In this interview, we sit down with Real Time Medical Systems (Real Time) VP of Clinical Operations Cindy Kreider, RN,BC RAC-CT and Kathy Derleth, RN, BSN, Senior Clinical Account Manager, to discuss Getting Back to the Basics in 2023. Cindy and Kathy will address what SNFs can do in preparation for the new year, challenges they face in implementing these practices, and how data driven technologies can help prioritize care and improve patient outcomes.
Real Time: What does “Getting Back to the Basics” mean, specifically for SNFs?
Derleth: Maintaining nursing home regulations can overwhelm even the best equipped facility – and that task has become more daunting since the pandemic increased CMS oversight and fueled additional reporting requirements. To comply with CMS regulations and all of the updated Phase 3 Requirements of Participation (RoP) changes moving forward, operators must “Get Back to the Basics” in preparing for compliance surveys and to maintain their value to all stakeholders, especially patients.
Kreider: Within skilled nursing, “Getting Back to the Basics” is moving beyond COVID-19 and always keeping the patient at the center of decisions being made, while striving to improve quality of care. Additionally, implementing new staffing strategies for the best operational performance and recognizing that value-based care (VBC) providers are growing exponentially and will require efficiencies in SNF operations. Utilizing interventional analytics and software solutions can assist in narrowing the gap, driving improved care and operational outcomes. Getting back to the basic assessments and utilizing solutions to streamline workload, is essential for SNFs success.
Real Time: What can SNFs do to “Get Back to the Basics” in preparation for 2023?
Kreider: Long-term care (LTC) has changed dramatically over the last few years and is a key player in the healthcare continuum. While disrupting all aspects of life around the world, the COVID-19 pandemic had an enormous, disproportionately impact on the LTC delivery system in this country. But as care providers, we understand that there is more to focus on than just COVID-19. The return of the Phase 3 RoP changes brings patient care forward and quality of life back into focus. Refreshing and revisiting all areas of care is important.
Interactive medical care is now being seen across all continuums with payer driven care standards. When systems lack real-time communication, providers and payers are limited in their ability to collaborate. With the utilization of technology, facilities will be able to support interactive care seamlessly and share data with their partners. Therefore, now is the time for sharing data, care standards, and interventional strategies. Implementing live data analytics technologies that can mine the data within the facilities EHR, in real-time, enabling nursing facility providers to optimize their performance and improve care outcomes in collaboration with their hospital and payer partners. Care provider’s time can then be spent focused on early patient intervention versus spending significant time collecting data.
With no additional work needed by staff, skilled nursing operators can leverage live post-acute analytics and pull directly from their electronic health records (EHRs). This data can assist in meeting state and federal requirements, prepare for regulatory reporting and onsite surveys, conduct infection surveillance, and mitigate risk.
Real Time: What are some challenges SNFs face in implementing “Getting Back to the Basics” practices?
Kreider: There are numerous challenges faced by SNFs including staffing barriers and time spent combing through the patient records within the EHR for necessary information. In addition to the voluminous number of Federal and State regulations that SNF’s are bound by, the healthcare industry has a significant staff turnover rate at many levels of their organization, including those in leadership positions, that are new to LTC requiring additional education and training. It is pivotal to understand the current state that is facing our healthcare delivery systems. There is little room or margin for error in current times. Care providers must deliver the best quality care, meet care expectations, and adhere to the vast number of regulatory requirements.
Furthermore, with a continued push towards VBC – a system of care delivery where the primary financial reward is tied to improving patient outcomes, measured against the cost of care – it will drive SNFs to change standard practices and force review of their current care structure. This means facilities will need to better collaborate with their healthcare partners around shared goals and risk.
Derleth: There are a few key principles to keep at the forefront as SNFs “Get Back to the Basics.” Firstly, within our structure, we must communicate. Successful leaders communicate the “what” and the “why.” Leaders who explain the purpose of the change and connect it to the organization’s values or explain the benefits, create stronger buy-in and urgency for the change. Secondly, our clinical framework has to include collaboration. It is essential to work across boundaries, encourage employees to break out of their silos, and refuse to tolerate unhealthy competition. It’s important to also include employees in decision-making early on, strengthening their commitment to change. Lastly, we must commit to expected success outcomes. Change is difficult, but leaders who negotiate it successfully are resilient and persistent, and willing to step outside their comfort zone.
Real Time: What are some ways to overcome these challenges?
Derleth: Understanding acuity levels and care requirements in the facility and utilizing technology to collect the data to provide an analysis to prioritize care is one way to overcome barriers. Having a clinical meeting is also a must as it is the anchor for most basic clinical care systems. If the clinical meeting is completed every day (even on the weekend), care providers will have line of sight into a current patient’s status allowing for early interventions and the most comprehensive approach for care. Advanced EHR technology brought predictive analytics (restrictive algorithms, standard baseline data and early standards of care), but now we are learning the difference between predictive analytics and interventional analytics. Being able to access a patient’s chart and receive real-time data metrics with suggested interventions is a game changer.
With interventional analytics, such as Real Time, programs can sift through vast amounts of live structured and unstructured data. Receiving instant alerts – inclusive of suggested interventions – care teams will be notified when a subtle change in condition occurs. By prioritizing these changes and implementing care treatments or interventions, providers can alter the patient’s course of illness. Additionally, clinical meetings can help in identifying and stratifying risk, and directing care based on the risk with the outcome of improved and timely patient centered care.
Real Time: What are some ways Real Time can help?
Derleth: At a time when staff turnover is often inevitable, using a data analytics solution with the ability to provide information without any additional work, will be the key to getting back to nursing care beyond COVID-19. It’s about being able to assess a patient’s clinical need and target the correct intervention to the right patient, at the right time, regardless of what that is. With over 900 tags of deficiency potential, care providers are not always going to be able to keep it together. By having technology in place to institute and analyze basic data and processes will be critical to success.
Kreider: With nurses at a minimum these days, it is vital to equip them with patient centric data and risk assessments to prioritize and maximize patient care. A well-managed and efficient clinical meeting is multi-disciplined, maintains a focused review of key patient data, allows for early intervention for the patient to mitigate risk and improve outcomes and is best performed within the patients desires and goals for care. It is a communication meeting that sets the course of care for the patient, family, and staff. This is where the Real Time Interventional Analytics solution is a game changer.
Having an analytics solution that can apply standards of care, monitor risk, identify subtle change, and provide early detection of infectious disease is critical to improved patient outcomes. The right solution can scan hundreds of structured and non-structured pieces of medical records and prioritize the most urgent patients. It is Interventional Analytics, providing suggested interventions for the clinical staff and its ability to identify change on the patient’s normal baselines versus industry standards.
Real Time: In your own words, what will Skilled Nursing look like in 2023?
Kreider: The challenges related to staffing may continue, but I am hopeful that facilities will continue to focus on strategies that will improve efficiencies for their staff and help streamline their workload, in an effort to positively impact care outcomes to our most vulnerable population. The significant changes with reimbursement and MDS will continue to be a force to be reckoned with in 2023 and these changes will surely be time consuming. Nursing homes are facing ongoing tough times post COVID-19, staff shortages, declining census, and new and highly demanding regulatory requirements. Getting back to the basic processes and systems by utilizing analytical tools to help achieve outcomes while reducing the burden on staff is key.
Derleth: Skilled nursing has been forced to make swift and varying policy changes through the last 2-3 years. With the RoP Phase 3 regulations being revisited, that hasn’t changed. LTC workers are resilient, I am hopeful that we have learned that ensuring a Back to the Basics approach secures our foundational systems of care, prioritizes patient centered care, and enables regulatory compliance that is easier to achieve and maintain. Implementing these basic systems gives providers a chance to remain viable and thriving within the patient continuum.
To learn more about Real Time’s interventional analytics solution, contact us today.