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If you have questions regarding the conference or need assistance completing the online registration process, call 800-422-3106. All attendees must register and pay applicable fees. Walk-in registrations are accepted only if space permits. Pre-registration is strongly recommended. If you require any special aides or services identified by the ADA, please contact IHCA prior to the program.
 

6 pm

Welcome Reception

7:30 pm

Adjourn

7:30 am

Registration and Breakfast

8:30 am

Welcome and Introductions
Steve Ackerson and Mary Jane Carothers, RN, BA, LNHA, ALMC

9 am

Keynote: The Changing Role of the Medical Director and Consultant Pharmacist in the Delivery of Quality Care                                  
Susan Levy, MD, President of The Society for Post-Acute and Long-Term Care Medicine (AMDA) 
Erin Foti, PharmD, CGP

At last year’s conference both the medical provider and pharmacy provider round table discussions both yielded the same question: How can facilities help prepare their medical directors and consultant pharmacists, who often are in facilities a few short hours monthly or quarterly, to engage as effective members of the professional care team given all the pressing issues of today? There is an immediate need to provide comprehensive care planning to avoid unnecessary hospital transfers and to reduce medication errors and untoward side effects and drug interactions. This session will look at how long term care providers can best help prepare these two important practitioners on the care team to be more effective in their roles as medical directors and consultant pharmacists and help facilities elevate the quality of care and quality of life for their rehab patients and long stay residents.

• Discuss National Initiatives where Medical Directors and Consultant Pharmacist can collaborate.
• Understand roles and responsibilities of the medical director, prescribers and pharmacist in medication management in the PA‐LTC setting.
• Identify areas to focus collaborative QAPI efforts.
• Describe collaborative models that have shown impact on improving care across the PA‐LTC setting.

10:30 am

Break

10:45 am

Chronic Disease Management in Long Term Care
Susan Levy, MD

CMS identifies chronic disease issues such as diabetes, COPD, congestive heart failure, pneumonia and urinary tract infections as some of the most frequent causes of re‐hospitalizations within 30 days of hospital discharge or as the cause of unnecessary hospitalizations for those suffering from these conditions. Medical Directors, Consultant Pharmacists and nursing staff members will have to work much more cooperatively to manage these chronic disease issues that affect many elderly people. Improved nursing clinical skills at the facility level, highly effective transitions of care and discharge planning will be crucial for facilities to be successful. Participants in this session will have the opportunity to hear best practices in the team management of these chronic conditions.

• Understand the basic approach to the care of patients in the PALTC setting with chronic diseases.
• Understand the clinical course of COPD.
• Appreciate some unique features to management of COPD in the PA/LTC setting.
• Understand the basic approach to Diabetes Management.
• Appreciate some of the unique issues to managing Diabetes in the PA/LTC setting.

12:15 pm

Lunch

12:45 pm

The Shifting World of Reimbursement                                  
Mark Levy, MD, Chief Medical Officer, Amerigroup

The advent of managed Medicaid in Iowa on April 1, 2016 has required virtually all federally certified nursing facilities in the state to make the switch from a traditional fee for service model to insurance plans that will emphasize quality patient care outcomes and cost containment through case management. Often referred to as Value Based Models of Care (VBM), long term and post‐acute care have been slower to integrate these models than have other sites of service. The next several years will see a rapid evolution to various types of value based models of care including accountable care organizations (ACO’s), increased use of Medicare MCO’s (managed care plans), or Medicare Advantage Plans (MA’s) and bundled payment models. This presentation will review the evolution of these payment models and how they will affect post‐acute and long term care delivery for nursing facilities, physicians and pharmacists and the residents that they serve.

• Understand the roles of five critical payers in long term care; Medicare FFS, Medicaid FFS, Medicare, Advantage, Managed Medicaid, and private pay.
• Describe at least three potential changes to long term care reimbursement created by the Affordable Care Act.
• Describe at least three theoretical models for value based purchasing including the potential impact to beneficiaries, providers, and payers.
• Understand key aspects of population management and member attribution as applied to alternative payment methodologies and long term care.
• Understand the alignment of incentives and potential value based purchasing for long term care under Iowa Medicaid Modernization.

1:45 pm

Engaging the Entire Team in Quality Improvement  
Sheryl Marshall, RN, Telligen QIO
Kate LaFollette, RN, Telligen QIO
Justin Rash, PharmD, Martin Health Services

CMS intends to release the final rule on the implementation of quality assurance performance improvement programs (QAPI) in nursing facilities before year’s end. The regulations will require a much more active role for many medical directors and consultant pharmacists as a part of the QAPI team than in previous practice. Participants will hear how they can become effective members of the QI team who focus on and create improved systems for the delivery of quality care.

• Identify barriers to Quality Improvement Teams and development.
• Discuss the ‘ideal state’ for Quality Improvement teams.
• Recognize strategy and tactics implemented to demonstrate successful improvement.
• Apply theories of quality improvement to creating meaningful change and improvement.
• Identify the new QAPI regulations in the proposed Requirements of Participation.
• Discuss the role of the interdisciplinary team that includes the medical director and consultant pharmacist in the implementation of the new rules.
• Discuss the integration of QAPI principles within the nursing facility operational structure, including the use of root cause analysis, data collection, and cyclical improvement efforts to improve care delivery systems.
• Identify how medical directors and consultant pharmacists may be involved in the quality improvement committee structure and also serve on performance improvement project teams.

2:30 pm

Adjourn

7:30 am

Breakfast

8 am

Understanding the Practice Implications of the Revised CoP’s
Mary Jane Carothers, RN, BA, LNHA, ALMC

In the fall of 2016 CMS intends to release the most sweeping changes in the nursing facility Requirements of Participation since OBRA ’87. The four hundred plus pages of rule revisions will require changes for physicians and pharmacists who serve long term care facilities. This session highlights the proposed changes and the impact for facilities and their professional consultants.

• Discuss the current nursing home regulatory environment and the influence of CMS on the State Survey Agency.
• Discuss the revised Requirements of Participation proposed for release by CMS in the fall of 2016 and operational implications for nursing facilities under the new rules.
• Discuss the new CMS Emergency Preparedness Rule and requirements that facilities must meet.
• Identify the specific rule revisions that impact the role of the Medical Director within the nursing facility.
• Identify the specific rule revisions that impact the role of the Consultant Pharmacist within the nursing facility.

9:30 am

Using INTERACT to Prevent Hospitalizations                      
Mary Jane Carothers, RN, BA, LNHA, ALMC

INTERACT (Interventions to Avoid Acute Care Transfers), developed in 2012 by Florida Atlantic University using CMS grant funds, has been used successfully by many long term care facilities to keep residents from unnecessary hospital admissions. Today many ACO’s require the use of the INTERACT program by providers in their networks. This collection of early assessment and documentation tools has been integrated in the many of the electronic health care
products available to providers today. Participants in this session will have an overview of the program and the role of medical and pharmacy providers to its success in facilities.

• Discuss the various documentation and communications tools used within the INTERACT program.
• Discuss how the Decision Support Tools can assist professional nurses and consultant pharmacists to identify individual patient data which should be reportable to medical providers.
• Understand how use of the Advance Care Planning tools may help prevent unnecessary hospitalizations for residents with chronic conditions.
• Identify how the Quality Improvement Tools employing root cause analysis will help facility

10 am

Break

10:15 am

Antibiotic Stewardship and Improved Long Term Care Infection Control  
Chris Barten, RN, Iowa Veterans Home
Patrick Hogan, PharmD, Iowa Veterans Home

While hospitals have been focused on infection control improvement for years, this effort is relatively new to many long term care providers. The revised RoP’s mandate a much expanded role for an infection control professional in the QI program including requirements for expanded training and data collection, incorporation of infection control efforts in the QAPI plan for the facility and the establishment of an antibiotic stewardship program. This session will focus on the program used at the Iowa Veterans Home and give guidance how facilities will be able with the help of medical directors and pharmacists to meet the new regulations regarding infection control practices.

• Describe inappropriate use of antibiotics leads to resistance.
• Changing federal rules will change procedures in long term care facilities to avoid penalties.
• Implementing an antibiotic stewardship program in the long term care setting.
• Describe strategies to use for decreasing antibiotic resistance in long term care facilities.

11:30 am

Lunch and Breakout Round Table Discussions
Physicians - Led by Victoria Walker, MD

This session will focus on best practices and strategies that long term care facility medical directors and medical providers can employ to assist facilities to improve the delivery of medical care to those they serve. How do the revised RoP’s impact the part time medical director in Iowa facilities? How do medical directors lead the efforts to reduce hospitalizations of nursing facility residents, including the increased need for care coordination efforts across the care spectrum? What are some best practices to coordinate the efforts of medical directors and pharmacists to work to reduce medication errors and untoward side effects in LTC facilities? Participants will be encouraged to share experiences and problem solve around challenges that face medical directors and the entire multidisciplinary team in regard to these issues.

• Discuss the challenges in being a part time medical director with the expanding role expectations mandated in the Requirements of Participation.
• Discuss the role the medical director to influence best practices related to decreased use of hospital stays with the LTC multidisciplinary team and other physicians and medical providers in the facility, including new emphasis on care coordination planning that may include hospice or palliative care or discharge to the community.
• Discuss the role of the medical director as the leader in influencing the appropriate use of psychotropic drugs and antianxiety agents among nursing home residents.
• Effectively engage with the LTC interdisciplinary team including the consultant pharmacist and other medical providers to develop systematic approaches to avoid unintended health care outcomes such as medication errors, falls and health care acquired infections.
• Identify effective strategies and best practices related to antibiotic stewardship in LTC organizations.

Pharmacists - Led by Ryan Carnahan, PharmD and Justin Rash, PharmD, CGP

This session will focus on best practices and strategies that long term care facility consultant pharmacists may employ to assist facilities to improve the delivery of quality long term care. How will pharmacists effectively engage with facility QI teams when implementing the new RoP’s? How do pharmacists lead efforts for effective and thoughtful pharmacologic treatment of seniors that emphasizes quality of life and safety? What is the role of the pharmacist in care coordination efforts that may include palliative or hospice care or successful return to the community? Participants will be encouraged to share their experiences and problem solve around the new challenges facing consultant pharmacists and the entire long term care multidisciplinary team.

• Discuss the expanded role expectations of the revised requirements of the participation for the consultant pharmacist’s role in quality improvement strategies that facilitate systematic organizational improvement.
• Discuss the pharmacist’s role in coordinating medication reconciliation upon nursing facility admission and discharge to community.
• Discuss the pharmacist’s roles and opportunities in ensuring appropriate use and monitoring of all medications used in the long term care environment including psychotropic medications, anticholinergics, anticoagulants and antibiotics.
• Discuss barriers to ensuring appropriate medication administration and prevention of medication errors and untoward side effects.
• Discuss opportunities for pharmacists to effectively engage with the LTC interdisciplinary team including the medical director, and other medical providers to be effective members of the organizational quality improvement team.

1 pm

Adjourn