AMDA Long Term Care Medicine - 2012

Mar 8, 2012 ‐ Mar 11, 2012


Standard: $395.00

Sessions

Data Sanity: The Effective Use of Statistical Process Control in the Nursing Home

Mar 8, 2012 8:00am ‐ Mar 8, 2012 11:30am

Identification: A02

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 educational activity 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:
All work is a process. Your current processes are perfectly designed to get the results they are already getting and designed to get, with its corollary: insanity is doing things the way you have always done them while expecting different results. This session will provide an in depth look at how to start to work towards a better quality improvement process in your facility. Examples of actual data analysis with audience participation will be used. Presenters will teach the basics of variation and statistical process control, and then advance to how this mechanism can be used to improve care at your site.

Learning Objectives(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.
  • Utilize run charts and control charts to analyze data in your nursing home
  • Explain 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)


Speakers(s):
Leonard Gelman, MD, CMD; Matthew Wayne, MD, CMD

Disclosure(s):
Leonard Gelman, MD, CMD has no financial disclosures to report. Matthew Wayne, MD, CMD has no financial disclosures to report.

References(s):
Data Sanity - Davis Balestracci Jr 2009

Speaker(s):
Standard: $24.00

The Use of Micronutrients in Long Term Care

Mar 8, 2012 8:00am ‐ Mar 8, 2012 11:30am

Identification: A04

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 educational activity 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:
Malnutrition is common in the older population; with nutritional deficiencies being a critical issue in the long term care setting. In nursing home residents, an increase in morbidity and mortality is evident in those with malnutrition and weight loss. Although composite nutritional assessment instruments have been developed, the recognition of micronutrient deficiencies in nursing home patients often falls short of optimum. This session will provide a comprehensive account of the prevalence, manifestations, prevention and management of a select group of micronutrients including the B vitamin group, vitamin E, iron, magnesium, zinc, selenium, and copper. The session will conclude with an audience question and answer period.

Learning Objectives(s):


  • Describe the prevalence and clinical manifestations of nutrient deficiencies in the long term care setting.
  • Discuss the approach to diagnosis, prevention and management of micronutrient deficiencies.
  • Recognize the adverse effects of inappropriate and excessive of micronutrients.


Speakers(s):
Meenakshi Patel, MD, CMD; Naushira Pandya, MD; T S Dharmarajan, MD

Disclosure(s):
Meenakshi Patel, MD, CMD has no financial disclosures to report. Naushira Pandya, MD has no financial disclosures to report. T S Dharmarajan, MD has no financial disclosures to report.

References(s):
1. Rude RK. Magnesium deficiency: A cause of heterogeneous disease in humans. J Bone Miner Res 1998;13:749-58. [PubMed abstract] 2. Wester PO. Magnesium. Am J Clin Nutr 1987;45:1305-12. [PubMed abstract] 3. Saris NE, Mervaala E, Karppanen H, Khawaja JA, Lewenstam A. Magnesium: an update on physiological, clinical, and analytical aspects. Clinica Chimica Acta 2000;294:1-26. 4. Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride. National Academy Press. Washington, DC, 1999. 5. U.S. Department of Agriculture, Agricultural Research Service. 2003. USDA National Nutrient Database for Standard Reference, Release 16. Nutrient Data Laboratory Home Page, http://www.nal.usda.gov/fnic/foodcomp. 6. Ford ES and Mokdad AH. Dietary magnesium intake in a national sample of U.S. adults. J Nutr. 2003;133:2879-82. 7. Vormann J. Magnesium: nutrition and metabolism. Molecular Aspects of Medicine 2003:24:27-37. 8. Feillet-Coudray C, Coudray C, Tressol JC, Pepin D, Mazur A, Abrams SA. Exchangeable magnesium pool masses in healthy women: effects of magnesium supplementation. Am J Clin Nutr 2002;75:72-8. 9. Ladefoged K, Hessov I, Jarnum S. Nutrition in short-bowel syndrome. Scand J Gastroenterol Suppl 1996;216:122-31. [PubMed abstract] 10. Rude KR. Magnesium metabolism and deficiency. Endocrinol Metab Clin North Am 1993;22:377-95. 11. Kelepouris E and Agus ZS. Hypomagnesemia: Renal magnesium handling. Semin Nephrol 1998;18:58-73. [PubMed abstract] 12. Ramsay LE, Yeo WW, Jackson PR. Metabolic effects of diuretics. Cardiology 1994;84 Suppl 2:48-56. [PubMed abstract] 13. Kobrin SM and Goldfarb S. Magnesium Deficiency. Semin Nephrol 1990;10:525-35. [PubMed abstract] 14. Lajer H and Daugaard G. Cisplatin and hypomagnesemia. Ca Treat Rev 1999;25:47-58. [PubMed abstract] 15. Tosiello L. Hypomagnesemia and diabetes mellitus. A review of clinical implications. Arch Intern Med 1996;156:1143-8. [PubMed abstract] 16. Paolisso G, Scheen A, D'Onofrio F, Lefebvre P. Magnesium and glucose homeostasis. Diabetologia 1990;33:511-4. [PubMed abstract] 17. Elisaf M, Bairaktari E, Kalaitzidis R, Siamopoulos K. Hypomagnesemia in alcoholic patients. Alcohol Clin Exp Res 1998;22:244-6. [PubMed abstract] 18. Abbott L, Nadler J, Rude RK. Magnesium deficiency in alcoholism: Possible contribution to osteoporosis and cardiovascular disease in alcoholics. Alcohol Clin Exp Res 1994;18:1076-82. [PubMed abstract] 19. Shils ME. Magnesium. In Modern Nutrition in Health and Disease, 9th Edition. (edited by Shils, ME, Olson, JA, Shike, M, and Ross, AC.) New York: Lippincott Williams and Wilkins, 1999, p. 169-92. 20. Elisaf M, Milionis H, Siamopoulos K. Hypomagnesemic hypokalemia and hypocalcemia: Clinical and laboratory characteristics. Mineral Electrolyte Metab 1997;23:105-12. [PubMed abstract] 21. American Diabetes Association. Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 1999;22:542-5. [PubMed abstract] 22. Rude RK and Olerich M. Magnesium deficiency: Possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453-61. [PubMed abstract] 23. Bialostosky K, Wright JD, Kennedy-Stephenson J, McDowell M, Johnson CL. Dietary intake of macronutrients, micronutrients and other dietary constituents: United States 1988-94. Vital Heath Stat. 11(245) ed: National Center for Health Statistics, 2002:168. 24. Takahashi M, Degenkolb J, Hillen W. Determination of the equilibrium association constant between Tet repressor and tetracycline at limiting Mg2+ concentrations: a generally applicable method for effector-dependent high-affinity complexes. Anal Biochem 1991;199:197-202. 25. Xing JH and Soffer EE. Adverse effects of laxatives. Dis Colon Rectum 2001;44:1201-9. 26. Qureshi T and Melonakos TK. Acute hypermagnesemia after laxative use. Ann Emerg Med 1996;28:552-5. [PubMed abstract] 27. DePalma J. Magnesium Replacement Therapy. Am Fam Phys 1990;42:173-6. 28. Klasco RK (Ed): USP DI

Speaker(s):
Standard: $24.00

Palliative Care Part I: Clinical and Ethical Considerations

Mar 8, 2012 8:00am ‐ Mar 8, 2012 11:30am

Identification: A03

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 educational activity 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 communication, advance care planning, and assessment and control of pain and other distressing symptoms experienced by patients in long term care.

Learning Objectives(s):


  • Define palliative care as it relates to each resident within the long term care continuum.
  • Examine a systematic approach to assessing and managing pain and non-pain symptoms.
  • Describe comprehensive assessment and treatment of pain in the nursing facility.
  • Enhance communication with patients, families, and caregivers regarding goals of care and advanced care planning.


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

Disclosure(s):
William D. Smucker, MD, CMD has no financial disclosures to report. Amy M. Corcoran, MD, CMD has no financial disclosures to report. Peter Winn, MD, CMD has no financial disclosures to report.

References(s):
These presentations are all based on the AMDA Palliative Care Curriculum, the AMDA Palliative Care Toolkit, the AMDA Pain CPG, and relevant updates to the literature

Speaker(s):
Standard: $24.00

Care Transitions: Preventing Them, Improving Them and Measuring Them

Mar 8, 2012 8:00am ‐ Mar 8, 2012 11:30am

Identification: A05

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 educational activity 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:
There are nearly two million discharges from nursing homes annually, of which 29% are discharged to a hospital (Kasper 2005); and, some 25% of Skilled Nursing Facility residents are transferred to an emergency department yearly (Grunier, Bell et al. JAGS 2010). This session will address care transitions from three perspectives. First, it will discuss how to reduce transitions that are unnecessary by means of better assessment of the patient combined with improved communication. Next, tools will be provided to make those transfers that are clinically necessary safer. Finally, techniques to determine quality in transitions will be provided along with measurements of quality currently being utilized.

Learning Objectives(s):


  • Discuss pitfalls of using INTERACT II and strategies to overcome barriers to achieve the full benefit of INTERACT II.
  • Describe common medication mistakes in transfers between the skilled nursing facility and the hospital.
  • Explain medication reconciliation in long term care continuum transfers.
  • Review recent literature on measuring quality in care transitions.


Speakers(s):
James E. Lett, II, MD, CMD; Joseph Ouslander, MD, CMD; Kenneth Boockvar, MD, MS; Ed Davidson, PharmD, MPH; Gwendolyn Buhr, MD, CMD

Disclosure(s):
Kenneth Boockvar, MD, MS has no financial disclosures to report. Gwendolyn Buhr, MD, CMD has no financial disclosures to report. James E. Lett, II, MD, CMD has no financial disclosures to report. Joseph Ouslander, MD, CMD has no financial disclosures to report.

Speaker(s):
Standard: $24.00

Managing Your Small Long Term Care Practice

Mar 8, 2012 8:00am ‐ Mar 8, 2012 11:30am

Identification: A11

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 educational activity 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:
Long term care medicine is a rewarding career choice. Succeeding at it in a very small practice is a big challenge. This session covers the fundamental management principals needed to build and maintain your long term care practice.

Learning Objectives(s):

  • Discuss how to start a long term care practice.
  • Identify and implement strategies to grow a long term care practice
  • Discuss and avoid common pitfalls associated with long term care.
  • Describe effective tools to enhance productivity and still maintain job satisfaction.


Speakers(s):
Rod Baird, MS; Gregory P. Zydiak, MD, CMD

Disclosure(s):
Rod Baird, MS - Geriatrics Practice Management: Board member, shareholder, employee. Company is in process of developing a LTC specific ePrescribing program: 'Complete Ambulatory EHR' Application. Gregory P. Zydiak, MD, CMD has no financial disclosures to report.

Speaker(s):
Standard: $24.00

Latest Approaches to Difficult Medical Issues in Long Term Care

Mar 8, 2012 1:30pm ‐ Mar 8, 2012 5:00pm

Identification: A06

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 educational activity 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 by four experienced speakers from Cleveland Clinic and St. Louis University will present an intensive session on updates in treating chronic disease in frail elders in the continuum of care, including transitions from one setting to another. Recent advances in our approach to chronic disease in the older population suggest we revise our approach to frail elders in the continuum of care. Additional data on the relationship of delirium to dementia and depression may help us understand how to assess and treat delirium in patients admitted to skilled settings. These and other related issues will be address during this session.

Learning Objectives(s):


  • Identify opportunities to adapt disease management guidelines to frail elders.
  • Account for patient-centered goals and geriatric syndromes.
  • List opportunities to improve delirium detection and treatment in the nursing home


Speakers(s):
Barbara Messinger-Rapport, MD, PhD, CMD; Dulce Cruz, MD; John E. Morley, MB BCH; David R. Thomas, MD

Disclosure(s):
Barbara Messinger-Rapport, MD, PhD, CMD - Omnicare: P&T Member. John E. Morley, MB BCH has no financial disclosures to report. David R. Thomas, MD has no financial disclosures to report.

References(s):
Reid IR, Bolland MJ, Avenell A, Grey A. Cardiovascular effects of calcium supplementation. Osteoporosis International. Jun 2011;22(6):1649-1658. Peterson PN, Shetterly SM, Clarke CL, et al. Health literacy and outcomes among patients with heart failure. JAMA: The Journal of the American Medical Association. April 27, 2011 2011;305(16):1695-1701. Fong TG, Jones RN, Rudolph JL, et al. Development and validation of a brief cognitive assessment tool: The sweet 16. Archives of Internal Medicine. Mar 14 2011;171(5):432-437

Speaker(s):
Standard: $24.00

Palliative Care Part II: Clinical and Organizational Considerations

Mar 8, 2012 1:30pm ‐ Mar 8, 2012 5:00pm

Identification: A07

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 educational activity 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 program provides 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 will be discussed.

Learning Objectives(s):


  • Describe benefits and burdens of artificial nutrition and hydration.
  • Discuss 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.


Speakers(s):
William D. Smucker, MD, CMD; Deborah Way, MD, CMD; Lory E. Bright-Long, MD, CMD; Anthony J. Lechich, MD, CMD

Disclosure(s):
William D. Smucker, MD, CMD has no financial disclosures to report. Deborah Way, MD, CMD has no financial disclosures to report. Lory E. Bright-Long, MD, CMD has no financial disclosures to report. Anthony J. Lechich, MD, CMD has no financial disclosures to report.

References(s):
These presentations are all based on the AMDA Palliative Care Curriculum, the AMDA Palliative Care Toolkit, the AMDA Pain CPG, and relevant updates to the literature. They also draw on best practices for policies and procedures.

Speaker(s):
Standard: $24.00

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

Mar 8, 2012 1:30pm ‐ Mar 8, 2012 5:00pm

Identification: A08

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 educational activity 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 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 Objectives(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.


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

Disclosure(s):
Alva S. Baker, III, MD, CMD has no financial disclosures to report. Leonard Gelman, MD, CMD has no financial disclosures to report.

Speaker(s):
Standard: $24.00

When is Quality Improvement (QI), Research? A Training Program on Team QI Activities in Your Nursing Facility

Mar 8, 2012 1:30pm ‐ Mar 8, 2012 5:00pm

Identification: A09

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 educational activity 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:
Medical directors are leading their staff to focused care improvement by applying the basic principles of quality improvement (QI) in a variety of inventive and unique ways in this setting. Building on the successes of several AMDA Foundation training programs, QI experts and in the trenches practitioners will meet to skill build around the concept of "team science," including discussions of key strategies for effective research collaboration at the facility level. Topics will prepare Interdiciplinary Team members to participate in QI -- data sources, choosing a QI topic, the Internal Review Board approval process and how the IRB assesses projects, challenges posed by the issues around frailty and cognition in the study population, skill building on Microsoft Excel and how to use its statistical capabilities with QI data. At the end of the day, the attendee will be able to return to his/her facility and begin a QI activity.

Speakers(s):
Suzanne M. Gillespie, MD, RD, CMD; Jurgis Karuza, PhD; Paul R. Katz, MD, CMD; Christie Tiegland, PhD

Speaker(s):
Standard: $24.00

Improving Care by Reducing Avoidable Hospitalizations: Implementing the INTERACT Program in Your Facility

Mar 8, 2012 1:30pm ‐ Mar 8, 2012 5:00pm

Identification: A10

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 educational activity 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 a comprehensive overview of how your facility can implement a quality improvement program ("INTERACT" or Interventions to Reduce Acute Care Transfers) that will assist you in responding to federal policy and reimbursement initiatives designed to reduce avoidable hospitalizations and hospital readmissions. The INTERACT tools are designed to improve the early identification, evaluation, and management of acute changes in condition, improve communication and documentation, and facilitate proactive advance care planning. Lessons learned from implementing INTERACT in over 100 facilities will be discussed, and participants will have the opportunity to interact in small group breakout activities designed to stimulate thinking about successfully implementing and sustaining the program over time. Participants will receive a packet of resources to help initiate or further develop their quality initiatives related to hospital transfers.

Learning Objectives(s):


  • Describe the importance of potentially avoidable hospitalizations of nursing home (NH) residents in relation to health care reform initiatives.
  • Discuss strategies to reduce potentially avoidable hospitalizations.
  • Use tools developed for a quality improvement program ("INTERACT") designed to improve the management of acute changes in condition and reduce potentially avoidable hospitalizations.
  • Explain strategies for efficient and effective implementation of the INTERACT program in clinical practice.


Speakers(s):
Joseph G. Ouslander, MD; Laurie Herndon, MSN, GNP

Disclosure(s):
Laurie Herndon, MSN, GNP has no financial disclosures to report. Joseph Ouslander, MD, CMD has no financial disclosures to report.

Speaker(s):
Standard: $24.00
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