Programs

THURSDAY, October 22, 2009

8:30 to 10:00 a.m.

The Power of Myth: How the Media-Fueled Undervaluation of Nursing Wastes Health Care Resources and Takes Lives

Sandy Summers, RN, MSN, MPH

The nursing shortage is a public health crisis and a severe drain on hospital operations. Sandy Summers, Executive Director of the Truth About Nursing, will explore some overlooked roots of the nursing crisis and offer strategies to help nurses respond. By reconsidering how our society thinks and acts toward nursing, we can increase efficiency, reduce turnover, improve care technologies, and enhance community satisfaction.

Media products have long shaped and reinforced inaccurate perceptions about the nature of nursing work. The media commonly presents nurses as handmaidens, sex objects, angels, or battleaxes. Such depictions suggest to the public that physicians are the only health care professionals whose work matters, and that nurses lack substantive knowledge and autonomy. They discourage talented, self-respecting people, especially men, from entering the profession, legitimize the dilution of nursing care delivery with under-educated technicians, demoralize practicing nurses and legitimize the chronic under-funding of nursing education, research and clinical practice. These are all factors in the nursing shortage that is taking lives worldwide. For the shortage to end and public health to improve, we must increase the public’s understanding of nursing, and only nurses can make that happen. Sandy Summers will explore strategies to help nurses reach out to the media, including through the Truth About Nursing’s website, in order to move the image of nursing toward that of a profession that’s second to none.

10:30 to 12 Noon

The New Survey Focus: Abuse Reporting and What It Means to You

Daniel J. Sheridan, PhD, RN, FNE-A, FAAN

The survey tags for Abuse at F-223 to F-226 will be discussed. Institutionalized people of all ages are at increased risk for abuse and neglect. In this session, participants will learn how injuries can “talk” to the nurse. Using a forensic nursing approach based on principles of forensic pathology, participants will learn how to differentiate accidental from intentional injuries. In addition, participants will learn basic forensic terminology for common injuries that will improve the accuracy of documentation in the health record.

Upon completion of this presentation the learner will be able to:

more accurately document violence related injuries using correct medical forensic terminology
identify the physical indicators of intentional abuse that will help differentiate intentional from accidental trauma
apply the principles of forensic documentation, including photography into health record documentation
identify the rapidly expanding role of clinical forensics in nursing practice

1:00 to 2:30 p.m.

(1) When Injuries Speak: Forensic Implications of Possible Abuse/Neglect

Daniel J. Sheridan, PhD, RN, FNE-A, FAAN

Building on the plenary session of forensic wound identification and documentation, this session will track a series of actual cases investigated by a forensically trained nurse. Common documentation errors will be reviewed, as well as how to get key witnesses and/or persons suspected or accused of abuse to re-create mechanisms of injury. The importance of thoroughly exploring all potential causes of injury during the investigative process will be highlighted.

Upon completion of this presentation the learner will be able to:

analyze a series of injury slides to determine if the injuries were consistent with the histories given
use a series of photographs to “re-create” mechanisms of injuries
identify common documentation errors and red flags for possible cover-up of abuse and neglect

1:00 to 2:30 p.m.

(2) Successfully Transforming Nursing through Culture Change

Linda Kettles, RN and K.J. Langlais, CEO, LACHA

While many organizations struggle with how to transform their organizations through Culture Change and the Resident-Centered Care model, our experience liberated and transformed the Nursing Department from chaos to calm. It redefined roles, empowered care-givers, stabilized staff, and improved clinical outcomes through a new focus bridging culture change, regulations and outcomes. In this session participants will receive real solutions for transforming a nursing department to become successful in a resident-centered care model within survey and regulatory guidelines.

1:00 to 2:30 p.m.

(3) A Primer for Diagnosis Coding

Patrice Macken, RHIA, LNHA

Many MDS professionals are responsible for coding the diagnoses on the MDS but have had no training on ICD-9-CM coding protocols. This workshop will take nurse clinicians through the ICD-9-CM coding books and explain the coding protocols currently in use. Accurate diagnosis coding is imperative for completion of the MDS and for an accurate UB billing document.

1:00 to 2:30 p.m.

(4) The Recovery Audit Contractor (RAC) Survival Guide

Lauri Shofner, RN, RAC-CT

How will the Recovery Audit Contractor (RAC) audits impact your facility? Attend this session for a fundamental understanding of Center for Medicaid & Medicare Services (CMS) RAC demonstration project and its implications for skilled nursing facilities. More importantly, you will learn the steps necessary to prepare your facility in advance of a RAC audit. Get the tips and tools you need to survive the RAC.

3:00 to 4:30 p.m.

(5) QIS – What You Need to Know

Kenneth Daily, LNHA

The CMS is implementing the Quality Indicator Survey (QIS) process to better determine the regulatory compliance of nursing facilities. The QIS incorporates a more comprehensive and systematic approach to review a wide range of regulatory areas and to subsequently compare facility practice with national norms. In addition, it triggers potential areas of concern for further investigation by surveyors. This new approach utilizes sophisticated computer software, standardized surveyor interviews and focused chart reviews and observations that guide the surveyor through the process to make inferences about care and determine a facility’s compliance with Federal regulations. This session will examine the QIS process and provide an overview of these crucial changes.
(Note: This is a very condensed version of the Pre-conference QIS Course)

3:00 to 4:30 p.m.

(6) Steps to Minimize Impact of Fiscal Intermediary Documentation Review

Josephine Cronin, RN, MBA, RAC-CT

This program will provide a review of the main elements reviewed by FI during an ADR review and identify for the audience the specific document requirements that the facility should have in place to comply with FI review. The audience will be provided with an overview of eligibility criteria, Physician Certifications, and therapy and nursing documentation requirements for skilled care. This program is a review of what needs to be in place to ensure that PPS reimbursement is accurate.

3:00 to 4:30 p.m.

(7) Legal Documentation

Donna Dalton, RN, C-NE, RAC-CT, Paralegal

Upon completion of this session, the learner will be able to identify:

Areas of documentation that cause the most concern for nursing staff in long-term care
How to read what the nurse is charting and understand that the words alone can be of concern
How to think better about language, attitude, use of abbreviations and other pitfalls of the written word
That litigation may take years and the nurses need to be proactive in their documentation in order to be able to remember what they wrote and why

3:00 to 4:30 p.m.

(8) MDS 3.0 Implementation Strategies: NOW is not too soon to begin!

Rena R. Shephard, MHA, RN, RAC-MT, C-NE

MDS 3.0 implementation will be upon us before we know it. As difficult as change can be, it doesn’t have to be traumatic. With a good understanding of the requirements, effective advance planning, and a facility-wide team spirit, rather than a dreaded challenge, this transition can take on a process improvement focus with better resident care and quality of life as the payoff. This session will explore changes in operational and clinical systems and processes that can help to pave the way to successful implementation. It also will highlight some of the key MDS 3.0 items that will require a new approach to completion.
(Note: This is a very condensed version of the Pre-conference MDS Course)

FRIDAY, October 23, 2009

8:00 to 9:30 a.m.

CMS Updates

Mary Pratt, MSN, RN; Sheila Lambowitz, MBA; and Peggy Williams, SW, MS

This program is intended to keep you up-to-date with an overview of the RAI/MDS activities under development at the Centers for Medicare and Medicaid. Participants will receive updated information on the status of the MDS 3.0 and implementation plans. Additional updates will be provided on RUGs IV, development of new quality measures, Value Based Purchasing (Pay for Performance), the Recovery Audit Contractor (RAC) Program, the Five Star Program and the Quality Indicator Survey (QIS).

10:00 to 11:30 a.m.

Legal Update

Fred Miles, Esq., JD and Carol Manteuffel, Esq.

This program will be an overview of national statutory, regulatory and legal case developments over the course of the last year that have impacted the long-term care facility environment. Highlights will include proposed legislation at the national level, a discussion of CMS initiatives regarding the five star rating system, special focus facilities and decisions of the DAB in federal enforcement appeals. Special attention will be given to new interpretative guides for several regulatory tags and trends in national survey deficiency findings. The program will be presented in an “interactive” format from both a legal and clinical perspective.

Breakouts
12:30 to 2:00 p.m.

(9) State Medicaid Nursing Home Pay for Performance...Status of State Programs

Christine Mueller, PhD, RN, BC, NEA-C, FAAN and Carol Job, RN, RAC-CT

Presenters will provide an overview of the current Pay for Performance Programs in several states. The program will cover development of the measures, data collection, validation of data and payment systems used in several states. The Minnesota Performance Incentive Program will be featured and will include the impact it has had on outcomes of care and best practices.

12:30 to 2:00 p.m.

(10) RUGS IV - Changes to Payment, Acuity and Facility Practice Patterns

Sheryl Buchholtz Rosenfield, RN, BC, RAC-MT

Dealing with the new payment categories under RUGs IV will change admission and care patterns. With the Medicare program requirements under the new payment system, staff needs to prepare for changes in payment. Understanding the cost of delivering care and benchmarking current facility practice to determine future care delivery will be discussed.

12:30 to 2:00 p.m.

(11) CMS Five Star Rating System, What You Really Need to Know

Andrew Porch

An Overview of the Five Star Rating System
How the Ratings Really Work
Rate the Rating System
What is Next for Five Star
How to Improve Your Rating
Andrew Porch

12:30 to 2:00 p.m.

(12) The War on the Sore: Strategies for Pressure Ulcer Management

Jennifer Pettis, RN, RAC-MT, C-NE and Sandy Biggi, BSN, SNT, RAC-MT, C-NE

The speakers will highlight the critical steps to follow when assessing your facility’s current skin management program, including a quality improvement process. They will define the pressure ulcer quality measures/quality indicators and the MDS coding pertinent to them and discuss strategies to prevent pressure ulcers by thoroughly assessing resident risk factors. Additionally, the speakers will discuss state-of-the-art management of pressure ulcers and offer the latest information from the National Pressure Advisory Panel’s updates.

2:30 to 4:00 p.m.

(13) MDS and Medicare – Billing and Reimbursement

Carol Maher, RN-BC, RAC-CT

This session will include instructions about the PPS windows, MDS assessments, timeframes for assessments, midnight rule, HMO to traditional Medicare, HIPPS assessment codes, OMRAs and Physician Certs and recerts. Medicare MDS schedules are often not well understood and can cause problems with billing. Learn the most up-to-date instructions on PPS MDS completion to avoid default rate and provider liability.

2:30 to 4:00 p.m.

(14) Five Steps to Successfully Reduce Rehospitalization Rates

Sheila Capitosti, RN-BC, NHA, MHSA

This session will focus on the use of evidence-based practice and an MDS-based hospitalization prediction model to predict resident risk for hospitalization. Best practice recommendations that will enable facility staff to effectively manage the care of these high-risk residents will also be discussed. The discussion will also address the need for resident and family education regarding advanced care planning to assist in reducing transfers of residents who are terminally ill or on a palliative care plan.

2:30 to 4:00 p.m.

(15) Pain Management and the Survey Process: Avoid Deficiencies and Achieve Great Outcomes

Rena Shephard, MHA, RN, RAC-MT, C-NE

Pain is something everybody knows about - from the tiniest baby plagued with colic to athletes, cancer victims, and the elderly with chronic problems – everyone knows how miserable pain can be. The effects of unrelieved pain take their toll on the individual in functional decline, complications of immobility, skin breakdown, and infections. It significantly affects a person’s qualify of life as well. But, despite everything that is known about pain, studies show that it is significantly undertreated in nursing homes. As a result, surveyors are taking a closer look at pain as a part of the overall survey process with the new guidance to surveyors updating the Quality of Care F-tag, F309. This session will review the new guidance and explore methods for improving pain management and reducing the risk of survey deficiencies in this Quality of Care area.

2:30 to 4:00 p.m.

(16) RUG IV is Here for Medicare

Carol Job, RN, RAC-CT

The Centers for Medicare and Medicaid Services (CMS) has just completed a time study analysis to update the current Resource Utilization Groups (RUG-III). Beginning October 1, 2009, CMS will require skilled nursing facilities to utilize the new RUG-IV classification system for Medicare. States utilizing the RUG-III classification system for Medicaid will not have to implement the new RUG IV system until they have had time to complete fiscal impact studies. This program will cover the pitfalls and pratfalls of implementing the new RUGs IV system.