Final Alabama Nursing Home Association Convention.pptNews and Announcements • Infection Control Updates in NH – CMS Webinar May 18, 2011 12:00 to 1:00 pm • ANHA Infection Control

Alabama Nursing Home

Association Convention

May 3, 2012

Mia Sadler, RN

Division of Healthcare Facilities

News and Announcements

• New surveyors

• Wykeshia Horne – recently appointed as

LTC supervisor in Jefferson County

• QA Director

News and Announcements

• Infection Control Updates in NH –

CMS Webinar May 18, 2011 12:00 to

1:00 pm

• ANHA Infection Control Seminar –• ANHA Infection Control Seminar –

June 19, 2012

MDS 3.0

• Changes to MDS 3.0 Form and

Manual

• Effective April 1, 2012

• www.cms.gov/Medicare/Quality-

Initiatives-Patient-Assessment-

Instruments/NursingHomeQualityInit

s/NHQIMDS30TrainingMaterials.html

MDS 3.0

• ADPH – Healthcare Facilities –

MDS page

–www.adph.org/HEALTHCARE

FACILITIES/Default.asp?id=55

05

DINING PRACTICE STANDARDS

Pioneer Network – Food and Dining

Clinical Standards Task Force -

August 2011August 2011

www.pioneernetwork.net/Data/Do

cuments/NewDiningPracticeStand

ardsfinal8-26-11.pdf

Link to Survey and Certification

Letters (S&C letters)

• http://www.cms.hhs.gov/Medicar

e/Provider-Enrollment-and-

Certification/SurveyCertificationGCertification/SurveyCertificationG

enInfo/Policy-and-Memos-to-

States-and-Regions.html

Independent Informal Dispute

Resolution (IIDR) Process

• Required by the Patient Protection Affordable

Care Act

• Interim advance guidance – S&C 12-08-NH

(superseded S&C 12-02)(superseded S&C 12-02)

• Applies only to surveys, begun after 01/01/12,

which results in deficiencies with a scope and

severity level of G or above for which CMS has

imposed a CMP and is subject to being placed

in escrow.


Resolution Process

• Letter from Dr. Geary dated April 10, 2012

included in the weekly round up notifying all

nursing home administrators that the

Alabama Department of Public Health’s policy Alabama Department of Public Health’s policy

was posted on the ADPH website:

– http://www.adph.org/healthcarefacilities/Default.

asp?id=688


Resolution Process

• The CMS RO will communicate the

offer of the IIDR to the facility.

• The facility must request an IIDR • The facility must request an IIDR

to the State Agency within 10

calendar days of receipt of the

offer.


Resolution Process

Within two working days of receipt

of the request the State Agency

will send a letter to the state and will send a letter to the state and

local ombudsman inviting them to

review the 2567 and provide

written comments.


Resolution Process

• If there is a “involved resident”

the State Agency will send a letter

to the resident or the “resident to the resident or the “resident

representative” describing the

noncompliance and providing

contact information for the state

survey.


Resolution Process

• The IIDR panel will provide a

written record of their

decision as soon as possible decision as soon as possible

but no later than ten calendar

days after completing the

review.


Resolution Process• Upon receipt of the IIDR’s

recommendations the SA will:

–If no changes are recommended –If no changes are recommended

and the SA agrees, the SA will

send the results to the facility

and the RO within 10 calendar

days.


Resolution Process

• If the SA agrees with IIDR

recommendations or has received a

final decision from the CMS RO and

changes need to the made to 2567, changes need to the made to 2567,

the SA will notify the facility and CMS

RO within 10 calendar days of

receiving the written record from the

IIDR.


Resolution Process

• If the SA disagrees with any of

the IIDR recommendations,

the complete written record the complete written record

will be sent to CMS for review

and final decision.


Resolution Process–No later than 10 calendar days the

RO will provide written notification

to the SA of the final decision. The

SA will send the final decision to the SA will send the final decision to the

facility within 10 calendar days of

receiving the final notification from

the RO.


Resolution Process

• IIDR must be completed within 60 days of

the a facility’s timely request.

CMS National Initiative to

Improve Behavioral Health and

Reduce the use of

Antipsychotics in Nursing Antipsychotics in Nursing

Home Residents with

Dementia

CMS Webcast March 29,2012

CMS Webcast March 29,2012

Improving Behavioral Health and Reducing

Use of Antipsychotic Medications

Source: MDS National Quality Indicator System

https://www.cms.gov/MDSPubQIandResRep/02_qmreport.asp?isSubmitted=qm3&group

=10&qtr=23

Improving Behavioral Health and Reducing

Use of Antipsychotic Medications

• High prevalence rates of antipsychotic drug use in

nursing home residents have been reported in

several studies. Much of the use is in residents with

a diagnosis of dementia .a diagnosis of dementia .

• According to CMS’s QM/QI report, between July and

September 2010, 39.4% of nursing home residents

nationwide who had cognitive impairment and

behavioral problems but no diagnosis of psychosis

or related conditions received antipsychotic drugs.

2005 FDA Black Box Warning

• In April 2005, the FDA issued a black box warning of

increased risk of death associated with use of

atypical (second-generation) antipsychotics in

elderly population with dementia.

• Of seventeen placebo controlled trials of olanzapine

(Zyprexa), aripiprazole (Abilify), risperidone (Zyprexa), aripiprazole (Abilify), risperidone

(Risperdal), or quetiapine (Seroquel) in elderly

demented patients with behavioral disorders,

fifteen showed increased risk of mortality in the

drug-treated group compared to the placebo-

treated patients.

2008 FDA Block Box Warning

• In 2008, FDA extended the black box warning to the

conventional (first-generation) antipsychotics.

– Elderly residents with dementia-related psychosis

treated with conventional or atypical

antipsychotic drugs are at increased risk of death.antipsychotic drugs are at increased risk of death.

– Antipsychotic drugs are not approved for the

treatment of dementia-related psychosis.

Healthcare professionals should consider other

management options.

2008 FDA Black Box Warning

• Physicians who prescribe antipsychotics to elderly

patients with dementia-related psychosis (“off-

label” use) should discuss this risk of increased

mortality with their patients, patient’s families, and

caregivers caregivers

Source: Information for Healthcare Professionals: Conventional

Antipsychotics FDA ALERT [6/16/2008]

http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformatio

nforpatientsandproviders/ucm124830.htm

National Initiative

• CMS is developing a national action plan to improve

dementia care and non-pharmacologic

interventions in nursing homes, hoping to reduce

unnecessary antipsychotic medication use in

nursing homes.nursing homes.

• Goal for the national initiative 15% reduction in the

prevalence rate by the end of CY2012 (from 20% to

17% or so)

How will the survey process support

this initiative? • Look to see that the facility is carrying out

certain processes (e.g., specific target

behaviors, goals of treatment, length of

anticipated time on the medication, how anticipated time on the medication, how

monitoring will be done)


this initiative?

• Require direct care staff and others to be

able to articulate, in surveyor interviews,

that person-centered care practices are

being usedbeing used

• Engage physicians, nurse practitioners

and other primary care providers, as well

as the medical director, in dialogue about

facility practices


this initiative?

Ensure that residents or families/legal

representatives have been engaged in the

decision-making process including being

informed about the risks and benefits of informed about the risks and benefits of

the medication, including the black box

warning, the rationale for use and target

behaviors .

THE MESSAGE

The message is NOT to take all residents with

dementia off antipsychotics.

The message is to do a better job of evaluating why

residents with dementia may be having the

behaviors and to try to improve the quality and the behaviors and to try to improve the quality and the

quantity of behavioral health interventions.

University of Iowa Website

www.healthcare.uiowa.edu/igec/IAADAPT

•University of Iowa College of Public Health worked

with the Iowa Health Care Association in developing

this website.

•Many resources on the website related to

antipsychotic drug resources

•Can request laminated copies of some of the

information

F329 Citations – FY2012

• National 6.0%

• Region 4.3%

• State 3.8%• State 3.8%

QAPI

• https://www.cms.gov/Medicare/Provider-

Enrollment-and-

Certification/SurveyCertificationGenInfo/QAPI.html

Final Alabama Nursing Home Association Convention.pptNews and Announcements • Infection Control Updates in NH – CMS Webinar May 18, 2011 12:00 to 1:00 pm • ANHA Infection Control

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