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Hello,

Host Welcome And Disclaimer

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I will be your host. My name is Deanna Fe. I am a registered nurse and healthcare analyst. Let's get started.

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The views or opinions expressed in this podcast are for informational purposes only, not intended as legal or professional advice, and may not represent those of Verity Consulting. Although we make strong efforts to make sure our information is accurate at the time the podcast episode was recorded, Verity Consulting cannot guarantee that all information in this podcast is always correct, complete, or up to date. All information in this podcast is subject to change without notice.

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Well, welcome.

Why ER Transfers Keep Rising

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Today, uh in this episode, I want to discuss the, well, critical issue of nursing home residents being transferred to the emergency room and also the issue of residents being admitted to hospitals and how this has become an increasing issue. We do know the CMS does track this information in quality measures, both at the state and national levels. We do know the Office of Inspector General does monitor this information. So I'll look at a little bit of that throughout this discussion and highlight some things and talk about the overall quality of care concerns. So,

OIG And CMS Regulatory Scrutiny

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first of all, regulatory scrutiny. Well, the Office of Inspector General and the Centers for Medicare and Medicaid Services have consistently examined nursing home resident transfers to the emergency room and then hospital admissions. Their primary goal is to determine if these incidents are avoidable or preventable due to, well, significant cost and overall quality of care implications. And certainly nursing homes are concerned about this as well, and as are the hospitals. So

Underreporting And Public Trust Risks

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it revealed significant underreporting. So we did know residents were coming, going rather, to the hospital with major injuries. So that just further illustrated, you know, something's happening. People are going to the hospital, and the quality measures were rep were being represented in that regard. Nursing homes were failing to report this in their MDSs. So more scrutiny there. The inaccuracy was misleading the public, or that's how it was being suggested.

Dashboards For Quality Measure Tracking

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And so with that, I'm going to talk a little bit about the dashboards, why it's so important that facilities develop dashboards. If you don't have one, you need to look at that. What is a dashboard? A dashboard's like what you have in your car, right? You're driving down the road, you look at your dashboard, do I have enough gas? How fast am I going? A dashboard can is a is a dashboard for a facility to look at your quality measures. How are we doing each month? How are we doing each quarter regarding falls, falls with major injury? How are we doing in our facility with resident readmission to the hospital? The incidents of residents going to the emergency room. A dashboard will be a quick snapshot of that to tell us how we're doing. So

Diagnoses Trends And Root Causes

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with that, some things that you're going to want to look at are kind of peeling the onion back a little further, taking a look at not just at face value, why are that residents are rather going to the emergency room, that residents are being hospitalized, but taking it a little further. Why are they going? What are some of the top diagnoses that are taking them there? So once the resident gets to the ER, once the residents are admitted to the hospital, take a look at those top diagnoses or secondary diagnoses. Because they may get admitted with one diagnosis, but then later determine this is the real issue. So take a look at that and track and trend that information to help you to find out are there some things that you may be missing in your nursing facility that maybe some early detection could have picked up on, perhaps, to prevent. Because again, we want to avoid, to the extent possible, to prevent hospitalization in an emergency room transfers.

Avoidable Vs Unavoidable Transfers

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We do know residents have a choice. We do know that. Families may say, look, I know, I know we said we don't want mom or dad to go to the ER, we don't want them to get hospitalized, but I want them to go anyway. We know that people will say, I'm changing my mind, I want to go anyway. Okay, so you're going to want to track and trend times when we had ER transfers, we had admission to the hospital. You're going to want to further identify avoidable, unavoidable.

unknown 6:00

Okay.

SPEAKER_00 6:00

You're also going to want to say, these were times when family insisted that we go, and this was avoidable. This was unavoidable. So you're going to want to really do some data mining to help find out are is are there times when we need to do some re-education for clinical staff? Are there times when we need to have some education for our families, for our providers? Okay. We do know that this information is going to be helpful to your facility interdisciplinary team, to your medical director, to look at the course of care, quality of care throughout the facility.

unknown 6:47

Okay.

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Now we

Surveyor Focus And Ongoing Monitoring

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do know the CMS surveyors are going to be coming in to your facilities. They will have already looked at all of these quality measures, of course, before they come in. They're going to look at your trends and they're going to focus a little bit more on certain indicators to find out a little bit about what some of your practices are. So the facility, you have a responsibility to continuously monitor for your resident populations that are at risk for developing certain conditions that may lead them to go to the emergency room to be transferred for resident populations that may be hospitalized. We know

Early Detection Systems That Help

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residents are coming to our nursing homes with a lot of complex illnesses. And so anything you can do to stay on top of picking up in early changes is crucial. And so putting some practices in place, having some good systems to pick up on some of those changers. So I'm going to pick this conversation up a little bit more detail in the next episode. I hope this was a helpful primer for you. It's really important to develop a dashboard to track the data and to start querying the data and asking why now. So I hoped to I hope you check in with me on the next episode. Thanks for listening. Thank you for listening. Your time is appreciated. We hope

Next Steps And How To Reach Us

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you enjoyed this episode of Vital Compliance Insights and found this to be informative. Please feel free to reach out to Verity Consulting at Verity Team.com if you'd like further assistance with your healthcare compliance needs. Stay tuned for the next episode.