by Tim Gieseke MD, CMD

On July 8th, the California Senate Select Committee on Aging and Long-Term Care will meet in Glendale California to hear from experts like our own Dr. Cheryl Phillips (now Senior VP of Leading Age). They will hear about the anticipated demographic changes in our state with the doubling of those living over 65 y/o between 2010 and 2030. This group will become much more culturally diverse with significant increases in the Latino and Asian communities. Almost 70% of this population will require LTC for some of those years. The current LTC system is complex with gaps in services and problems with care coordination.

by Robert M. Gibson, Ph.D., J.D., Rebecca Ferrini, MD, CMD, MPH

Ms. A has no friends and family to speak for her, had advanced dementia and is bedbound. She is unable to speak, but can nod.  Who signs her into your facility? What is her Code Status?

Ms. B has dementia and a conservator, her sister who lives out of state.  Who signs her in? Who manages her money? Who signs consent forms for psychotropic medications?

Mr. X signed himself into the facility a few years ago, but he is declined a lot now. You want to start him on an SSRI but he really cannot understand what you are saying. Who can sign for him?

by Tim Gieseke, MD, CMD

At this year’s annual CALTCM meeting Jennifer Wieckowski of HSAG (Health Services Advisory Group) presented the most recent data on California Hospital 30 day Readmissions.  This October 1, COPD will be added to the penalty list for readmissions with maximum penalty going up to 3%.  In addition, MedPAC (Medicare Payment Advisory Commission) has recommended penalizing SNFs with high admission rates with payment reductions up to 3% as of 2017.  To avoid these penalties facilities will need to focus on patient centered care that improves care transitions upstream and downstream.  One tool being used in my community is the “My COPD Care Plan” tool from the American Lung Association (see attachment).

by Timothy Gieseke MD, CMD

Several months ago, the OIG (Office of Inspector General) released a historic report on Adverse Events in SNF post-acute care patients (https://oig.hhs.gov/oei/reports/oei-06-11-00370.pdf ).

I believe this was a historic moment for several reasons.  The study was done with the assistance of AMDA - The Society for Post-Acute and Long-Term Care Medicine (formerly known as the American Medical Directors Association), using AMDA’s Clinical Practice Guidelines (CPGs) to set care expectations and to educate the investigators on this setting of care.  In addition, several well-known members of AMDA including Past President James E. Lett II MD, CMD, assisted in the development of a new SNF Trigger Tool used to identify cases for physician review.  These AMDA consultants partnered with the OIG to review select cases, define levels of harm and the types of injury, and to determine whether the injury was preventable.