NICHE Section
Provider partnerships improve geriatric care across the continuum Judy Santamaria, MSPH a, *, Rhonda Lange, DNP, APRN, GNP-BC b a b
Membership Development, NICHE, USA Program Manager and NICHE Coordinator, CHI Health, USA
The 2010 Affordable Care Act (ACA) set measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity, of care they give patients. The Goals of the ACA are meant to address the Triple Aim of health care: Better care that is more patient-centered, reliable, accessible, and safe; Better health through the use of interventions proven to improve health outcomes; and Lower cost for individuals, families, employers, and government. The ACA introduced several reforms for health care delivery and reimbursement that affect both hospitals and nursing homes and have caused them to seek partnerships that maximize their ability to meet these triple aims. For example, Medicare is bundling payments to providers for episodes of care, tying payment to outcomes achieved rather than for individual services provided. Providers across the continuum e hospitals, nursing homes, physician groups and home care e are forming Accountable Care Organizations (ACOs) with the goal to deliver higher quality, more coordinated care at a lower cost. In providing evidence-based best practices and educational tools that focus on strengthening clinical care for the geriatric patient, NICHE (Nurses Improving Care for Healthsystem Elders) has long been an important resource for hospitals seeking to reduce unnecessary re-hospitalizations and higher-than-expected lengths of stay. Recognizing the importance of partnerships between providers across settings, NICHE now offers resources and a designation to post-acute providers as well. And we are seeing an increasing number of NICHE hospitals recognizing their post-acute partners as integral to their financial health and their ability to provide the best care.
* Corresponding author. E-mail address: [email protected] (J. Santamaria). 0197-4572/$ e see front matter http://dx.doi.org/10.1016/j.gerinurse.2016.08.005
CHI Health in Omaha, Nebraska, is a NICHE-designated hospital system that received funding through the Centers for Medicare and Medicaid (CMS) for a demonstration project to decrease potentially avoidable hospitalizations of long-term care patients. The CMS grant enabled CHI Health to work with the nursing homes to ensure they had the knowledge and tools to proactively identify and treat acute changes in the long-term care population that otherwise might require hospitalization. Program managers utilized nurse practitioners (NPs) in 14 facilities in the Omaha, Nebraska, area to provide care, education and support to nursing staff. For the educational component, CHI Health chose to partner with the NICHE program to improve geriatric knowledge of site staff beginning with a cohort pilot from September to December 2015. Courses that were offered included: Geriatric Resource Nurse Education for RNs and LPNs. Geriatric Patient Care Associate Education for CNAs and CMAs. Introduction to Gerontology Education for non-medical personnel.
Lessons learned CHI Health received positive feedback from sites that completed the NICHE educational courses, and overall hospitalizations were reduced during the four-month pilot period. On-site NP support and education of staff at all levels to identify earlier changes in condition had a positive impact on their ability to manage problems in place. The pilot faced challenges, however, in that fewer staff than expected completed the educational modules. Reasons cited were the same ones that often create training barriers in the long-term care setting, including: Lack of available computers that were not in use for charting; Tight scheduling which made finding time for learning difficult; High turnover among staff; and Lack of computer literacy among staff.
2
NICHE Section / Geriatric Nursing xx (2016) 1e2
“We refer to these facilities often and know them quite well, and we were surprised at how difficult it was to institute facility-wide education,” stated Rhonda Lange, DNP, APRN, GNP-BC, who worked on the project. “In the future, we would offer an in-person educational component as well, and make sure to factor in time for learning in the workday.” These learning experiences are important as a greater number of older adults are cared for in the post-acute setting. Long-term care providers will be held to value-based standards of efficiency and quality and staff education and commitment will become increasingly vital. Organizations will have to invest in education, technology and programs that reduce staff turnover.
1
U.S. Department of Health and Human Services.
The NICHE designation for long-term care sites offers a way to make this investment. NICHE is more than educational courses. NICHE encourages an organization-wide, nurse-led program to improve clinical outcomes in geriatric care, foster professional opportunity and growth for staff, and improve patient and family satisfaction. The focus of the American health care system has been on acute care provided in hospitals but as our population ages, a greater proportion of care will be chronic and long-term. In fact, 70% of people turning age 65 can expect to use some form of long-term care during their lives.1 Funded demonstration projects like the one described here give us the chance to learn the most effective ways to improve training and education for staff in the long-term care setting.
Contents lists available at ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
NICHE Section
Provider partnerships improve geriatric care across the continuum Judy Santamaria, MSPH a, *, Rhonda Lange, DNP, APRN, GNP-BC b a b
Membership Development, NICHE, USA Program Manager and NICHE Coordinator, CHI Health, USA
The 2010 Affordable Care Act (ACA) set measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity, of care they give patients. The Goals of the ACA are meant to address the Triple Aim of health care: Better care that is more patient-centered, reliable, accessible, and safe; Better health through the use of interventions proven to improve health outcomes; and Lower cost for individuals, families, employers, and government. The ACA introduced several reforms for health care delivery and reimbursement that affect both hospitals and nursing homes and have caused them to seek partnerships that maximize their ability to meet these triple aims. For example, Medicare is bundling payments to providers for episodes of care, tying payment to outcomes achieved rather than for individual services provided. Providers across the continuum e hospitals, nursing homes, physician groups and home care e are forming Accountable Care Organizations (ACOs) with the goal to deliver higher quality, more coordinated care at a lower cost. In providing evidence-based best practices and educational tools that focus on strengthening clinical care for the geriatric patient, NICHE (Nurses Improving Care for Healthsystem Elders) has long been an important resource for hospitals seeking to reduce unnecessary re-hospitalizations and higher-than-expected lengths of stay. Recognizing the importance of partnerships between providers across settings, NICHE now offers resources and a designation to post-acute providers as well. And we are seeing an increasing number of NICHE hospitals recognizing their post-acute partners as integral to their financial health and their ability to provide the best care.
* Corresponding author. E-mail address: [email protected] (J. Santamaria). 0197-4572/$ e see front matter http://dx.doi.org/10.1016/j.gerinurse.2016.08.005
CHI Health in Omaha, Nebraska, is a NICHE-designated hospital system that received funding through the Centers for Medicare and Medicaid (CMS) for a demonstration project to decrease potentially avoidable hospitalizations of long-term care patients. The CMS grant enabled CHI Health to work with the nursing homes to ensure they had the knowledge and tools to proactively identify and treat acute changes in the long-term care population that otherwise might require hospitalization. Program managers utilized nurse practitioners (NPs) in 14 facilities in the Omaha, Nebraska, area to provide care, education and support to nursing staff. For the educational component, CHI Health chose to partner with the NICHE program to improve geriatric knowledge of site staff beginning with a cohort pilot from September to December 2015. Courses that were offered included: Geriatric Resource Nurse Education for RNs and LPNs. Geriatric Patient Care Associate Education for CNAs and CMAs. Introduction to Gerontology Education for non-medical personnel.
Lessons learned CHI Health received positive feedback from sites that completed the NICHE educational courses, and overall hospitalizations were reduced during the four-month pilot period. On-site NP support and education of staff at all levels to identify earlier changes in condition had a positive impact on their ability to manage problems in place. The pilot faced challenges, however, in that fewer staff than expected completed the educational modules. Reasons cited were the same ones that often create training barriers in the long-term care setting, including: Lack of available computers that were not in use for charting; Tight scheduling which made finding time for learning difficult; High turnover among staff; and Lack of computer literacy among staff.
2
NICHE Section / Geriatric Nursing xx (2016) 1e2
“We refer to these facilities often and know them quite well, and we were surprised at how difficult it was to institute facility-wide education,” stated Rhonda Lange, DNP, APRN, GNP-BC, who worked on the project. “In the future, we would offer an in-person educational component as well, and make sure to factor in time for learning in the workday.” These learning experiences are important as a greater number of older adults are cared for in the post-acute setting. Long-term care providers will be held to value-based standards of efficiency and quality and staff education and commitment will become increasingly vital. Organizations will have to invest in education, technology and programs that reduce staff turnover.
1
U.S. Department of Health and Human Services.
The NICHE designation for long-term care sites offers a way to make this investment. NICHE is more than educational courses. NICHE encourages an organization-wide, nurse-led program to improve clinical outcomes in geriatric care, foster professional opportunity and growth for staff, and improve patient and family satisfaction. The focus of the American health care system has been on acute care provided in hospitals but as our population ages, a greater proportion of care will be chronic and long-term. In fact, 70% of people turning age 65 can expect to use some form of long-term care during their lives.1 Funded demonstration projects like the one described here give us the chance to learn the most effective ways to improve training and education for staff in the long-term care setting.