Skilled Nursing Advisory Committee
On August 25, 2010 an introductory meeting between the NHCA, Administrator of the Nevada State Health Division, Richard Whitley, and Wendy Simons, newly appointed Bureau Chief for Health Care & Quality Compliance (HCQC) was held. This introductory meeting concluded with the agreement to form Skilled Nursing Advisory Committee (SNAC). The first SNAC meeting was held on September 16, 2010 to discuss common goals between the Skilled Nursing Facilities (SNFs), HCQC and HealthInsight. This meeting concluded with an agreement that an educational program provided by NVHCA to address Nevada’s “top 10 most cited deficiencies” would be the main purpose of SNAC.
A Trio of Partners Embark on a Quality Journey in Nevada
Nevada’s 51 skilled nursing facilities (SNFs) historically receive significantly more state survey deficiencies, compared to other states in the country and this trend has been evident for decades (2010 CASPER Deficiency Count Report). It was not a surprise to Nevada to learn that its’ performance in quality fell behind the rest of the nation, although its’ approach to the problem, until recently, was inadequate. In November 2010, the Nevada Health Care Association (NVHCA) and the Nevada Bureau of Health Care Quality & Compliance (HCQC) began discussions about what they could do to impact Nevada’s performance in quality measures and reduce the frequency, scope and severity of deficiencies identified in SNFs and to establish a more collaborative working relationship among providers and regulators. The group sought the input and partnership of the state’s Quality Improvement Organization (QIO), HealthInsight Nevada, and soon a “trio” of partners, serving as leaders in what is now the “Quality First Initiative: Achieving Compliance” began to identify additional members to participate including corporate clinical representatives from SNFs statewide . By December 2010, the group had formed what is now known as the Nevada Skilled Nursing Advisory Council (SNAC) whose primary goal is to reduce the frequency, scope, and severity of the top ten SNF survey deficiencies by 50%, by December 31, 2013.
With the direction of the NVHCA, HCQC, and HealthInsight Nevada the SNAC committed to explicit areas of focus to help them achieve their goal.
- Obtain support and engagement of all Nevada SNFs expressed through their attendance at all educational sessions with the expectation that by the second year facilities would share and present their improvement projects
- State surveyor and surveyor leadership to attend the educational sessions alongside the SNF staff to gain a shared mental model on all areas of focus
- Host six workshops each year aimed at the Top Ten Deficiencies – one workshop every two months
- Measure & monitor performance over time through a performance dashboard (maintained and analyzed by HealthInsight Nevada)
To meet the growing need to operationally support and fund the educational workshops, the NVHCA created The Perry Foundation, a private, non-profit organization that has sought the use of Civil Monetary Penalties (CMP) monies held by the State. Since January 2011, the SNAC has hosted 14 workshops, seven in Las Vegas, and seven in the Reno area all of which have targeted the identified top ten deficiencies. The table below illustrates preliminary successes already achieved in the first year of the initiative.
|
Regulation Name |
Baseline |
Interim |
Relative Improvement |
| Medically Related Social Services – F250 |
28.1% |
5.9% |
79% |
| Accommodation of Needs & Preferences – F246 |
22.9% |
13.7% |
40% |
| Services Meet Professional Standards – F281 |
47.5% |
27.5% |
42% |
| Comprehensive Care Plans – F279 |
61.4% |
41.2% |
33% |
(Source: Nevada SNF Top Ten Deficiency Performance Dashboard, January 2012)
The remaining areas of focus with further opportunity for improvement are: infection control (F441), quality of life (F309), storing and preparing foods under sanitary conditions (F371), proper labeling of food and drugs (F431), dignity (F241), and accidents and hazards (F323).
In addition, as multiple healthcare settings begin to look deeper into the issues of preventing avoidable hospitalizations, SNF facilities have found this to be an area of great potential. As a result, the “trio” of founders, the NVHCA, HCQC, and HealthInsight Nevada have engaged SNF and hospital leaders to work in reducing avoidable hospitalizations. This same group has now formed a Reducing Return to Acute Task Force, and with the support of HealthInsight Nevada, will roll out the INTERACT II model statewide and will work to improve the communication among physicians across these two health care settings.
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