AMDA Long Term Care Medicine - 2014

Feb 27, 2014 ‐ Mar 2, 2014


The information provided in this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
 

Contact Information: For questions about this CME activity contact AMDA’s Education Department at 410-740-9743 or at education@amda.com

Instructions for Course Participation
  • Click on the session title to review the materials on Terms of Use and Disclaimer statements, accreditation information, target audience, learning objectives, and disclosure information
  • Complete the entire self-study activity (viewing the PowerPoint presentation and listen to the audio recording in its entirety)
  • Complete and submit the evaluation/post-test and CME claim form. You must earn a minimum 80% correct answers to claim credit. You may repeat the post-test until you receive the passing score at no additional fee.
  • Print out CME certificate
  • The online library awards credits for sessions ranging from 1 to 3.5 hours. Each activity should take you approximately the number of hours to complete as credits which are awarded for that activity, (e.g. for 1.5 credit hours awarded, the completion of the activity should take approximately 1.5 hours to complete.)

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Sponsored by the American Medical Directors Association (AMDA)

Release Date: 06/2014    Valid Through: 06/30/2017

Click here for a list of Management and Clinical credit designations.

Accreditation
AMDA – The Society for Post-Acute and Long-Term Care Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
AMDA – The Society for Post-Acute and Long-Term Care Medicine designates this enduring material for a maximum of 94 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDA Certification Program (AMDCP) Credit Designation
This seminar has been approved for a total of 95.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD). 72.5 credits have been designated as Management education credits and 23 hours have been designated as Clinical education credits. The AMDA CMD program is administered by the American Medical Directors Certification Program. Each physician should claim only those hours of credit actually spent on the activity.

ACCME STANDARDS FOR COMMERCIAL SUPPORT
As an ACCME accredited provider of CME, AMDA adheres to all elements of the ACCME Standards for Commercial Support. Individuals in a position to control the content of this education activity were required to disclose all relevant financial relationships with any commercial interest to AMDA. Disclosures were reviewed by the AMDA Education Department to identify any conflicts of interest and methods of conflict resolution were conducted for each of the identified conflicts. Individual presenter’s disclosures can be found within the CME information for each session.
 
PROGRAM PLANNING

AMDA wishes to gratefully acknowledge the Program Planning Committee for their dedication to AMDA education and Long Term Care Medicine - 2014.


Suzanne Gillespie, MD (2014 Program Chair)
Thomas Edmondson, MD, CMD (Vice Chair)
Heidi K. White, MD, CMD (2014 Program Chair)
Patricia Bach, PsyD, RN
Michele F. Bellantoni, MD, CMD
Erin Brooks, RPA-C
Amy M. Corcoran, MD, CMD
Suzanne C. Cryst, RD, CSG, LD
Mary P. Evans, MD, CMD
Ralf Habermann, MD, MMHC
Melinda Henderson, MD, CMD
Keith Krein, MD, CMD
Dheeraj Mahajan, MD, CMD
Patrick J. Murphy, MD, CMD
Lindsey Neal, MD
Meenakshi Patel, MD, CMD
James S. Powers, MD, CMD
Kenneth Scott, DO
Verna Reynolds Sellers, MD, MPH, CMD
Ronald Shumacher, MD, CMD
Dennis Stone, MD, MBA
James Thomason, NHA
 
Program Committee members with relevant financial relationships are listed below. All other Planning Committee members have reported they have no relevant financial relationships to disclose.

Planning Committee Member Disclosures
According to AMDA and ACCME policy, all those in a position to control content are required to disclose any relevant financial relationships. Program Committee members with relevant financial relationships are listed below. All other Planning Committee members have reported they have no relevant financial relationships to disclose.

Mary P. Evans, MD, CMD – Golden Living: Corporate Medical Director; Ralf Habermann, MD, MMHC – American Health Companies: Board Member; Melinda Henderson, MD, CMD – United Healthcare: Employee; Keith Krien, MD, CMD – Kindred Haelthcare: Employee, Consultant; Meenakshi Patel, MD, CMD – Grants-Research: Avanir, Cubist, Duke, Eisai, Eli Lilly, Forest, GSK, Merck; Speaker: Novartis, Sanofi, BI, Forest, Avanir, Pfizer, Eisai; Pharmacy & Therapeutics Committee: Omnicare; James S. Powers, MD, CMD – Health Spring: Pharmacy Nursing Committee Member; Kenneth Scott, DO – Life Care Centers of America: Corporate Medical Director; Ronald Shumacher, MD, CMD – Employee: Optum.

Faculty disclosure information is provided with the individual session information for each session on the CME information page.

Target Audience:
Medical Directors, Attending Physicians, Nurses (NP, DON, RN, CNA), Administrators, Consultant Pharmacists, Therapists

Standard: $395.00

Sessions

Developing the Skills for Quality Assurance Performance Improvement (QAPI) in Long-Term Care

Feb 27, 2014 8:00am ‐ Feb 27, 2014 5:00pm

Identification: 102

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this Internet Enduring Material for a maximum of 7.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 7.0 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
Looking forward, a major challenge facing nursing homes is implementing Quality Assurance and Performance Improvement (QAPI) programs. The recently mandated QAPI activities significantly expands the level and scope of facility quality improvement activities, mandating adoption of advanced, systematic data-driven quality improvement methodologies to sustain and improve the quality of care and quality of life of nursing home residents (CMS, 2013). Nursing homes are now working to build the training and infrastructures needed to implement effective QAPI programs. The Centers for Medicare & Medicaid Services (CMS) has identified five key elements for QAPI programs: 1) design and scope, 2) governance and leadership, 3) feedback, data systems and monitoring, 4) performance improvement projects (PIPs), and 5) systematic analysis and systematic action. This session will be structured around those elements and equip nursing home leaders with core skills for designing their own QAPI programs and developing QAPI skills in their interdisciplinary teams with an emphasis on the knowledge and skills needed to use a systematic approach to analyze, initiate, implement, and monitor performance improvement projects. Key skills include problem identification, flow diagraming, data collection and trending data, root cause analysis and monitoring. Participants will learn from brief didactic introductions to skills and small group case studies that apply those skills.

Learning Objective(s):

  • Perform an in-depth evaluation of current data analysis processes and how they can be improved to improve the quality of care in your nursing home.
  • Describe variation as a component in improving performance through statistical thinking.
  • Distinguish the difference between process-oriented thinking (Quality Improvement) vs. results oriented thinking (Quality Assurance)
  • Utilize run charts and control charts to analyze data in your nursing home.


Speaker(s):
Suzanne M. Gillespie, MD, RD, CMD; Tobie Olsan, PhD, RN; Karyn P. Leible, MD, CMD; Dallas Nelson, MD, CMD; Jane Carol Pederson, MD, MS

Disclosure(s):
None

Reference(s):
Centers for Medicare and Medicaid Services. QAPI at a Glance: A Step by Step Guide to Implementing Quality Assurance and Performance Improvement (QAPI) in Your Nursing Home. Accessed July 15, 2013. From .http://cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/QAPIAtaGlance.pdf Institute of Medicine, ed Health professions education: A bridge to quality. Wasington, DC: National Academy Press; 2003.

Speaker(s):
Standard: $24.00

Teaching Medical and Interprofessional Learners in the Nursing Home: Overcoming Barriers and Changing Attitudes (AMDA Foundation Sponsored Session) - CME/CMD credits are not available for this session

Feb 27, 2014 8:00am ‐ Feb 27, 2014 5:00pm

Identification: 101

Session Description:
Teaching medical students, resident physicians, geriatric medicine fellows, and interprofessional learners in the nursing home setting can be a rewarding experience for the learners, the supervising attending and patients. In fact, such experiences are critical to the future of geriatric medicine and the quality of our long-term care health system. Unfortunately, it can become a negative experience when attempting to navigate the ever-changing Medicare rules, residency training regulations and academic political landscape, while still maintaining high quality patient care. This full-day workshop will include an important review of core competencies, training requirements, and proper documentation to ensure LCME/ACGME and Medicare obligations are met. Providing constructive feedback to learners is a core skill that even seasoned instructors struggle to do well. From novice to expert, we can all benefit from learning how to do this better. In the afternoon, participants will have the opportunity to work in small groups choosing two of four breakout sessions that will allow each attendee to take home new content and instructional strategies that can be adapted to their teaching situation.

Learning Objective(s):

  • Review the US experience with teaching nursing homes, including the implications for meeting core competencies, primary care training requirements, and ACGME requirements.
  • Delineate and practice practical ways to improve feedback for learners.
  • Discuss practical content and innovative educational strategies for teaching long term medicine and interprofessional care in the nursing home setting.
  • Enhance communication with patients, families, and caregivers regarding goals of care and advanced care planning.


Speaker(s):
Mercedes Bern-Klug, PhD, MSW; Gwendolen Buhr, MD, MHS, MEd, CMD; Manuel A. Eskildsen, MD, MPH, CMD, AGSF; Paul Katz, MD, CMD; Milta Little, DO, CMD; Sid Feldman, MD; Sandro O. Pinheiro, PhD, MA, MRE; Daniel L. Swagerty, MD, MPH, CMD; Aida Wen, MD, CMD

Disclosure(s):
None

Reference(s):
Merriam, SB, et al. Learning in adulthood: a comprehensive guide. 3rd ed 2007.Janicik, RW. Fletcher, KE. Med Teach 2003; 25 (2): 127-30. Jones AL, et al. Vital Health Stat 2009;13(167):1–1552. Blumenthal D, et al. JAMA 2001;286(9):1027–34.3.Association of American Medical Colleges. 2010 GQ Medical school graduation questionnaire all schools summary report. Accessed October 19, 2010Katz PR, et al. Clinics in Geriatric Medicine 11: 503-516, 1995Buhr, GT. Paniagua, MA. Clin Geriatr Med 27 (2011) 199-211

Speaker(s):
Standard: $24.00

Innovations in Care Delivery: Practical Lessons Learned from the Center for Medicare and Medicaid Innovation (CMMI) Projects on Reducing Unnecessary Hospitalizations in the Nursing Home

Feb 27, 2014 8:00am ‐ Feb 27, 2014 11:30am

Identification: 103

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates thisInternet Enduring Material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 3.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This session will review the facilitators and barriers encountered in reducing unnecessary hospitalizations learned from the Center for Medicare & Medicaid Innovation (CMMI) Enhanced Care and Coordination Provider (ECCP) Projects. Four of the seven national project medical directors will discuss how their experience in implementing their projects strategies (including staff education, utilization of tools and systems, physician engagement, early change in condition identification, and technology) can be utilized by the practicing medical director and attending physician to improve the quality and transitions of care of residents. Medical directors and practitioners working with facilities to develop and implement the new Quality Assurance and Performance Improvement (QAPI) requirements should find “practical pearls” to use in their own practice.

Learning Objective(s):

  • Review the healthcare reform and the impact on traditional organization and level of care relationships.
  • Describe a model for partnering with a focus on quality outcomes, transparency and successful transition of clinical care.
  • Use facilitated breakout sessions to review the infrastructure guides and tools and begin to create your own Joint Quality Committee.
  • Share the “foundational” components that will generate meaningful dialog between the partnering organizations.

Speaker(s):
Charles A. Crecelius, MD, PhD, CMD; Clare I. Hays, MD, CMD; Arif Nazir, MD, CMD; Steven Phillips, MD

Disclosure(s):
None

Reference(s):
Alexander, G. L. (2008a). Analysis of an integrated clinical decision support system in nursing home clinical information systems. Journal of Gerontological Nursing, 34(2), 15-20.Alexander, G. L. (2008b). A state profile of IT sophistication in nursing homes. Washington DC: American Medical Informatics Association, 1-6.Alexander, G. L., & Madsen, R. (2009a). IT sophistication and quality measures in nursing homes. Journal of Gerontological Nursing, 35(7), 22-27.Alexander, G. L., & Staggers N. (2009b). A systematic review on the designs of clinical technology: Findings and recommendations for future research. Advances in Nursing Science, 32(3), 252-279.Alexander, G. L., Madsen, R, Herrick, S., & Russell, B. (2008c). Measuring IT sophistication in nursing homes. Rockville, MD: Agency for Healthcare Research and Quality. Report No.: 08-0034-CD.Alexander, G. L., Madsen, R., & Wakefield, D. (2010). A regional assessment of information technology sophistication in Missouri Nursing Homes. Policy, Politics, & Nursing Practice 11(3), 214-225.Alexander, G. L., Rantz, M., Skubic, M., Koopman, R. J., Phillips, L. J., Guevara, R. D., & Miller, S. J. (2011a). Evolution of an early illness warning system to monitor frail elders in independent living. Journal of Healthcare Engineering, 2(3) 337-363.Alexander, G. L., Rantz, M. J., Flesner, M. K., Diekemper, M., & Siem C. (2007). Clinical information systems in nursing homes: An evaluation of initial implementation strategies. CIN: Computers, Informatics, Nursing, 25(4), 189-197.Alexander, G. L., Wakefield, B. J., Rantz, M., Skubic, M., Aud, M., Erdelez, S., & Al Ghenaimi, S. (2011b). Passive sensor technology interface to assess elder activity in independent living. Nursing Research, 60(5), 318-325.Alexander, G. L., & Wakefield, D. S. (2009c). Information technology sophistication in nursing homes. Journal of the American Medical Directors Association, 10(6), 398-407.Castle, N. G., & Mor, V. (1996). Resident transfers from nursing homes to hospitals: Areview of the literature 1980-1995. Medical Care Research and Review, 53(2), 123-148.Centers for Medicare and Medicaid Services. (2011). Medicare Hospital Quality Chartbook. Downloaded 5/21/2012 from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/HospitalChartBook2011.pdf.Creditor, M. C. (1993). Hazards of hospitalization of the elderly. Annals of Internal Medicine, 118(3), 219-223.Culler, S. D., Parchman, M. L. & Przybylski, M. (1998). Factors related to potentially preventable hospitalizations among the elderly. Medical Care, 36(6), 804-817.Galambos, C., Skubic, M., Wang., M., Rantz, M., (In press,2012). Using density map visualization for early detection and management of dementia and depression, Gerontechnology, 11(2).Gillick, M., & Steel, K. (1983). Referrals from long-term care to acute facilities. Journal of the American Geriatric Society, 31, 74.Goodman, D. C., Fisher, E. S., & Chang, C. (2011). After hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries. Downloaded 5/11/12 http://www.dartmouthatlas.org/data/topic/topic.aspx?cat=30Grabowski, D. C., O’Malley, A.J., & Barhydt, N.R. (2007) The costs and potential savings associated with nursing home hospitalizations. Health Affairs, 26(6), 1753-1761. Grabowski, D. C., Stewart, K.A., Broderick, S.M. & Coots, L.A. (2008) Predictors of nursing home hospitalizations: A review of the literature. Medical Care Research and Review, 65(1), 3-39.Hicks, L. L., Rantz, M. J., Petroski, G.F., Madsen, R.W., Conn, V.S., Mehr, D., & Porter, R. (1997). Assessing contributors to cost of care in nursing homes. Nursing Economics, 15(4), 205-212. *Hicks, L. L., Rantz, M.J., Petroski, G.F., & Mukamel, D.B. (2004). Nursing home costs and quality of care outcomes. Nursing Economics, 224, 178-192.*Intrator, O., Zinn, J. & Mor, V. (2004). Nursing home characteristics and potentially preventable hospitalizations of long-stay residents. Journal of the American Geriatrics Society, 52(10), 1730-1736.Kane, R. L., Keckhafer, G., Flood, S., Berhadsky, B. & Siadaty, M. S. (2003). The effects of Evercare on hospital use. Journal of American Geriatric Society, 51(10), 1427-1434.Loeb, M., Carusone, S. C., Goeree, R., Walter, S. D., Brazil, K., Hrueger, P., Simor, A., Moss, L. & Marrie, T. (2006). Effect of a clinical pathway to reduce hospitalization in nursing home residents with pneumonia. Journal of American Medical Association, 295(21), 2503-2510.Maslow, K., & Ouslander, J. G. (2012). Measurement of Potentially Preventable Hospitalizations. White Paper prepared for the Long Term Quality Alliance.Mezey, M., Fulmer, T., Burl, J. B., Bonner, A., Rao, M. & Khan, A. M. (1998). Geriatric Nurse Practitioners in long-term care: Demonstration of effectiveness in managed care. Journal of the American Geriatrics Society, 46(4), 506-10.Ouslander, J. G., Lamb, G., Perloe, M., Givens, J. H., Kluge, L., Rutland, T., Atherly, A. & Saliba, D. (2010). Potentially avoidable hospitalizations of nursing home residents: Frequency, causes, and costs. Journal of the American Geriatric Society, 58(4), 627-635.Ouslander, J. G., Lamb, G., Tappen, R., Herndon, L., Diaz, S., Roos, B. A., Grabowski, D. C. & Bonner, A. (2011). Interventions to reduce hospitalizations from nursing homes: Evaluation of the INTERACT II collaborative quality improvement project. Journal of the American Geriatrics Society, 59(4), 745-753.Ouslander, J. G., Weinberg, A. D., & Phillips, V. (2000). Inappropriate hospitalization of nursing facility residents: a symptom of a sick system of care for frail older people. Journal of the American Geriatrics Society, 48(2), 154-163.Popejoy, L. L., Rantz, M. J., Conn, V., Wipke-Tevis, D., Grando, V., & Porter, R. (2000). Improving quality of care in nursing facilities: The gerontological clinical nurse specialist as research nurse consultant. Journal of Gerontological Nursing, 26(4), 6-13.Popescu, M., Chronis, G., Ohol, R., Skubic, M., & Rantz, M. (2011). An eldercare electronic health record system for predictive health assessment. Submitted to Proceedingsof the 13th IEEE International Conference on e-health Networking, Application, & Services, Columbia, MO, June 13-15, 2011 pp. 193-196.Rantz, M. J., Alexander, G., Galambos, C., Flesner, M. K., Vogelsmeier, A., Hicks, L., Scott-Cawiezell, J., Zwygart-Stauffacher, M., & Greenwald, L. (2011a). The use of bedside electronic medical record (EMR) to improve quality of care in nursing facilities: A qualitative analysis. Computer, Informatics, Nursing, 29(3), 149-156.* PMID: 20975545.Rantz, M. J., Cheshire, D., Flesner, M., Petroski, G. F., Hicks, L., Alexander, G., Aud, M. A., Siem, C., Nguyen, K., Boland, C., & Thomas, S. (2009). Helping nursing homes "at risk" for quality problems: A statewide evaluation. Geriatric Nursing, 30(4), 238-249.Rantz, M. J., Flesner, M. K., & Zwygart-Stauffacher, M. (2010a). Improving care in nursing homes using quality measures/indicators and complexity science. Journal of Nursing Care Quality, 25(1), 369–376.* PMCID: PMC3254212.Rantz, M. J., Grando, V., Conn, V. S., Zwygart-Stauffacher, M., Hicks, L., Flesner, M., Scott, J., Manion, P., Minner, D., Porter, R., & Mass, M. (2003a). Getting the basics right: Critical processes of care delivery in nursing homes that achieve good resident outcomes. Journal of Gerontological Nursing, 29(11), 15-25.*Rantz, M. J., Hicks, L., Grando, V. T., Petroski, G. F., Madsen, R. W., Mehr, D. R., Conn, V., Zwygart-Stauffacher, M., Scott, J., Flesner, M., Bostick, J., Porter, R., & Maas, M. (2004). Nursing home quality, cost, staffing, and staff-mix. The Gerontologist, 44(1), 24-38.* PMID: 14978318.Rantz, M. J., Hicks, L., Petroski, G. F., Madsen, R. W., Alexander, G., Galambos, C., Conn, V., Scott-Cawiezell, J., Zwygart-Stauffacher, M., & Greenwald, L. (2010b). Cost, staffing, and quality impact of bedside Electronic Medical Record (EMR) in nursing homes. Journal of the American Medical Directors Association, 11(7), 485-493.* PMID: 20816336.Rantz, M. J., Popejoy, L., Petroski, G. F., Madsen, R. W., Mehr, D. R., Zwygart-Stauffacher, M., Hicks, L. L., Grando, V., Wipke-Tevis, D. D., Bostick, J., Porter, R., Conn, V. S., & Maas, M. (2001). Randomized clinical trial of a quality improvement intervention in nursing homes. The Gerontologist, 41(4), 525-538.Rantz, M. J., Skubic, M., Alexander, G. L., et al. (2010c). Developing a comprehensive electronic health record to enhance nursing care coordination, use of technology, and research. Journal of Gerontological Nursing, 36(1), 13-27.Rantz, M. J., Skubic, M., Alexander, G. L., et al. (2010d). Improving nurse care coordination with technology. Computers Informatics Nursing, 28(6), 325-332.Rantz, M. J., Skubic, M., Koopman, R. J., Alexander, G., Phillips, L., Musterman, K. I., Back, J. R., Aud, M. A., Galambos, C., Guevara, R. D., & Miller, S. J. (2012a) Automated technology to speed recognition of signs of illness in older adults. Journal of Gerontological Nursing, 38(4) 18-23.Rantz, M. J., Skubic, M., Koopman, R., Phillips, L., Alexander, G. L., & Miller, S. J. (2011b). Using sensor networks to detect urinary tract infections in older adults. Submitted to Proceedings of the 13th IEEE International Conference on e- Health Networking Application and Services, Columbia, MO, June 13-15, 2011, pp. 142-149.Rantz, M. J., Vogelsmeier, A., Manion, P., Minner, D., Markway, B., Conn, V., Aud, M. A., & Mehr, D. R. (2003b). A statewide strategy to improve quality of care in nursing facilities. The Gerontologist, 43(2), 248-258.Rantz, M. J., Zwygart-Stauffacher, M., Hicks, L., Mehr, D., Flesner, M., Petroski, G. F., Madsen, R. W., & Scott-Cawiezell, J. (2012b). Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvement. Journal of the American Medical Directors Association, 13(1), 60-68.* PMCID: In Process.Rantz, M. J., Zwygart-Stauffacher, M., Popejoy, L., Mehr, D. R., Grando, V. T., Wipke-Tevis, D. D., Hicks, L. L., Conn, V. S., Porter, R. & Maas, M. (1999). The minimum data set: No longer just for clinical assessment. Annals of Long-Term Care, 7(9), 354-360.Resnick, H. E., Manard, B. B., Stone, R. I., & Alwan, M. (2009). Use of electronic information systems in nursing homes: United States, 2004. Journal of the American Medical Informatics Association, 16, 179-186.Simons, K., Connolly, R., Bonifas, R., Allen, P., Bailey, K., Downes, D., & Galambos, C. (2012). Psychosocial assessment of nursing home residents via MDS 3.0: Recommendations for Social Service training, staffing, and roles in interdisciplinary care. JAMDA, 13, 190.e9-190.e15.Stone, S., Loesch, P., Hernandez, B., Hubbell, Sweet, C., & Muntner, D. (2010). Sustaining provider engagement in care transitions: Community Collaborative Action. The Remington Report.Tague, N. R. (2005). The Quality Toolbox, 2nd Ed. Milwaukee, WI: ASQ Quality Press.Trisch, D. D., Simpson, W. M., & Burton, J. R. (1985). Relationship of long-term and acute-care facilities: The problem of patient transfer and continuity of care. Journal of Geriatric Society, 33, 819.Zhang, N. J., Gammonley, D., Paek, S. C., Frahm K. (2008). Facility service environments, staffing, and psychosocial care in nursing homes. Health Care Financing Review, 30, 5-17.Zimmerman, J., & Dabelko, HI. (2007). Collaborative models of patient care: New opportunities for hospital social workers. Social Work in Health Care, 44(4), 33-47.

Speaker(s):
Standard: $24.00

Palliative Care Part I: Clinical and Ethical Considerations

Feb 27, 2014 8:00am ‐ Feb 27, 2014 11:30am

Identification: 104

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this Internet Enduring Material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 3.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This session will present an overview of practical approaches to communication, advance care planning, and assessment and control of pain and other distressing symptoms experienced by patients in long-term care (LTC). Presenters will emphasize audience participation using case-based discussions. To allow for discussion, presenters will post on www.prolibraries.com/amda the core information required to ‘solve’ the cases prior to the session. Self-study of these materials prior to the sessions is recommended, but is not a prerequisite for attendance.

In addition, the presenters are seeking questions, ethical dilemmas, organizational or cultural challenges related to hospice and palliative care in LTC from the audience and will adapt the session according to attendee input. Attendees should submit their question or difficult clinical, ethical or organizational case to AMDA at llang@amda.com by January 3, 2014. Although questions will be confidential, please do not include information that could identify your patients, providers or facilities.

Learning Objective(s):

  • Use the Medicare Carriers Manual as a reference source for defining payment parameters.
  • Explain the concept of medical necessity as it relates to reimbursement.
  • Delineate and apply evaluation and management codes for long term care for physicians and other providers.

Speaker(s):
William D. Smucker, MD, CMD; Amy M. Corcoran, MD, CMD; Peter Winn, MD, CMD

Disclosure(s):
None

Reference(s):
These presentations are all based on the AMDA Palliative Care Curriculum, the AMDA Palliative Care Toolkit, the AMDA Pain CPG, best practice documents produced by national hospice and geriatric organizations and relevant updates to the literature.

Speaker(s):
Standard: $24.00

Everything You Wanted to Know about Billing and Coding in Long-Term Care

Feb 27, 2014 8:00am ‐ Feb 27, 2014 11:30am

Identification: 105

Accreditation
AMDA - The Society for Post-Acute and Long-Term Care Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
AMDA - The Society for Post-Acute and Long-Term Care Medicine designates this Internet Enduring Material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 3.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This session provides a review of the most recent payment policies, including Current Procedural Technology (CPT™) changes relevant to nursing home services, and discusses lessons learned in their use. Procedural codes, codes with modifiers, coding for care by nurse practitioners, and day-of-death codes are discussed in-depth. Instruction includes case-studies and vignettes as examples and participants are led through a process of determining codes based on modifiers and procedures.

Learning Objective(s):

  • Describe benefits and burdens of artificial nutrition and hydration.
  • Enhance understanding of emotional and spiritual issues at the end-of-life.
  • Describe how hospice and nursing homes can work together productively.
  • Identify organizational barriers to improving end-of-life care and describe practical policies to promote better end of life care.

Speaker(s):
Alva S. Baker, III, MD, CMD; Leonard Gelman, MD, CMD

Disclosure(s):
None

Reference(s):
None

Speaker(s):
  • Alva S. Baker, MD, HMDC, CMDR, Chief Medical Officer, Hospice of Washington County
Standard: $24.00

Latest Approaches to Difficult Medical Issues in Long-Term Care

Feb 27, 2014 8:00am ‐ Feb 27, 2014 11:30am

Identification: 106

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this Internet Enduring Material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of clinical 3.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This popular session will provide updates on treating chronic disease in frail elders in the continuum of care. Topics of current interest to be addressed this year include sarcopenia, diabetes, heart failure, delirium, prognostication and hospice, a nutritional supplementation including oral, enteral, and parenteral arcopenia.

Learning Objective(s):

  • Identify opportunities to adapt disease management guidelines to frail elders.
  • Account for patient-centered goals and geriatric syndromes.
  • List opportunities to improve transitions between different settings of care.


Speaker(s):
Julie K. Gammack, MD, CMD; Barbara Messinger-Rapport, MD, CMD, PhD; John E. Morley, MB, BCH; Milta O. Little, DO

Disclosure(s):
None

Reference(s):
Aging and Endocrinology Frailty, Sarcopenia, and Hormones . John E. Morley, and Theodore K. Malmstrom .Endocrinology and Metabolism Clinics, 2013-06-01, Volume 42, Issue 2, Pages 391-405.Sinclair A, Morley JE, Rodriguez-Mañas L, et al. Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes. J Am Med Dir Assoc 2012; 13: 497–502.June 2013 MedPAC report to congress: http://www.leadingage.org/Hospice_June_2013_MedPAC_Report_to_Congress.aspx accessed 7/5/2013

Speaker(s):
Standard: $24.00

We Like to Move-it, Move-it: Its Time to get Active in Falls Reduction and Exercise Training in Long-Term Care! An Interprofessional Approach

Feb 27, 2014 1:30pm ‐ Feb 27, 2014 5:00pm

Identification: 111

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this Internet Enduring Material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 3.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
In this session, attendees will participate in an interactive, interprofessional workshop designed to improve communication and collaboration between health care providers to reduce falls and injurious falls through more effective exercise interventions. Learning will occur through active demonstration, case discussion and review of pertinent related literature.

Learning Objective(s):

  • Describe and distinguish available screening and evaluation tools that accurately assess fall risk and physical function in the post-acute/long term care setting.
  • Demonstrate a variety of individual and group exercise interventions that address aging physiology and disease pathology that lead to sarcopenia, frailty and falls.
  • Successfully implement individualized and group exercise programs in their facilities through the identification and conquering of common communication, regulatory and financial barriers.
  • Evaluate the effectiveness of their interventions through quality improvement tools and protocols.


Speaker(s):
Jill Fitzgerald, PT, DPT; Kelly Hawthorne, PT, DPT; Cynthia M. Kempf, OT; Milta O. Little, DO, CMD

Disclosure(s):
None

Reference(s):
1. Shubert TE. Evidence-based exercise prescription for balance and falls prevention: a current review of the literature. J Geriatr Phys Ther 2011; 34:100-108 2. Jensen LE and Padilla R. Effectiveness of interventions to prevent falls in people with alzheimer's disease and related dementias. Am J Occupational Therapy 2011; 65:532-540 3. Thomas S, Mackintosh S and Halber J. Does the Otago exercise programme reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing 2010; 39:681-687 Are these good ones? Which others do we need to include and review? 4. Section on Geriatrics, American Physical Therapy Association. Exercise Recommendations for Older Adults. GeriNotes 2008; 15 (1), 31-32. 5. Avers D, Brown M. White Paper: Strength Training for the Older Adult. Journal of Geriatric Physical Therapy 2009; 32 (4), 148-158. 6. Fritz S, Lusardi M. White Paper: "Walking Speed: the Sixth Vital Sign". Journal of Geriatric Physical Therapy 2009; 32 (2), 2-5. 7. Tinetti M, Doucette J, Claus E, Marottoli R. Risk Factors for Serious Injury During Falls by Older Persons in the Community. J Am Geriatr Soc 1995; Nov 43 (11) 1214-21. 8. Smith, M. L., Ory, M. G., Ahn, S., Bazzarre, T. L., & Resnick, B. (2011). Older adults' participation in a community-based falls prevention exercise program: Relationships between the EASY tool, program attendance, and health outcomes. Gerontologist, 51(6), 809-821.

Speaker(s):
Standard: $24.00

The SNF/ED/Hospital Nexus of Care: A Case Autopsy of Transitions Gone Wrong

Feb 27, 2014 1:30pm ‐ Feb 27, 2014 5:00pm

Identification: 108

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this Internet Enduring Material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 3.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This session will highlight the interplay of transitions of care among hospitals, emergency departments and nursing facilities. This intensive case-based program will showcase transitions between these three silos of service. The presenters (a hospitalist, an emergency medicine physician, a SNFologist, a DON and a consultant pharmacist) will present an “autopsy” of the transitions highlighted in the case, including what best practices and tools are available to assist in creating a better transition experience. The final portion of the intensive will be a panel representing various perspectives of the continuum of care responding to questions from the audience.

Learning Objective(s):

  • Discuss how to start or transition to a full time long term care practice.
  • Identify the various types of practice models and how to choose the one that's right for you based on overhead, income and job satisfaction.
  • Describe how to identify and implement systems in practices to increase profit, reduce overhead and improve efficiency, and identify those to avoid.
  • Identify strategies on how to market and expand their practice effectively.

Speaker(s):
H. Edward Davidson, PharmD, MPH; Aysha Kuhlor, RN, BA, CDONA; William Jaquis, MD; James E. Lett, II, MD, CMD; Karl E. Steinberg, MD, CMD; Robert Young, MD, MPH

Disclosure(s):
None

Reference(s):
None

Speaker(s):
Standard: $24.00

Palliative Care Part II: Clinical and Organizational Considerations

Feb 27, 2014 1:30pm ‐ Feb 27, 2014 5:00pm

Identification: 109

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this Internet Enduring Material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 3.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This session will provide an overview of practical approaches to ethical decision-making, evaluating benefits and burdens of artificial nutrition and hydration, encouraging spiritual and emotional considerations in end-of-life care, collaboration between nursing homes and hospice, and organizational changes to improve end-of-life care. Presenters will emphasize audience participation using case-based discussions. To allow for discussion, presenters will post on www.prolibraries.com/amda the core information required to ‘solve’ the cases prior to the session. Self-study of these materials prior to the sessions is recommended, but is not a prerequisite for attendance.

In addition, the presenters are seeking questions, ethical dilemmas, organizational or cultural challenges related to hospice and palliative care in LTC from the audience and will adapt the session according to attendee input. Attendees should submit their question or difficult clinical, ethical or organizational case to AMDA at llang@amda.com by January 3, 2014. Although questions will be confidential, please do not include information that could identify your patients, providers or facilities.

Learning Objective(s):

  • Describe benefits and burdens of artificial nutrition and hydration.
  • Enhance understanding of emotional and spiritual issues at the end-of-life.
  • Describe how hospice and nursing homes can work together productively.
  • Identify organizational barriers to improving end-of-life care and describe practical policies to promote better end of life care.

Speaker(s):
William D. Smucker, MD, CMD; Deborah Way, MD, CMD; Anthony J. Lechich, MD

Disclosure(s):
None

Reference(s):
These presentations are all based on the AMDA Palliative Care Curriculum, the AMDA Palliative Care Toolkit, the AMDA Pain CPG, best practice guidelines from national geriatric and palliative care organizations and relevant updates to the literature. They also draw on best practices for policies and procedures.

Speaker(s):
Standard: $24.00

Demystifying "Challenging Behaviors" by Using a Common Sense Approach to Dementia Care

Feb 27, 2014 1:30pm ‐ Feb 27, 2014 5:00pm

Identification: 110

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this Internet Enduring Material for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 3.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
Centers for Medicare & Medicaid Services (CMS) formed a task force charged with improving dementia care by delivering “person-centered, individualized interventions for behavioral health in nursing homes.” Medical directors, long-term care providers, directors of nursing, and consultant pharmacists have been tasked with identifying non-pharmacologic dementia care strategies across disciplines at all levels of patient care with the hope of reducing unnecessary antipsychotic medication use. The purpose of this session is to help audience members deconstruct and reduce resistance to care by developing key skills and demonstrating specific effective interventions that clinicians may practice and use immediately when behavioral challenges occur. Teepa Snow, OT, MS, a nationally recognized dementia care and dementia education specialist, and her colleagues will introduce an approach to help people with dementia during interactions with clinicians and caregivers.

Learning Objective(s):

  • Discuss common causes for refusals and resistance to care assistance based on level of dementia and brain changes, personal history and preferences, and caregiver approach and behavior.
  • Demonstrate key verbal and physical care skills that can improve initial interactions.
  • Describe simple changes in task demands and environments based on individual backgrounds and preferences that overcome behavior challenges and positively impact care outcomes.
  • Compare the use of a structured problem solving approach to dementia care and use of caregiver skills and knowledge to traditional caregiver behaviors that includes use of medications to manage resident behavior challenges.

Speaker(s):
Peg Chabala; Beth A. Nolan, PhD; Teepa Snow, OT, MS; Rollin M. Wright, MD, MPH, MS

Disclosure(s):
None

Reference(s):
Bonner A, January 31, 2013. Improving Dementia Care and Reducing Unnecessary Use of Antipsychotic Medications in Nursing Homes, a CMS Dementia-Care-presentation, retrieved July 15, 2013 from http://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2013-01-31-Dementia-Care-presentation.pdf.

Speaker(s):
Standard: $24.00
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