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Quality symposium February 24, 2012. Mary K. Ousley. Improving Our Relationship with CMS. History Medicare 1965 Institute of Medicine 1986 Omnibus Reconciliation Act of 1987 Stronger Federal role in improving quality;

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Quality symposium february 24 2012

Quality symposiumFebruary 24, 2012

Mary K. Ousley


Improving our relationship with cms
Improving Our Relationship with CMS

History

  • Medicare 1965

  • Institute of Medicine 1986

  • Omnibus Reconciliation Act of 1987

    • Stronger Federal role in improving quality;

    • Revision of performance standards, inspection process, and remedies to improve nursing home services;

    • Better training for staff;

    • Create a dynamic and evolutionary survey process.

    • Enforcement provisions apply to those who are unwilling or unable to achieve and sustain compliance.


Improving our relationship with cms1
Improving Our Relationship with CMS

Omnibus Reconciliation Act of 1987

  • Eliminate hierarchy of conditions, standards and elements (nursing facilities compliance, expectations would forever be different)

  • If a State finds, on the basis of a standard, extended, or partial extended survey under subsection (g)(2) or otherwise, that a skilled nursing facility no longer meets arequirement of subsection(b),(c), or (d), a

  • Compliance determined according to the degree or likely degree of harm.

  • Resident assessment and plan of care sets the standard of expectation of facility performance.

  • Quality Assessment & Assurance (facility internal controls) becomes a requirement.



Improving our relationship with cms3
Improving Our Relationship with CMS

  • Current Environment

    • Affordable Care Act

    • Deficit

    • Customer/Stakeholder Expectations

      • Value

  • End Old Debate

    • Regulatory Model

      • Cycle

    • No, because!

    • Silo Operation


Improving our relationship with cms4
Improving Our Relationship with CMS

  • Current Environment

    • Affordable Care Act

    • Deficit

    • Customer/Stakeholder Expectations

    • Value

  • End Old Debate

    • Regulatory Model

      • Cycle

    • No, because!

    • Silo Operation


Improving our relationship with cms5
Improving Our Relationship with CMS

Achieve & Sustain Compliance

  • Proactive

  • Continuous

  • Data Driven Management

    • Quality Control

    • Improvement Opportunities

    • Improvement Plans

    • Improving Core Process/Outcomes

  • Share Best Practice


Improving our relationship with cms6
Improving Our Relationship with CMS

Achieve & Sustain Compliance

  • Proactive

  • Continuous

  • Data Driven Management

    • Quality Control

    • Improvement Opportunities

    • Improvement Plans

    • Improving Core Process/Outcomes

  • Share Best Practice


Improving our relationship with cms7
Improving Our Relationship with CMS

Internal Controls, Quality Assurance Ensures:

  • Organization

    • Early Identification of low performers

      • Outcomes of care, turnover, customer satisfaction, regulatory results, financial.

      • Aggressive sustainable comprehensive plan


Improving our relationship with cms8
Improving Our Relationship with CMS

Internal Controls, Quality Assurance Ensures:

  • Organization

    • Early Identification of low performers

      • Outcomes of care, turnover, customer satisfaction, regulatory results, financial.

      • Aggressive sustainable comprehensive plan


Improving our relationship with cms9
Improving Our Relationship with CMS

  • Collaboration at All Levels:

    • State “All Politics is Local”

      • Community Outreach

      • State Association

      • Advancing Excellence

      • Quality Improvement Organization

    • Region

    • Central Office


Improving our relationship with cms10
Improving Our Relationship with CMS

  • Collaboration at All Levels:

    • State “All Politics is Local”

      • Community Outreach

      • State Association

      • Advancing Excellence

      • Quality Improvement Organization

    • Region

    • Central Office


Improving our relationship with cms11
Improving Our Relationship with CMS

Crossing the Quality Chasm:

AHCA MEMBER COMMITMENT

A New Health System for the 21st Century

  • Six Aims:

    • Safe

    • Effective

    • Patient-Centered

    • Timely

    • Efficient

    • Equitable

Values and Principles

  • CARE: High quality, person-centered care that respects individual choice and nurtures the physical, emotional and spiritual.

  • STAFF: Value, respect our staff, ensure the training and resources necessary to deliver highly skilled compassionate care.

  • LEADERSHIP: Empower our staff to embrace innovation and to create a rich environment for those in our care.

  • TRUST: Communicate with honesty and clarity and to treat each other with respect.

  • TRANSPARENCY: Accountable to meet the needs of our residents, patients and families and to share this information freely.

  • STEWARDSHIP: Managing our resources in accordance with the needs of those we serve and our surrounding community.


Improving our relationship with cms12
Improving Our Relationship with CMS

Crossing the Quality Chasm:

AHCA MEMBER COMMITMENT

A New Health System for the 21st Century

  • Six Aims:

    • Safe

    • Effective

    • Patient-Centered

    • Timely

    • Efficient

    • Equitable

Values and Principles

  • CARE: High quality, person-centered care that respects individual choice and nurtures the physical, emotional and spiritual.

  • STAFF: Value, respect our staff, ensure the training and resources necessary to deliver highly skilled compassionate care.

  • LEADERSHIP: Empower our staff to embrace innovation and to create a rich environment for those in our care.

  • TRUST: Communicate with honesty and clarity and to treat each other with respect.

  • TRANSPARENCY: Accountable to meet the needs of our residents, patients and families and to share this information freely.

  • STEWARDSHIP: Managing our resources in accordance with the needs of those we serve and our surrounding community.


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