by Tim Gieseke MD, CMD

As you may be aware, Value Based Payments (VBPs) are an integral part of health care reform.  The current volume based fee for service payment system will have VBPs modifiers for each provider in the future tied to outcomes on specific measures developed by specialty societies and organizations such as the National Quality Forum.  These measures require computer EHRs that report meaningful use assessments which have become the norm this year in the acute hospital and office settings.

Meet the CALTCM Board of Directors

Frank Randolph, M.D., C.M.D.

Frank Randolph, M.D., C.M.D, completed residency training in Family Medicine in 1984 and fellowship training in Geriatric Medicine in 1985, maintaining continuous board certification in Family Medicine and Geriatric Medicine. He serves as Geriatric section chief at Arrowhead Regional Medical Center, teaching Family Medicine and Internal Medicine residents. He has been program director for two geriatric fellowship programs (UCI, ARMC). He has considerable experience as medical director and attending physician in skilled nursing facilities. A former President of the California Association of Long Term Care Medicine, he has been a member and board member since 1985. He has also been an AMDA member and certified medical director for over 25 years.

Interview with Dr. Randolph:

CALTCM: What is your training background, practice setting and how many years have you been in practice?

Dr. Randolph: Family med residency, geriatric fellowship, and 30 plus years of practice.

CALTCM:  What are you passionate about in long term care?  How are you pursuing your passion?

Dr. Randolph:  My interests have varied over time from primary care in the nursing home, RCFEs to medical
direction in SNF, home care, and hospice settings. Of late, I have been more interested in transitional care.

CALTCM:  What advice would you give to a new graduate contemplating a career in long term care?

Dr. Randolph:  That would depend upon the individual graduate’s background, attitude, and general goals.
If you truly want a career in LTC, the first step after a primary care residency would be a one year geriatric
fellowship at a program that is strong in the LTC area you desire.

CALTCM:  What additional training do you wish you had that may help with your current practice?

Dr. Randolph:  Evidence-based concepts related to care transitions to and from the various settings
such as acute hospital, home, nursing home.

CALTCM:  How has CALTCM impacted your practice?

Dr. Randolph:  Ideas derived from the experience of attending the seminars and interacting with members has
influenced the way I approach long term care as an attending, as a teacher, and as a medical director, in diverse
ways, from both business and clinical perspectives.

by Tim Gieseke, MD, CMD

Chair, CALTCM Education Committee

On August 1st, the CDPH sent out the attached ALF advising us of enhanced surveyor oversight for our use of antipsychotics.  In California, we have made significant progress in this area.  As a part of CMS region 9, we have reduced the frequency of antipsychotic use in our long stay residents (>100 days) to 16.7% (excludes schizophrenia, Huntington’s and Tourette’s).  We are the second best region in the country with Alaska #1.

Included in the "doc fix" passed in April 2014, H.R. 4302, the Protecting Access to Medicare Act of 2014 (PAMA), was a value-based purchasing (VBP) program for skilled nursing facilities (SNFs). PAMA establishes an incentive pool for high performing SNF's as it pertains to preventing unnecessary hospital readmissions. The Congressional Budget Office projects the program will save Medicare $2 billion over the next 10 years.