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W H AT ’ S I N S I D E 2 AANAC Speaks 10 Q+A 11 Workshop Schedule 13 What’s New in AANAConnect 14 What You Need to Know 16 New C-NEs and RAC-CT®s SUMMER 2012 LTC QUARTERLY SPEC IA EDITI L ON CMS Posts Revised Five-Star Nursing Home Quality Rating System Judi Kulus, lnha, rn, mat, rac-mt, Vice President of Curriculum Development, AANAC There are a few things that have become certain in long-term care: annual survey, Quality Measures (QMs), and five-star quality ratings. The nursing home annual licensing and certification survey process is in the middle of being transformed from the traditional survey methodology to the Quality Indicator Survey (QIS) process. Quality Measures have been reworked using the MDS 3.0 data. continued on page 4 Harness the Power of Your Team Betty Frandsen, rn, nha, mha, c-ne AANAC 400 S. Colorado Blvd., Suite 600 Denver, Colorado 80246 Phone 800.768.1880 Fax 303.758.3588 1 © 2012 AANAC. No part of this publication may be reproduced without written permission from AANAC. The information presented is informative and does not constitute direct legal or regulatory advice. Every nursing department is composed of individuals serving in the variety of roles required to meet residents’ needs. The fact that there are RNs, LPNs, and CNAs whose names appear together on a schedule, and who are assigned to work in a particular area of the nursing home, does not mean that this group functions as a team. Nursing staff can be fragmented and headed in different directions, or they can have a defined focus continued on page 7 AANAC SPEAKS AANAC Members Are Represented in Washington, DC When it comes to legislation impacting health care, the atmosphere on Capitol Hill was described as more polarized and tense than it has been in years. This was a common theme heard by members of the AANAC board and staff as they visited their respective states’ senators and representatives during the annual American Health Care Association (AHCA) congressional briefing. The explanation for this atmosphere is election-year positioning and the difficulty at this time for our elected officials to find common ground. inform them about the needs of the elderly. Regardless of whether we visited the office of an elected Democrat or Republican, the AANAC representatives were welcomed warmly and we were assured of the member’s commitment to legislation that cares for our elderly. Ten AANAC board members and staff visited over thirty members of Congress from nine states, asking these representatives to support the following key issues: • Address Nurse and Critical Caregiver Shortages. Amend the Nurse Reinvestment Act to include educational and financial assistance for caregivers in all health care settings, establish a national nursing database, and enhance the number of nurse educators. During our visit to Washington, we • Support Stable Medicare Funding joined hundreds of nursing home Necessary for Quality Care. Stable and assisted living professionals who Medicare funding is essential to gathered to receive information on protect seniors’ access to quality longlegislation impacting long-term and postterm and post‐acute care. acute care providers and to personally meet our members of Congress to 2 • Update the Medication Law to Match Current Patient Needs. Revise the Controlled Substances Act of 1970 (CSA) to recognize that the longterm care nurse acts as “an agent of the prescriber” in documenting, transmitting, and communicating orders for controlled substances to the pharmacy. • Sponsor the Improving Access to Medicare Coverage Act of 2012. Since extended hospital observation stays constrain Medicare beneficiaries’ access to skilled nursing facility services, ensure observation stays count toward the required three-day stay by cosponsoring the Improving Access to Medicare Coverage Act of 2012 (H.R. 1543/S. 818). As an AANAC member, you are encouraged to read the Issue Briefs that were discussed with our representatives and take a moment to send them to your senator and representative. If we all take a small step in letting our voices be heard, it will add up to a resounding thunder. continued on page 3 A A N AC LT C L E A D E R 7. 2 4 . 2 012 AANAC Members Are Represented in Washington, DC, continued from page 2 Here are some of our personal experiences: This week I had the pleasure of The junior senator from Illinois is Mark representing AANAC on Capitol Hill by visiting the offices of Colorado state senators Mark Udall and Michael Bennett, as well as Mike Coffman, my state representative. While I didn't meet my senators or representative personally, I am hoping the visits may assist in arranging a personal visit to my long-term care community back home. I intend to visit each local office to invite them personally to visit our residents, families, and staff. If, in fact, a visit occurs, I will let you know. I continue to think it is important that we actively look for ways to educate our politicians, talk about the nursing shortage, and promote favorable long-term care legislation. Kirk (52), who suffered a stroke in January of this year and who remains in a rehab facility to this day. When I went to meet with his staff, I knew the concerns that I was to share with them would be very close to home. The issues we face daily in our long-term care industry (funding/staffing/reputation) are ones Senator Kirk is actually experiencing, and his staff feel that when he returns he will be able to advocate for our industry with a strong and credible voice. Our thoughts and prayers remain with him as he slowly recovers from this debilitating stroke, and his staff are heartened by his recovery and strength. On a personal note, this was my first Ruth Minnema, rn, ma, nha, rac- ct, time “inside” the Capitol and the history Board Chair that permeated the building filled me with a sense of awe. The staff at the Senate offices that I visited (Senator Kirk, Senator Durbin, and Representative Biggert) were all knowledgeable, intelligent, and open to discussing the issues that we face in our industry. I felt heartened by actually seeing the “business” of government instead of reading about it or seeing it on the news. The biggest challenge each office stated was how to manage the baby boomer demand for services ne Powell, Ruth Minnema, Carol and how we as a nation are Left to right: Peter Arbuthnot, Joan Macken, Gail Harris, Susan Duong Maher, Diana Sturdevant, Patrice going to pay for that. We all share their concern(s)! I left with a renewed When I was in Washington for the sense that we as individuals can make a congressional visits, I had the privilege of difference, but we need to “do something, meeting with my senators and congressman however small.” from the great state of Mississippi. I met with Patrice E. Macken, mba, rhia, lnha, rac- ct, Congressman Gregg Harper, his legislative Board Member assistant, and the special assistants to Senators Roger Wicker and Thad Cochran. Once again, this year's visit to The meetings were positive and they all Washington, DC, was fruitful. Being from indicated that they would keep me as a California, I visited the offices of Senators reference should they have questions about Dianne Feinstein and Barbara Boxer, as SNF issues. It was a privilege to represent the well as House Representative Zoe Lofgren members of AANAC to these national leaders. from California's 16th District. Of special Peter Arbuthnot, aa, ba, rac- ct, Board Member 3 note from my meetings was the reaction of Representative Lofgren. She expressed a great deal of interest and asked a lot of questions. During our meeting, I was impressed with how much genuine concern she expressed about how all these issues affect the plight of our elderly and disabled populations. I was happy to hear that she had some knowledge of most of the issues I discussed with her. She shared with me that there is still a nursing shortage in some parts of our country. She was most concerned with the acute care hospitals' use and over-use of "observation" stays and she immediately asked her legislative counsel, Melody Reis, to obtain more information on the matter. As for the Controlled Substance Act, she said she will also delve more into this issue. It's important to her that our residents do not suffer needlessly due to our inability to obtain pain medication for them in a timely manner. She knows the importance of having access to pain medications. She shared that she had experience with pain-control issues when her father was under hospice care. Lastly, Representative Lofgren expressed support for our call for stable Medicare funding, and she is active in voting for affordable access to medical care, as well as for providers to have the funds needed to provide quality medical care. Susan Duong, rn, bsn, bs, nha, c-ne, rac- ct, Board Member During my visit to Washington, it was an honor to meet with a variety of representatives and staff including: Congressman John Thune and staff member Jayne Lucas; Congressman Tim Johnson and staff member Ashley Raspor as well as Congresswoman Kristie Noem and staff member Andrew Christianson. During these visits we discussed the three initiatives brought forward by AANAC, but more importantly our organization itself and the knowledge and experience these almost 14,000 members can be as a resource to any of the congressional offices. I left information with each and invited all of these offices to contact AANAC for “real life” solutions and look forward to continued collaboration between these important figureheads and our members as we shape long-term care together. Joanne Powell, nha, rhia, Board Member ● A A N AC LT C L E A D E R 7. 2 4 . 2 012 Revised Five-Star Rating System, continued from page 1 annual health inspections and complaint investigations. This domain uses the number, scope, and severity of deficiencies that were identified during the three most recent annual inspection surveys. It also calculates the substantiated findings from the most recent 36 months of complaint investigations. If a facility requires more than one revisit by the health inspectors to prove that a deficiency is corrected, then more points are added to the score, pushing the rating down. Here are some highlights from the user’s guide regarding this domain: • The system calculates the rating so that the top 10% of performing facilities in each state receive a five-star rating. • The middle 70% of facilities receive a rating of two, three, or four stars, with an equal number (approximately 23.33%) in each rating category. • The bottom 20% (with the highest score) receive a one-star rating. With the MDS 3.0 QM data, the Five-Star Nursing Home Quality Rating System has been revised on Nursing Home Compare. This five-star system is a set of quality “star” ratings for each facility, on a scale of 1 to 5. The newly posted, revised manual states that “the primary goal of this rating system is to provide residents and their families with an easy way to understand assessment of nursing home quality, making meaningful distinctions between high and low performing nursing homes” (Design for Nursing Home Compare Five-Star Quality Rating System: Technical Users’ Guide, July 2012, p. 2). The Nursing Home Compare reporting site is a place where consumers can go to evaluate their local nursing homes in order to make more informed choices about their care and service providers. The five-star rating system is composed of three domains: Health Inspections, Staffing, and Quality Measures. Since 4 the MDS 3.0 began, the Quality Measure domain of the five-star rating system has been in “freeze frame” with MDS 2.0 data. The other two domains have continued to be used to calculate facility ratings. Now that CMS has published the updated, July 2012 Five-Star Nursing Home Quality • In order to control for variation of the survey process in different states, the Health Inspection domain is calculated using the relative performance of facilities within a state. • The cut points are recalibrated each month so that the distribution of star ratings within states remains relatively Facility staff can once again fully and knowledgeably participate in quality assurance planning that works toward obtaining and maintaining a five-star rating. Rating System manual, facility staff can once again fully and knowledgeably participate in quality assurance planning that works toward obtaining and maintaining a five-star rating. Five-Star Health Inspection Domain The Health Inspection domain is a measure that is based on substantiated deficiencies from constant over time, in an effort to reduce the likelihood that the rating process affects the Health Inspection outcomes. • A facility’s rating will not change from month to month without new survey information from the facility, regardless of changes in the statewide distribution due to new surveys in other facilities. continued on page 5 A A N AC LT C L E A D E R 7. 2 4 . 2 012 Revised Five-Star Rating System, continued from page 4 Five-Star Staffing Domain utilizing the facility’s reported hours, dividing them by the expected hours, and then multiplying by a national average score posted by CMS. The result of this calculation is “adjusted hours,” which are then used to set the Staffing star. In order to receive a five-star rating, facilities need to achieve at least 4.418 hours per resident day of total nurse staffing and a minimum of 0.710 hours per resident day of registered nursing hours. The CMS staffing studies identified in the user’s manual found that there is “a clear association between nurse staffing ratios and nursing home quality of care.” The studies determined that there is a specific staff-to-resident threshold below which residents are at a substantially greater risk for quality problems. The goal of this rating is to encourage facility leaders to provide adequate staffing levels because of “considerable evidence of a relationship between nursing home staffing levels, staffing stability, and resident outcomes.” Five-Star Quality Measure Domain The staffing measure domain uses two separate but equally weighted measures to calculate the facility’s rating. They are (1) total registered nursing hours and (2) total nursing hours (including registered nurses, licensed practical nurses, and nurse aides), both on a per-resident-day basis. The rating system is calculated by There are 9 MDS-based Quality Measures that are used to calculate the Quality Measure domain. They include 2 shortstay measures and 7 long-stay measures. Facility ratings for the Quality Measures are based on a subset of the 18 QMs that are currently posted on the Nursing Home Compare website. These include: Short-Stay Residents: • Percent of residents with pressure ulcers (sores) that are new or worsened • Percent of residents who self-report moderate to severe pain Long-Stay Residents: • Percent of residents whose need for help with activities of daily living has increased • Percent of high-risk residents with pressure sores • Percent of residents who have/had a catheter inserted and left in their bladder • Percent of residents who were physically restrained • Percent of residents with a urinary tract infection • Percent of residents who self-report moderate to severe pain • Percent of residents experiencing one or more falls with major injury Each of the nine QMs is weighted equally and facilities are awarded points for each one, based on a score of 1 to 100. A perfect score for all nine QMs would be 900 and the worst score would be a 9. The scoring for all of the QMs is based on national percentile ranking, with the exception of the ADL measure, which is based on state ranking. The reason for the difference in the ADL QM scoring is compensation for variability in state case mix policies. Ratings for the QM domain are calculated using the three most recent quarters for which data is available. By using assessment data from three quarters, CMS hopes to increase the stability of estimates and reduce the impact of missing data. continued on page 6 5 A A N AC LT C L E A D E R 7. 2 4 . 2 012 Revised Five-Star Rating System, continued from page 5 Overall Nursing Home Rating (Composite Measure) In order to determine the overall five-star rating for a facility, the system follows these five steps: • Step 1: Start with the Health Inspection five-star rating. • Step 2: Add one star to the Step 1 result if Staffing rating is four or five stars and greater than the Health Inspection rating; subtract one star if Staffing is one star. The overall rating cannot be more than five stars or less than one star. • Step 3: Add one star to the Step 2 result if Quality Measure rating is five stars; subtract one star if Quality Measure rating is one star. The overall rating cannot be more than five stars or less than one star. • Step 4: If the Health Inspection rating is one star, then the overall quality rating cannot be upgraded by more than one star based on the Staffing and Quality Measure ratings. • Step 5: If the nursing home is a Special Focus Facility (SFF) that has not graduated, the maximum overall quality rating is three stars. A facility’s overall rating will be adjusted anytime health inspection survey information for a standard survey or Managing Your Five-Star Rating If you haven’t already gone to Nursing Home Compare and reviewed your facility’s five-star rating, now would be a good time to do so. Take a look at your overall star rating and the individual A facility’s overall rating will be adjusted anytime health inspection survey information for a standard survey or a complaint investigation is added to the database. a complaint investigation is added to the database. The Staffing measure is updated approximately annually based on when the standard survey is conducted and which quarter is used to calculate the Staffing measure. Updates to the QMs are posted mid-month in January, April, July, and October. At the same time, the scoring for the QMs is recalculated and changes can impact the facility’s rating. 6 stars assigned for the Health Inspection, Staffing, and Quality Measure domains. While you’re at it, look at the ratings for your competitor down the street. Then begin a plan to be proactive about improving or maintaining your five-star system rating. quality assurance committee process. Approaching it as a team will increase awareness and foster creative solutions to improve your five-star rating. Sources: American Association of Nurse Assessment Coordination. (2011). The Five-Star Quality Rating System. Denver, CO: Rena Shephard, mha , rn, rac-mt, c-ne. Centers for Medicare & Medicaid Services. (2012, July). Design for Nursing Home Compare Five-Star Quality Rating System. Available at: http://www. aanac.org/docs/reference-documents/usersguide. pdf?sfvrsn=0 and at http://www.cms.hhs.gov/Cert ificationandComplianc/Downloads/usersguide.pdf. Kramer, A. M., & Fish, R. (2001, Winter). “The relationship between nurse staffing levels and the quality of nursing home care.” In Abt Associates, Inc., Appropriateness of minimum nurse staffing ratios in nursing homes: Phase II final report (chap. 2). ● Every facility issue that negatively impacts your five-star rating represents potential underlying process problems and needs a thorough root-cause analysis. Be systematic about weaving quality-ofcare issues, staffing challenges, and MDS accuracy problems into your continuous A A N AC LT C L E A D E R 7. 2 4 . 2 012 Harness the Power of Your Team, continued from page 1 and work together toward common goals. The level of success achieved is frequently based on the strength or weakness of the nurse leader and this leader’s ability to inspire others. One of the most important realizations that can be grasped by a nurse leader is that no one person can achieve significant outcomes alone. Behind every successful person is a team of individuals who support their leader and pave the way for success through combined efforts. A leader who makes all the decisions may be perceived as a dictator who does not value the team members’ experience or ideas. Although this type of leadership displays the leader’s strengths, it also exposes weaknesses that would be minimized in a team atmosphere. Nursing staff achieve more when the department functions as a team. According to inspirational speaker John C. Maxwell, leaders who fail to grasp this fact are often hampered by ego, insecurity, or temperament. • Ego—Most leaders don’t enjoy admitting to their staff that there are things they cannot do or don’t understand. Often they try to do all things, yet they may not be doing them well. Failing to delegate and taking on more than is reasonable results in a juggling act in which some things are going to be dropped. Kerry Wells of INJOY says, “Spinning more plates doesn’t increase your talent—it increases your likelihood of dropping a plate.” continued on page 8 IT’S HERE! FIVE-STAR FOR MDS 3.0 How much do you know about the new rating system? Are you prepared to excel in the three specific areas of focus? How exactly does your coding accuracy influence final rating? If you have questions like these—we invite you to join Rena R. Shephard on August 2nd at 2 pm EDT (1 pm CDT, 12 noon MDT and 11 am PDT) to get easy-to-understand answers that will prepare you to give yourself and your facility a “high five.” 7 You’ll be able to: •Describehowsurveyresultsimpactyourrating. •ReviewtheroleofQMs. •Describehowtheratingforstaffingiscomputed. •ProactivelyinstituteQAactivitiestoenhanceyourrating. Register today at www.aanac.org/webinars A A N AC LT C L E A D E R 7. 2 4 . 2 012 Harness the Power of Your Team, continued from page 7 • Insecurity—When a leader feels threatened by others, he or she is less likely to draw on the strength of the team. Insecurity is often behind the failure to foster a team atmosphere. We have all known people who won’t hire individuals they perceive as very capable because they fear being overshadowed. Only leaders who are secure in their skills and knowledge will empower others. Leaders who fail to build teams may want to maintain control of everything, or may fear being replaced by someone they perceive as more capable. President Woodrow Wilson would offer this advice to insecure leaders: “We should not only use all the brains we have, but all that we can borrow.” • Temperament—There are people who never think of asking others for help. Their personalities may not be very outgoing, or they simply don’t think in terms of team building and participation. If they try to do everything on their own, they limit their own potential. independent people to creating team players? Everything starts with creating a vision and working together toward a goal. We need to point our staff toward a meaningful target if we expect them to achieve a goal. We must first see the vision of what we want the team to A nurse leader is charged with painting the big picture for his or her staff, making sure the right people are in the nursing roles, and modeling the behavior that is desired of others. A team is not just a group of people who are directed by one leader. Every person on the team has a role to play, and these combined roles contribute to the overall big picture. It is the responsibility of the nurse leader to help others grasp the big picture by continually keeping in the forefront a vision of where the team needs to go. How does a nurse leader shift from leading a group of DID YOU KNOW? YOUR RAC-CT CERTIFICATION EXPIRES AFTER TWO YEARS. ® Refresh your RAI/MDS 3.0 knowledge and maintain your mark as an expert in assessment by recertifying today. We’ve compiled the most recent information into two easy-to-complete courses available online or in hard copy manual formats: MDS 3.0 Common Coding Errors MDS 3.0 Updates DON’T LOSE THIS VALUABLE CREDENTIAL. Click here before your designation expires. achieve in order to help everyone else see it. A nurse leader is charged with painting the big picture for his or her staff, making sure the right people are in the nursing roles, and modeling the behavior that is desired of others. continued on page 9 A Team Ahead: SunSolutions Consulting TM Prepare now to stay ahead in this ever-changing industry! • MedicareAdvantage • Hospitalreadmissions • Qualitymeasuresandoutcomes • ADR,ZPICandRACaudits • Surveyreadiness Audit and train for peace of mind! Consulting excellence for partners in care (888) 267-2220 [email protected]•www.sunsolutionsconsultingservices.com 8 A A N AC LT C L E A D E R 7. 2 4 . 2 012 Harness the Power of Your Team, continued from page 8 Assess to determine what kind of attitude the members of your team have when it comes to the big picture. Do they see outcomes that benefit them individually, or are they committed to doing whatever it takes for the team to succeed? As a nurse leader, determine to model a willingness to achieve the big picture rather than to serve self. Motivate team members by sharing the vision with enthusiasm, and recognize those who come on board and work with others toward the desired goal. When we think about the process of completing the MDS 3.0, we see that various team members complete sections that are appropriate to their set of skills and knowledge. It takes the expertise of a team to gather the data that is used to build an individualized care plan and maximize a resident’s potential. If only one person were to take responsibility for 9 completing all sections and interviews that are part of the MDS, the outcome would be weak, important perspectives would be missed, and important elements would be missing from the resident’s care plan. Just as it takes a team to properly complete the MDS and develop a meaningful care plan, it takes the whole nursing team to achieve positive outcomes for all residents. Nurse leaders who want to develop a strong and effective department must realize the importance of drawing on the strengths of each member of the nursing staff. A winning team can be built only through a shared vision and acknowledgement of each team member’s contribution. Start looking today to discover the specific strengths possessed by each of your team members, and draw on those strengths to harness the power of the nursing team. ● A A N AC LT C L E A D E R 7. 2 4 . 2 012 To Whom Does the MDS Nurse Report? Do your MDS teams report to Nursing or Finance or some other organization within your facility? Would anyone care to share your thoughts? What are the benefits of one over the other? I’m assuming that traditionally it’s always been Nursing, but I was wondering if anyone else has broken that mold and what the benefits are of doing so. I am an independent consultant, so I am not in one facility, but my business is MDS consulting, and I always recommend that MDS repor t to the administrator. Judy Wilhide Brandt, rn, c-ne, rac-mt ([email protected]) Q+A The MDS Connection community thread on this question also included these notable comments: Delores wrote: Although the MDS is a resident assessment tool, it is the direct link to reimbursement, therefore how can the final report-ability be other than to the administrator? In my experience, assigning report-ability for various departments to the DON is not effective. Some acute care hospitals have changed the title to VP of Nursing or something similar to side-step this issue. Just pile it on the DON. Eva wrote: Definitely the administrator. RNAC needs to be able to be at the level of the other department heads, so he/she can coordinate all the departments equally. The RNAC needs to be able to coordinate care from all departments as well as be sure reimbursement is in line. Judith wrote: I would also like to suggest that the MDS department should report to the administrator, with a copy of results to the DON through the administrator. The MDS should also be its own department, rather than a division under Nursing. MDS plays a direct role in financial compensation as well as maintenance or improvement in the provision of nursing care. Kristi wrote: A few months ago I negotiated to have the MDS made its own department at my facility. It’s very difficult to have it under a different department because there are so many hands involved (therapy, social work, nursing, billing, dietary). This way, I also am able to feel as though I am on a level playing field with other department heads when trying to get what I need or want, and I also am able to have more say when it comes to the process. It has been working pretty well so far! Karen wrote: As long as I have been an MDS Coordinator I have reported to my DON. She is very supportive of me when I need help to have the other IDT team members get their portions of the MDS completed timely. This doesn’t happen very often. We work well as a team. Qualifying for Short Stay I have a resident who was admitted June 26 on Medicare A, on PT and OT. She was hospitalized on July 9 and returned July 11. I did a Discharge 10 return anticipated and a Reentry. Does she qualify for a short stay? Do we do a 5-Day Readmission combined with SOT? Since she was here on Med A June 26, it wouldn’t be day 8 or earlier unless you don’t count the previous stay. She was discharged home on July 14. Thank you for all your help. continued on page 14 A A N AC LT C L E A D E R 7. 2 4 . 2 012 AANAC 2012 UPCOMING WORKSHOPS TRAINING PARTNER MASTER TEACHER DATES CITY/STATE MDS 3.0 RAC-CT CERTIFICATION WORKSHOPS | 3-DAY Harmony Healthcare International Jennifer Pettis July 31 – Aug 2 Napa, CA Pathway Health Services, Inc. Cynthia Perrault July 31 – Aug 2 Nashville, TN LeadingAge Kansas Ron Orth Aug 1 – 3 Wichita, KS Harmony Healthcare International Jennifer Pettis Aug 7 – 9 Glendale, AZ Colorado Health Care Association Rena Shephard Aug 7 – 9 Denver, CO Ohio Health Care Association Robin Hillier Aug 7 – 9 Columbus, OH Pathway Health Services, Inc. Judi Kulus Aug 7 – 9 Brookfield, WI Harmony Healthcare International Renay Corrigan Aug 13 – 15 Portland, ME Hill Educational Services, Inc. Carol Hill Aug 20 – 22 Florence, AL Harmony Healthcare International Jennifer Pettis Aug 21 – 23 Topsfield, MA LeaderStat Lisa Hohlbein Aug 21 – 23 Kansas City, MO Harmony Healthcare International Renay Corrigan Aug 27 – 29 Bloomfield, NJ Pathway Health Services, Inc. Cynthia Perrault Sep 11 – 13 Charleston, SC Leaderstat Lisa Hohlbein Sep 11 – 13 Baltimore, MD Pathway Health Services, Inc. Judi Kulus Sep 18 – 20 White Bear Lake, MN MDS 3.0 RAC-CT RE-CERTIFICATION WORKSHOPS | 1-DAY LeadingAge Ohio Jane Belt July 25 Columbus, OH Life Services Network Ron Orth July 25 Springfield, IL Life Services Network Ron Orth July 26 Woodridge, IL Life Services Network Ron Orth Aug 7 Rockford, IL North Dakota Long-Term Care Association Ron Orth Aug 9 Bismarck, ND LeadingAge NY Sandy Biggi Aug 10 Latham, NY Hill Educational Services, Inc. Carol Hill Aug 27 Fultondale, AL Harmony Healthcare International Jennifer Pettis Aug 7 – 9 Muncy, PA Life Services Network Judy Wilhide Aug 15 – 17 Springfield, IL MEDICARE UNIVERSITY WORKSHOPS The workshop schedule is subject to change and is updated regularly. To see a full AANAC Training Partner workshop schedule, visit aanac.org/workshops 11 A A N AC LT C L E A D E R 7. 2 4 . 2 012 E T A D HE T E V SA N SA ONIO T N A – 9 2 L A PR I , 2 013 3 M AY What’s new in New Tutorial Videos are Now Available We want to make using AANAConnect as easy as possible. To help you learn about the benefits your member community offers, we’ve created a series of short “how-to” videos. From updating your profile to using advanced search to find the information you need, these videos provide a visual navigation of the featured tool or resource and are all four minutes or less. Here’s what we cover: • My Profile: Learn how to maintain your profile information through AANAC.org, update and upload a photograph of yourself, and modify your privacy settings. • Communities: View the many communities available and take an in-depth look at our most popular community—MDS Connection. • Discussion Postings: Use the quick community links in discussion postings and email digests. Modify your signature and search for specific postings. • Joining a Community: Make sense of subscription options, set up different email delivery addresses and get involved in multiple communities. • Member Directory: Dive deep into the Member Directory feature using various functions like MDS software provider, group membership, “likeness” and much more. • My Contacts: Expand your professional network using mutual contacts and simple search techniques. Also covers the Inbox. • Posting a Message: Learn how to respond directly to postings through the discussion groups or conveniently from your email. • Resource Libraries: Upload documents to the community libraries or search for the samples you need to get the job done. Enjoy the power of your professional community. We’d invite you grab some popcorn, but the videos aren’t that long. (Well, unless you just love popcorn. Then grab it anyway!) Active Discussions this week on AANAConnect: LTC Network: Thread Subject: Overnight passes when on Medicare Posted by: Kim Lies We have a gentleman who is on Medicare. Ho wever, family keeps coming and getting him for pa ss and he is gone from 6 pm until 1am. He has now had 4 times of this and I’m not sure ho w to handle this? I’m cer tain it is a red flag to Medicare that he doesn’t need ski lled care since he is constantly leaving. Do we discharg e him from Medicare? (He just ha d knee surgery) Or ca n we say he cannot leave? Also, ho w do all of these overni ght passes when on Medicare aff ect his MDS schedule ? Have you experienced a similar situation as the one facing Kim? Click on the thread subject above an d be one of the first to provid e her with an idea of ho w to handle this scenario. n: MDS Connectio es RUG score averag S D M : ct je ub S Thread McDavid Posted by: Mark are rly RUG scores where the quar te k I am looking for yone post the lin S website. Can an posted on the CM ease? to this thread, pl n e MDS Connectio of ways to use th ty rie d va a an g e’s er Th about codin general questions om Fr . u ity yo un e, m ov m co one listed ab ific ones like the ec sp e or e m th t to ge re ca ty of ways to munity in a varie e can use the com read subject abov th ed. Click on e th ne u yo n d io te at ca rm lo e info G scores ar the quar terly RU to find out where Or th, one of our n ite thanks to Ro bs we S CM e th on moderators. expert community Click here to view. ● 13 A AA AN NAC AC LT LTC C LLEEA AD DEER R 7. 7.17. 2 4 . 2 012 Q + A, continued from page 10 What You Need to Know Check out these latest updates from the “Need to Know” section of the AANAC homepage and find the information you need to get the job done right. Five Star Technical Users Guide UPDATED July 12 SNF/LTC Open Door Forum: Agenda and Call-in Info OIG Slams Assessment / Care Planning for Atypical Antipsychotics UPDATED Medicare Tip If a Medicare resident admits to your facility with the expectation that he will remain overnight but is discharged or is transferred to a nonparticipating provider or a nonparticipating distinct part of the same provider or dies before midnight of the same day, the day can be billed for reimbursement. Judi Kulus, nha, rn, mat, rac-mt, c-ne ([email protected]) Treatment of Members Policy AANAC has posted the Treatment of Members Policy on the website. If you need to access it, please click here. Get Answers Now When you need answers fast, the best place to start is AANAConnect. We have thousands of member questions that have already been answered by our experts who moderate the communities 24/7. Just type your topic into the search box to see the discussions, tools and peer-submitted resources that may be just what you’re looking for. 14 The first stay was not a short stay since she was in the facility more than eight days. However, the readmission stay may qualify since the resident was discharged less than eight days since readmission. Carol Maher, rn-bc, rac-mt ([email protected]) Office of Inspector General Audits One of our facilities received a letter from the OIG requesting the full medical record of a resident, stating the Office of Evaluations and Inspections was conducting a random review of safety and quality of care to post-acute Medicare beneficiaries. Has anyone else received one of these? Also, at the risk of seeming cynical, I want to know if these are just what they say they are. Thank you. Yes. I have been a nurse that reviewed charts for those folks. They ask for charts and send them to medical professionals to supper the OIG work plan. They compile the results and publish studies, like the one on psychotropic drugs that got so much attention. You can read about them on the HHS OIG webpage. Give any government request the utmost priority. When I was reading charts for them, if I found something that clearly needed to be dealt with (such as quality or overpayment), they forwarded the chart to the appropriate authority for follow-up. You can also call the POC number on the letter and they will explain it to you. Give any government request the utmost priority. When I was reading charts for them, if I found something that clearly needed to be dealt with (such as quality or overpayment), they forwarded the chart to the appropriate authority for follow-up. They can take back overpayments or investigate anything that needs investigating, even though the reason for the chart request is a study. Judy Wilhide Brandt, rn, c-ne, rac-mt ([email protected]) Individual and Group Therapy I have a therapist that wants to see a Medicare Part A patient and a Medicare Part B patient at the same time and bill individual minutes for the Part A patient and group minutes for the Part B. I am being told that this is acceptable according the rehab policy, which states that a therapist can see a Part A and Part B for two different activities and bill group for B and individual for the A on the MDS. This is not how I understand it. Can someone please explain how this can be done and whether this is acceptable? Federal MDS regulations indicate individual therapy is one resident working with one therapist. For Part A Medicare, when two residents are working on different activities together it is considered concurrent. Part B does not recognize concurrent therapy, so when a Part B resident is working with another resident it is considered group for that Part B resident. The reference for this is the RAI User’s Manual, chapter 3, page O-16. Carol Hill, rn, cdp, c-ne, rac-mt continued on page 15 A A N AC LT C L E A D E R 7. 2 4 . 2 012 Q + A, continued from page 14 AANAC Board of Directors Carol Siem msn, rn, bc, gnp Chair Ruth Minnema rn, ma, c-ne, rac-ct Vice Chair Carol Maher rn-bc, rac- ct Secretary Peter Arbuthnot aa, ba, rac- ct Treasurer Susan Duong, rn, bsn, nha, rac- ct, c-ne Patrice E Macken, mba, rhia, lnha, rac- ct Gail Harris, rn, bsn, rac- ct, c-ne Joanne Powell nha, rhia Diana Sturdevant ms, gcns-bc Assessment Not Used for Payment One of my residents was ill and on medical hold for therapy, resulting in only four treatment sessions and a decline in RUG level on her COT date. Her COT observation date coincides with her 30-Day assessment for day 29. Since the days coincide and her rate would decrease, I wouldn’t need to do the COT, just a 30-Day, and my rate would change on day 31. On my next COT observation date, or day 36, the rate would go up, so I would do a COT. My question is: In this scenario, the 30-Day assessment wouldn’t be used for billing, since the COT on day 36 would pay from day 31, so do I have to do the COT for day 29? No, you don’t have to complete the COT. In this situation, there is no gap where an assessment that is “used for payment” is not available to bill on. The “used for payment” policy applies only if the resident is discharged from Part A before the beginning of the payment window for the respective assessment. Ronald A. Orth, rn, nha, cpc, rac-mt ([email protected]) AANAC Expert Panel AANAC is pleased to introduce you to our panel of volunteer reviewers who represent the best and the brightest in our field: Jennifer Pettis rn, wcc, rac-mt, c-ne Chair, Harmony Healthcare International Topsfield, MA Betty Frandsen rn, nha, mha, c-ne Nichols, NY Robin L. Hillier cpa, stna, lnha, rac-mt President, RLH Consulting Becky LaBarge rn, rac-mt Vice President, Clinical Reimbursement The Tutera Group Deb Myhre rn, c-ne, rac-mt Nurse Consultant, Continuum Health Care Services Ron Orth rn, nha, rac-mt Clinical Reimbursement Solutions, LLC, Milwaukee, WI Andrea Otis-Higgins rn, mlnha , cdona , clnc, rac-mt CEO, Administrator, St. Andre Healthcare Biddeford, ME Rena R. Shephard mha, rn, rac-mt, c-ne AANAC Executive Editor President, RRS Healthcare, Consulting Services, San Diego, CA Judy Wilhide Brandt rn, rac-mt, c-ne Regional MDS/Medicare Consultant President, Judy Wilhide MDS Consulting, Inc. Consistent Staffing I attended recent training and there seemed to be a big push for consistent staffing. I am curious whether anyone has recently switched to consistent staffing, how big is your building, and are there any ups/downs, pros/cons you would be willing to share. Consistent staffing has been the standard for awhile. If you Google “consistent staffing nursing homes,” you will get links to some important and informative documentation about this. David Farrell is one of the nationally recognized continued on page 21 15 A A N AC LT C L E A D E R 7. 2 4 . 2 012 LOOK AT WHAT YOUR COLLEAGUES HAVE BEEN UP TO! C-NE Recipients March 16 – July 19, 2012 MDS 3.0 RAC-CT® Recipients March 16 – July 19, 2012 Tamela Aaron Lori Allred Grace Ashu Kimberly Abdulghani Kandy Alters Martin Aunon Catherine Anderson Kemitashi Austin Mercy Abunaw Diana Adams Barbara Anderson Lori Adams Kim Andrews Nancy Adams Lily Anne Angeles-McGill Monica Adams Adeyinka Adebayo Ron Anglo Jody Angus Hasmin Affo-Worou Jacqueline Anongos Bose Ajayi Elaine Applin Jenny Akers Malcolm Aquino Deborah Alabran Marlene Aquino Margaret Alade Marites Arbolario Diana Alderman Cheryl Archibald Donna Alexander Malissa Armstrong Jennifer Alexander Kayl Armstrong Catherine Alfonso Sherrie Arp Nenita Alfonso Sheila Arroyo Linda Alford Jillian Arvelo Catherine Alloway Margie Ashby Ruth Avila Aleida Avila Daramola Ayoade Brenda Aznar Nora Badway Ron Anglo Jason Gedney Judi Kulus Valsamma Babu Deborah Green Lisa Leonard Leigh Bebber Jill Greenhoe Carrie Lukins Connie Black Chris Hanson Mary McBeath Doreatha Chase Deborah Kania Jeanne Mendoza Sandra Edmonds Nelia Kennedy Karen Parenti Lorraine Fabry Mary Klinger Suzanne Russell Alicia Bauer Regina Bishop Jo Ann Brunson Diane Baum Connie Black Evelyn Bryant Kay Campbell Dusty Baxter Misty Blackburn Debra Buchanan Aisha Canty Sherry Beal Inesha Blackwell Angie Budnick-Brissette Robert Carbonilla Shelly Beary Donna Blair Londa Beck Marilyn Blakeley Marie Bedford Deborah Blaschko Connie Beerbower Ofella Blewitt Leah Belimac Cheryl Bliefernich Elizabeth Bell Pamela Blohm Veronica Bellman Joyce Blount Leakie Bell-Wilson Julita Bocado Hazel Bennethum Akinfaye Bolanle Janet Bennett Mary Boles Jose Miguel Buhay Mary Ann Burdett Phyllis Burger Apryl Burgess Rachel Burgos Lariza Burgos Brenda Burk Dennis Burke Rebecca Burrus Bernardina Baes-Abayev Nancy Bensen Vicki Bollenbacher Maureen Baker Mary Beth Berda Shelia Bolwahnn Linda Baker Karen Beres Shereen Banarsee Ami Bernard Ann Bowman Sherrie Banas Donna Bernard Rhonda Barajas Holly Bernhardt Kasey Brandenburger Honesto Cacho Diane Barbera Miriam Berry Rhonda Brennan Arlene Cagampang Stephanie Barkey Dawna Berry Kimberley Brien Susan Cagnon Ashley Barnhart Maricelle Bertumen Heidi Brown Lisa Barnhart Janice Berube Brandi Caldwell-Petrus Joy Barr Rose Marie Bien-Aime Claire Barry Feliscity Bassett Cheryl Billman Pearl Binka Nicole Bowers Tiffany Brown Teresa Brown Michele Brown Suzan Brown Stacey Brown Kathleen Butler Kathy Butler Pam Byam Gina Byrge George Cabrera Kathleen Calhoun Jan Callanta Kathleen Caluag Diana Cameron Michelle Shoemaker Ewa Swiatek Laurie Terning Sherry Trumpower Wendy Wilson Wanda Wyse Kimberly Campbell Cheryl Cardwell Donna Carlone Kristina Carlson Sonya Carollo Diana Carpenter Karen Carr Lisa Carson Angela Carter Angela Carter Grace Castillo Leanne Ceccarini Jeanne Celestino Gretchen Chapman Mary Chapple Kathryn Chatman Sandy Cheatham Chiu Chen Chen Rose Chen Carla Chesbrough Florence Choge Latwinnie Chokureva Michael Christopherson continued on page 17 16 A A N AC LT C L E A D E R 1.10 . 2 012 Colleague Achievements, continued from page 16 Josephine Chu Amie Dautremont Louie Duque Alesandre Fowlks Lori Chuisano Bethany Davenport Laurie Duran Kathleen Fraire Ma. Paulita Ciriaco Vanessa Dyal Lisa Frazier Kristina Clark Bruce Davidson Rosella Ealy Cindy Frazier Sharon Clark Lisa Davis LuzElena Eaton Ruth Frebowitz Tania Cleaver Crystal Davis Adeluisa Edano Terri Frederick Caitlin Cohen Denise Davolt Patricia Eddy Marilyn Frederick Kimberly Cole Melvin Joseph De Guia Sandra Edmonds Amy Fridley Bridget Edwards Ashley Fritts Cathie Coleman Carol Collier Crystal Collins Jaime Comerford Fe Condeno-Lontoc Dawn Conley Debra Conrick Nancy Cook Janae Cook Misty Cook Karen Coppernoll Deborah Corado Anastasia Cormier Ashley Corner Mark Cosmiano Rebecca Coston Shannon Countryman Charlotte Covington Larissa Deblanc Michelle Del Valle Clarice Dela Cruz Lagrimas DeLeon Imelda Delimeos Maria Delson Martha Dempsey Dennise Derby-Bemis Leeah Develez Sujey Diaz Pamela Dick Joan Dillon Abegail Dimacali Margaret Dini Annika Dinovi Sherry Dobbs Gina Docteur Marcelita Doherty Nancy Cowan Carol Dollar Janice Craig Maricar Domingo Constance Cronacher Robin Donahue Susan Donella Chrystina Edwards Carlet Fromm Donna Edwards Su-hwei Fu Cheryl Ehrlich Gina Galang Deloris Ellibee Denise Gallagher Peggy Ellis Emilie Galyon Sandra Elswick Tamika Ganzy William Engerson MaryAnn Garcia George Enongene Elaine Garcia Askale Enyew Juliet Garvin Laurie Erhardt Virginia Garza Honey Erolan Jacqueline Gayle-Brown Jacqueline Esack Stephanie Escamilla Heidi Escobar Morgane Etienne Brooke Evans Patricia Falvey Zexu Fang Carol Farnsworth Marvis Farris Deborah Fein Ellen Donovan Sister Deirdre Ferguson Fe Dosado Kimberly Ferree Gail Dosey Heather Ferrell Veronica Douglass Marietta Fertig Rebecca Dowell Galyna Fishman Carrie Drake Laurie Fitzloff Colleen Drake Christine Flaurr Sabrina Fleming Deborah Curtis Maureen Drouillard Sherri Dabiew Kelli Duckett Donna Daffron Debra Duff Bethani Dandois Mary Joy Duller Edward Daniels Paula Duncan Judith Dantonio Kerry Dunning Konnie Cross Cynthia Crumb Michelle Cruz Sherry Cruz- Flores Donna Cuadra Rosemarie Cuadro Jennifer Cuaycong Amy Cullen 17 Regina Davidson Marcela Flores Rita Flynn Lisa Folson Denise Ford Deborah Foster Rose Gazzerro-Langford Mia Gehm Andrea Gele Tammy Genagon Tina Ghorley Sandra Giafardino Vicki Gidley Annette Gielchinsky Janice Giessinger Michelle Gillard Viviane Gilles Millicent Gillis Margaret Gillroy Brenda Gilmore Marilyn Glassco Nadira Godbout Monica Goetzinger Maureen Golas-Markure Stephanie Gonsalves Michelle Gonya Maria Ana Gonzales Monique Gonzales Valerie Gonzalez Johana Gonzalez Chastidy Goodwin Denise Gorrie Phyllis Graham Melissa Graybill Edna Green Angela Greene Debora Greene Jane Ellen Gregson Katherine Griffin Karin Hanna Mary Hite Chris Hanson Ann Hobson Roderick Harper Jennifer Hodges Janice Harris Patricia Hoffman Melinda Harrison Debra Hoffman Lindsey Hart Donna Hohm Carmisha Harvey Linda Hoisington Linda Hatter Cynthia Holden Martha Haugen Diane Holzberg Pamela Hawkins Beverly Holzer Mary Hawn Edy Homan Bonita Hayes Sheryl Hopson Shirley Hayes Tashina Hornaday Laura Hayth Brandy Hostetter Pavlina Head Paulette Hoyle Paulyn Headley Melissa Hudek Joann Heath Kathleen Hughes Noelle Heery Karen Hulsebosch Christie Heese Suellen Hunsinger Jennifer Heimann Linda Hunt Patricia Grilli Jolene Hein Paula Hunt Laci Gritton Jeanette Heitzler Tammara Hunter Eileen Grubbs Terry Hellman Robin Husman Jennifer Grube Jackie Helms Freda Iaizzi James Gruebner Christine Hemphill Uduak Ibanga Kathy Gruel Connie Hemphill Maureen Imperato Grace Indrakusuma Shannon Griffin Josephine Griffin H. Patricia Griffiths Gale Grunert Cathy Henderson Mary Grace Guanzon Debra Hennen Julie Guiler Elvira Hernandez Suzanne Guimond Christal Hertzog Lilian Guinto Darunee Gust Madonna Heshelman Juanita Gutierrez Valerie Hesse Chijioke Izuka Gregory Guymon Susan Hickson-Painter Janet Jackson Nancy Haas Sandra Hacker Lorinda Hagstrom Kathleen Haider Dorothea Hairston Pamela Hajewski Beverly Golmon Cristina Hall Jeannette Gonder Angela Hamer Michele Gonsalves Patricia Hamilton Beverly Hand Cyndi Hensarling Amy Higgins Lindsay Hight Donna Hill Sandra Hill-Harris Patricia Hillman Ramona Hinds Wendy Hinkle Rebecca Hinojoza Angela Hise Karen Irthum Dionne Isadore Katrina Isakoff Annie Iskenderian Rossana Itchon Tiffany Jaklevich Najma Jamal Dana James Kaelin Jansen Erica Jasperson Linda Jensen Diane Jensen Dana Jimenez Cerrisa John Barbara Johnson continued on page 18 A A N AC LT C L E A D E R 1.10 . 2 012 Colleague Achievements, continued from page 17 Betty Johnson Julie Kutz Jack Loer Valarie Mauro Stephanie Mitchell Marnie Nieves Patti Johnson Joyce LaCroix Marie Logsdon Kim Maxson Elaine Niewind Cathy Johnson Aleine Jubelle Lacuna Editha LoMonaco Naide Mazzochi Tujuana Mitchell-Simon Barbara Johnson Mary Johnson Kathryn Johnson Sandra Johnson Diane Johnson Robyn Jones Sherri Jones Shukriyyah Jones Donna Jones Susan Jones Gwendolyn Jones Tanya Jordan Paula Josephs Lilly Juarez Jennifer Kaczmarek Moses Kamande Leanna Kane Moses Karanja Victoria Karpman Wenxin Karshis Margaret Keck Sarah Kelley Theresa Kelley Christina Kelley Stacy Kelly Earl Kendall Jill Kennell Amy Keown Kellin Keyfauver Jim King Victoria Kinsman Tracy Klenda Jan Kliethermes Beatrice Klingel Brenda Kloster Cynthia Knauft Kathleen Kolodge Colette Kon Aminata Kone Aimee Kroeger 18 Donna Lagueux Beth Lambros Linda Lamson Lisa Lanausse Sherry Landis Dawn Landis Hollis Landskron Patrick Langat Helen Langford Connie Langlois Veronica Lanigan Andrea Long Glory Mbakwe Kristy Long Catherine Mbugua Rowena Long Elizabeth McAdams Rosina Lott Leanne Love Susan Lubeck Lupita Lucio Martha Lugo Carrie Lukins Mary Lunzer Deborah Lysik Anita Lanoue Archanaceline Macloen John Lao Reneena Maglunog Jennifer McAfee Kelly McArthur Brenda McCabe Lori McClenning Barbara McCurry Amelia McDonald Constance McEldowney Amber Mitchum Corinne Monahan Heather Monge Teresita Monsada Maureen Montanaro Karen Montgomery Sara Moody Robert Moore Angela Moore Lorie Moore Evelyn Morgan Pamela McGuire Emily Morgan Candace McKee Jeri-Ayn Morley Erin McLagan Larissa Moroz Denise McNamara Darlene Morris Norma Mears Cindy Morris Cynthia Mains Lydia Medders Sofia Moya Lenita Mallorca Aden Medhane Aimee Mullins Reginald Mamaril Taunya Medler Rachel Murawski Elaine Laufer Kathy Manalang Hilda Mejias Trevor Lavergne Gail Charmaine Manapat Jeanne Mendoza Claudine Murdaugh Jennifer Larner Anne Larson Lynda Larson Elisa Larson Christine Latondress Denise Lavon Terri Lawall Lynda Lawrence Kimberly Layfield Danielle Leahey Theresa Learst Keri Lease Monica Ledford Joung Hwa Lee Virgillio Legaspi Susan Mahaffey Melonie Mahnesmith Laura Manganiello Tresa Manning Edmond Marchi Sandra Mariano Karen Marlow Mary Grace Marqueses Tammie Marry Vicky Marsh Blanca Mendoza Mary Mercier Zarina Merrell Shannan Merritt Linda Metzler Terry Micelli Becky Michel Patti Mikes Julia Miller Christine Miller Susan Leigh-Cox LaKimbrell Marshall Kristi Miller Christine Leighton Kim Marshall Barbara Miller Deidre Lemke Stacey Marshall Dannie Miller Laura Lenhart Pamela Martin Leslie Miller Michele Leonard Pam Martin Christina Mills Benjamin Lequire Julie Martin Cheree Miner Paula Lewis Theresa Mason Michele Mingolello Susan Limmer Michelle Matthews-Wild Laura Jean Miniano Nancy Kroszner Corinne Livingston Dawn Minnesma Alyssa Mattson Aby Kuruvilla Cynthia Misius Tracy Loeffler Victoria Matzus Mary Mitchell Deborah Pegg Aubrie Novotny Nicola Peluso Christine Nowak Elizabeth Pentin Shirley Noyd Gertrudis Perada Brittney Nuckolls Gilda Peralta Julio Nunez Linda Pere Fanta Nuradin Kathleen Petricone Monica Nwosu Dianne Petrie Queen Nwoye Elaine Pettit Lilly Oh Opal Pierce Nancy O'Hearn Mary Pierson Chimdinma Ojini Jocelyn Pineda Kehinde Okunola Anna Pippin Dennis Olaniyi Dawn Platt Berlyn Oliveira Doris Pless Noemy Olmos Teri Polfer Rebecca Omerhi Neil Pornel Irene Ondieki Nicole Poropat Rachel ONeal Ana Porras Jowell Ong Sunday Joy Porras-Taton Nicole Ordich Ligaya Ordonez Marisol Ortega Kristina Murphy Elizabeth Osborne Charlesanna Musili Patricia Osterhaus Deborah Mussler Barbara Paggi Darla Myers Deborah Paine-Motyl Bridget Myers Diana Pearson Vicki Nordby Mary Murphy Yahaira Myers Regina Payongayong Lisa Poslock Sue Post Lynn Potsander Lisa Pottgeiser Rozanne Povey Dianna Powell Lovella Palarpalar Melende Paranpan Marie Myrthil-Cherubin Valerie Paré Maria Nadres Jackie Parker Diana Nahouraii Valerie Parks Roopa Naik Susan Parmeter Lilia Navarro Erika Parrish Rhoda Ndamukong Leticia Pascua Kristie Powers-McHatton Sandra Prentiss Mariah Priest Cecile Prince Mary Puhrmann Helen Quiles Jane Quiling Erin Race Pamela Nebel Janice Pate Arlenea Nelson Asma Patras Cyril Neric-Leyesa Juanita Patrick Donna Netland Savanah Patt Lachelle Newburn Charlotte Patterson Susan Newhart Patricia Paulus Judith Nielsen Sherry Pawlik Arshad Rahman Barbara Rains Denise Rallis Steven Ramos Ginger Ramsey Denise Raquet continued on page 19 A A N AC LT C L E A D E R 1.10 . 2 012 Colleague Achievements, continued from page 18 Sivaporn Ratankomol Amy Rau Shirley Ravina Lauri Redmon Blanche Reed Laurie Reeme Heather Reichenbach Louanne Shirk Kristen Stock Ann Marie Ryan Lacy Shirley Carol Stokes Ioana Salanta Alicia Salyards Debra Salyers Juana Sample Ruth Sanderson Kristy Shoemaker Michelle Shoemaker Kristen Shurman Roya Siddiq Suzanne Simes Marie Antonette Santos Karen Simmons April Santti Carolyn Simon Ellen Sassa Cory Simpson Elaine Saylor Debra Sims Pooja Singh Lisa Richards Josephine Schambelan Clare Richardson Carole Schleicher Carol Richelson Paula Schneider Karen Riggin Patricia Schortmann Patricia Reid Catherine Renz Lisa Reynolds Ketlie Richard Mary Ringley Sheila Risner Catherine Ritchie Stacey Rivera Victoria Roberts Tosha Roberts Dianna Schuetzle Kamlesh Singh Kelli Sipe Linda Skinner Marianne Skinner Roberta Smeal Carol Smith Jennifer Schultz-Damato Deena Smith Betty Schulze Kimberly Smith Yazmina Schulze Heather Smith Wilma Stout Kathryn Strack Michael Strack Melanie Strawder Britny Stricker Amber Stumne Katherine Torres Julia Toth Temmile Williams Carrie Vevoda Jayna Willis Jalen Villalobos Linda Wilson Alison Villee Angela Wilson Ashley Vinson Lois Wilson Patricia Virgin David Wilson Dorotea Vornsand William Wilson Robin Walker Wendy Wilson Gary Walls Toni Wilson Patricia Trenholm Barb Wanger Marie Wilson Claudia Trotter Loretta Wangler Wendy Wincewicz Emily Suhanovsky Diane Ward Mckin Winegeart Babatunde Sule Mary Lou Truettner Bobbie Ward Beth Wise Angela Swaggard Connie Trumble Victoria Warner Rebecca Witte Mary Sweeney Sherry Trumpower Rae Marie Warner Katherine Wood Lori Swengel Deborah Tubbs Lisa Swigart Mary Ann Washington Amelia Wood Aseneth Tubman Saroya Swiger Alekhine Tumangday Tracy Waters Tabitha Turner Angela Watson Jessica Upton Lorraine Watson Jacqueline Vachon Evelyn Watson Bonnie Talmich Michael Valderueda Mary Wegrzynowicz Rose Valladares Deborah Weightman Leslie Szewczyk Abigail Tabuena Jennifer Takes Stefanie Talbot Arlene Secillano Shauna Somers Michelle Tang-Posadas Sharon Secrist Kathy Souza Rita Taylor Pamela Seebach Nicole Speetjens Susan Taylor Darlene Seesengood Robert Spruell Dio Telmo Debra Rogers Jerren Spurlin Donna Tenner Ronda Rohl Delia Serafin Julie Spurrell Paula Terranova Laura Rohmann Mary Beth Sevigny Cindy Rollings Nettie Seward Phillis Joyce Sta. Maria Ferdinand Romero Gautam Shah Sheryl Stadnick Dedria Rongey Denise Shamis Sandra Stafford Jocelyn Rosales Hong Shan Tara Starzec Tamara Thibodeaux Kimberly Rothman Linda Shaner Traci Steele Krystal Roundy Angela Ruckh Stephanie Shanklin Celza Ruiz April Roby Susan Torralba-Borja Beth Vesterman Sunye Suh Tira Sokorich Valerie Robosson Cecelia Todd Michael Sugrue Donna Scuncio Gail Robison Aileen Tobias Joanne Suder Denise Smith Shirley Robinson Roz Marise Tiu-Rosana Michelle Trambauer LaTasha Scott Carmen Roberts Tina Van Derwerker Renae Van Gelderen Jennifer Van Leeuwen Mary Weikert Sheila Wein Gina Welch Becky West Christine Wheeler Lisa Terry Eileen Van Norman Terry Tetzlaff Randi White Brian Van Veghel Trudy Therre Micheal White Jacqueline Vanderpool Gloria Whitley Terri Wick Donna Thomas Virginia Wickham Donna Steele Roberta Thomason Alene VanPutte Linda Wiegner Ruth Stefanic Ingrid Thompson Melissa Wilkes Melissa Sharp Alisha Steil Teresa Thompson Carolyn Vanzee-Heethuis Karen Ruiz Nancy Shaw Erin Stepanski Barbara Vaughan Lee Williams Tina Russ Sheliegh Shillito Rebecca Stevenson Ronna Anabel Tiangco Trina Shilow Leslie Stewart Pamela Timmers Ralene Vaughn Faith Ventura Yvette Wood Melissa Wasmundt Wendy VanDerSloot Lynette Rutherford 19 Jennifer Ryals Bobbie Wilkinson Angela Williams Linda Wood Kim Woogerd Jeffrey Woolstrum Lakesha Wooten Kristina Word Jennifer Wormington Roberta Wunder Julie Yeager Jessie Young BethAnn Young Lisa Young Pamela Young Kelly Younker Shelly Zaborac Corazon Zapanta Catherine Zaug Jacquelinn Zavala Graciela Zebadua Yocheved Zentman Mary Lou Zepeda Glorificacion Zerna Patricia Zibelli Mary Ann Zielinski continued on page 20 A A N AC LT C L E A D E R 1.10 . 2 012 Colleague Achievements, continued from page 20 MDS 3.0 RAC-CT® Recertifications March 16 – July 19, 2012 Edna Adams Brenda Brooks Teri DeGraw Phyllis Adams Stephanie Broussard Lisa Delano Marie Andree Adolphe Diana Aduna Rosemary Brown Cheryl Ahlberg Tiare Brown Karen Ahlers Karan Bulvin Omana Alex Michele Busenlehner Linda Allen Penny Allison Jerry Amerman Debbie Arthur Tonya Ashford Mary Askegren Marie Gabrielle Avril Jennifer Butt Nancy Calizar Katina Campbell Richard Cannon Arlyn Carbonel Bonnie Carrillon John Carter Judy Bair Eimee Casal Musa Baldeh Elaine Casey Elizabeth Baldwin Alice Chambers Kristin Bangert Kathy Champion Kathy Barger Janette Chase Tina Bark Susan Chester Anne Bartlett Anita Cheung Diana Basko Betty Chilson Susan Battaglia Robin Christman Christy Beard Krishna Chugh Elnora Bedayo Nina Corea Jennifer Beranek Nancy Cornett Gloria Berbano Renay Corrigan Jennine Best-Baker Silvia Craig Stacey Biggart Jocelyn Crocker Sandy Biggi Heather Cullison Pamela Black Cecelia Cyrana Heather Boehlke Rito Nelson Daan Coletta Bontrager Pamela Darling Melinda Boucaud Elizabeth Darnell Barbara Bowes Cyndi Davis Judy Boyd 20 Deborah Brown Erica Davis Jeanne Boyle Kristina Davis Linda Brooke Victoria Dedrick Linda Demme Donna Deneen Ann Deziel April Diaz Stacy Dikeman Brian Dimit Cynthia Disrud Jo Ann Dobbs Xerxes Domingo Laura Donaldson Jeanne Dunker Sharon Gordon Alice Janes Janine Lehman Amanda Monnard Anne Goude Marie Jean Stephenye Leon Vicky Montalbano Elizabeth Grant Debra Jensen Vicki Lettau Anna Moody Shirley Grant Donna Jewell Margaret Leverette Cheryl Muller Melissa Green Rachelle Jiskra Karen Libby Robbin Mulvaney Summer Grinstead Claire Johnson Maria Emelia Lobino Peggy Munson Carol Gruber Dave Johnson Krista Gunter Diana Johnson Eden Hamada Jodi Johnson Pam Hammond Marsha Johnson Stephanie Han Steve Johnson Cynthia Hansen June Johnsonbaugh Randi Hansen Julie Kahl Pamela Hao Patricia Kemblowski Loren Haynes Shirley Hazen Charles Heath Cynthia Heglar Kim Kemp Maureen Kennedy Kayla Kickul Debra Lohman Kathleen Mychajlowskyj Donald Lowe Deborah Myhre Susamma Lukose Diane Narog Ruby Lusk Beth Nash Mary Lyczynski Loretta Neal Flordeliza Macatangay Ruth Nelson Marjan Neman Martha Mackey Linda Neumann Mary Madison Sandra Niles Lynne Marquardt Karen Nisja Dawn Marsh Karen Noffke Janice Martin Dorothy Kimberling Maryanne Martin Barbara King Trina Martin Pauline Kinney Jeanne Maschmeier Shirley Kinney Jodi Matelski Connie Kirkella Aleyamma Mathew Adrienne Hiester Olivia Kitcher-Yamikeh Sheela Mathew Nancy Hilbrands Roxann Kluender Carol Hill Mary Kolodziej Jill Eve Betty Hillier Nancy Koski Constance Farley Kimberly Hogan Julie Fedders Nancy Hoiberg Mandy Kreikemeier Bobbi Ferguson Nancy Holcomb Linda Krueger Darlene Feyerherd Julia Hopp Rebecca LaBarge Jean Fitzgerald Dianne Houvener Jennifer LaBay Mariola Flores Dawn Hover Debra Labella Donna Forjone Jane Huber Deborah LaBiosa Tanya Fox Margaret Huffman Sara Labosky Deborah Lake Cheryl Hugunin Dawn LaMagna Joyce Husband Deb Langenberg Cynthia Dutton Carolyn Dvorak Connie Dye Kimberly Eaton Karla Effland Linda Elizaitis Vickie Ellerman Rosalia Emily Enrade Caroline Frascone Nancy Frazee Madonna Freeman Jean Ann Garofalo Angela Gibbs Teresa Giltner Penny Helzer Karen Henderson Cynthia Heness Kimberly Hensley Joy Herring Sheri Heyn Misty Hymas Ruslana Lapchuk Victoria Immesoete Caroline Larson Aaron Irey Susan Lawrence Gail Irwin Debra Lee Cindy Good Marsha Italiano Hall Marcia Leemhuis Sherry Goodman Jayne Jahn Anita Goldbrand Rita LeGron Kathy Norris Lisa Novicky Wanda Nyx Lisa OBrien Renee Olmstead Virginia Mayhew Odette Osilla-Francisco Lisa McCaffrey Linda McCauslin Andrea Otis-Higgins Debra McDowell Shirley McGeachey Tamela McQuiston John McQuiston Jr. Gary Mertz Nancy Mikilia Joyce Milholland Tricia Miller Elizabeth Milton Trisha Miszewski Janice Modugno Lindsey Moneypenny Patricia Overdorf Linda Palmer Ann McLeod Jim Mercier Carol O’Brien Nancy O’Donnell Shelley Matthes Trudy Mekush Adela Obeso Christina Palmquist Vilma Patterson Teresa Pattie Paula Pecoraro Beverly Pehkonen Tracey Penny Cynthia Perrault Karan Perrett Andrea Perry Barbaralee Peters Kathleen Peters Gail Petrowsky Jennifer Pettis continued on page 21 A A N AC LT C L E A D E R 1.10 . 2 012 Colleague Achievements, continued from page 20 Julie Pierson Michelle Reisberg Peggy Pike Leslie Rew Doris Pitt Cynthia Reynolds Alison Platz Nancy Reynolds Margaret Plow Janet Rhodes Kris Ponto Marcia Potter Joanne Powell Brenda Premo Peggy Pringle Ruth Prisaznick Carolyn Prockup Rachel Quilal-lan Tonya Quimby Dora Ramos Kathryn Rath Amy Ray Tonya Rea Angela Reese Juanita Regier Caroline Reid Tammy Rhone Inez Richards-Gordon Christine Riker Sherri Robbins Bridget Rooney Barbara Rose Suzanne Rose Melanie Ross Amy Ruedinger Patricia Rugg Benjamin Ruggles Mojdeh Rutigliano Catherine Sack Erika Sakai Cindy Salomon Maria Victoria Salvador Katherine Sanders Gail Santangelo Cheryl Sawyer Donna Schampers Therese Schlegelmilch Martin Schneider Marilyn Schreiber Eva Scott Michelle Scott Janet Senner Judy Sgrillo Jill Shang Rena Shephard Jennifer Shive Carol Siem Maximo Simbulan Julie Simonson Joyce Sitzai Patricia Skidgell MaryAnn Steinitz Patricia Tomaselli Lucia Warnock Collette Smart Kelly Stimac Gail Tripp Joy Whitbeck Amanda Smith Carol Story Melanie Trout Barbara White Christine Smith Ronda Stovall Beth Tuttle Linda Wilhelm Lori A. Smith Joann Strouf Yaffa Ungar Lori Smith Debra Suski Maureen Valvo Judy Wilhide Brandt Sharon Smith Tara Sutherland Joanna Sohl Maragret Taylor Linda Van Der Veen Linda Solano Robert Taylor Shellie Sonnentag Barbara Thielke Shannon Sorber Belinda Thies Caryn Sparks Manda Thomas Tammy Spears Teresa Thomas Evalena Stahl Justine Thompson Marlaina Stahlman Marsha Thompson Katherine Stai Sandy Stames Rhonda Standish Linda Vanderstyne Barbara Vasile Barbara Vaughn Laurence Viernes Tammy Thompson Barbara Timko Karen Timmerman Debra Stearley Carol Timmons Karen Steigerwaldt Colleen Toebe Ermie Williams-Easton Kenna Williamson Jeri Wilmore Lisa Wilson Renata Wiltse Joan Woolson Pamela Villavicencio Pat Wooten Heidi Von Stein Danelle Wotka Tiffany Waisner Susan Wozniczka Kathy Waiters Sandra Wyman Janice Wallace Carol Yako Susan Wallace Patricia Yanoski Heather Ware Janice Yotty Michelle Warlick Mary Zorn ● Q + A, continued from page 15 experts on this topic. This link takes you to a piece he wrote on this in 2006: http://www.theconsumervoice.org/sites/ default/files/advocate/policy-resources/ Auld,Rosenthal-1of4-Concurrent(Consist entAssignment).pdf. This one is from the Advancing Excellence campaign—very helpful: http://www.nhqualitycampaign.org/files/ impguides/2_ConsistentAssignment_ TAW_Guide.pdf. Rena R. Shephard, mha, rn, rac-mt, c-ne ([email protected]) My Facility’s New Five-Star Rating I guess I don’t understand this fivestar system at all. I just reviewed my facility’s five-star breakdown. The way I am reading into it, we should be rated as a five-star building but our 21 total review stars read as a four-star. The breakdown is: inspection rating; subtract one star if staffing is one star. The overall rating cannot be more than five stars or less than one star. • Health inspection: 4 stars • QM: 4 stars • Staffing: 4 stars • RN staffing: 4 stars With these numbers, shouldn’t we be a five-star? Can someone please explain this to me? My administrator doesn’t get it either. Thank you so much. Here are the steps for determining your five-star rating. Notice that for the staffing rating, you would not get to add a star since it is not greater than the health inspection rating. • Step 1: Start with the health inspection five-star rating. • Step 2: Add one star to the Step 1 result if staffing rating is four or five stars and greater than the health • Step 3: Add one star to the Step 2 result if Quality Measure rating is five stars; subtract one star if Quality Measure rating is one star. The overall rating cannot be more than five stars or less than one star. • Step 4: If the health inspection rating is one star, then the overall quality rating cannot be upgraded by more than one star based on the staffing and Quality Measure ratings. • Step 5: If the nursing home is a Special Focus Facility (SFF) that has not graduated, the maximum overall quality rating is three stars. 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