2017 AMDA Conference

Transformational changes across the healthcare system are empowering providers to assume accountability for the Triple Aim of quality, cost, and patient experience. Shifting reimbursement from fee-for-service to value-based models is critical to enabling this important re-alignment, by providing the healthcare delivery system with the impetus and incentive to develop and test innovative models of care. Post-acute and long-term care represent prime opportunities for such breakthroughs. This session will review examples of value-driven redesign in these settings, with a practical emphasis on the key steps necessary to create a fully aligned, outcomes-focused culture. Presenters will share important considerations, from the perspective of people, process, and technology. Results of recent approaches to value-base redesign will be shared, including examples tied to the Bundled Payments for Care Improvement (BPCI) and the Medicare Shared Savings Program (MSSP) initiatives.

Learning Objectives:
(1) Discuss the opportunity and impact of new reimbursement models on PA/LTC.
(2) Describe strategies to succeed in an environment where providers assume increasing risk for outcomes.
(3) Explore innovative care models and how they can contribute to organizational success.
(4) Share successes and challenges, from those who have already been moving down this path.

This session will provide guidance on starting and sustaining an antibiotic stewardship program (ASP) in their facilities. This will be achieved by introducing the core elements that are essential to a successful ASP. The presenters will provide practical tips on implementing all the core elements using easily available free resources. The audience will also have the opportunity to interact with experts, including those who are currently helping various LTC facilities in developing their own ASP. The ultimate goal of this session is to prepare medical directors, other clinical practitioners, and nursing home administrators for implementing a sustainable ASP at their facilities, based on the Centers for Disease Control and Prevention (CDC) recommended core elements.

Learning Objectives:
(1) Describe core elements of an antibiotic stewardship program and the related CMS regulations.
(2) Discuss the need for implementing antibiotic stewardship program with all seven CDC recommended core elements and the role of medical director in the implementation.
(3) Demonstrate practical steps that can be taken to implement each element of antibiotic stewardship program using easily available resources.
(4) Review the available resources needed to successfully start and sustain an antibiotic stewardship program.

This session will provide attendees with an in-depth understanding of the issues affecting the care of patients with heart failure in skilled nursing facilities (SNFs). It is intended to provide attendees with expert insight into improving quality of care provided to this complex subset of patients. The speakers will review the clinical factors contributing to poor outcomes among these patients, provide insight into optimizing the medical management, and developing algorithms of care for these patients within their goals of care and expected discharge status, and discuss the indications, importance, and emerging use of palliative care and hospice consultation to patients with advanced/end stage heart failure.

Learning Objectives:
(1) Describe the SNF patient with CVD as a distinct high-risk patient with significantly increased morbidity, mortality, and risk for hospital readmission, and the importance of providing high quality care to these patients in the current regulatory environment.
(2) Discuss principles of cardiovascular disease management within the context of multimorbidity and goal directed patient care in the skilled nursing facility setting.
(3) Explain the need and methods for developing algorithms of care for complex heart failure patients in the SNF setting to improve patient outcomes, quality, and value of care.
(4) Discuss the importance of utilizing palliative care in patients with advanced heart failure in the SNF setting.
(5) Review the principles guiding patient selection for palliative care consultation, and medical management for refractory symptoms related to cardiovascular disease.

This panel will discuss how changes in our care delivery systems across the country are integrating medical and social supports services for better outcomes for patients and families living in the community and skilled nursing facilities A range of models will be discussed to better deliver care such as case managers for high risk patients and how different states are moving to managed LTC services and supports (MLTSS) which include services for those living in nursing homes. Topics include: 1) how different states are changing how LTC services are delivered and financed, 2) how high risk patients are being managed more in the community with waiver programs, 3) how one state is using a social justice model to help older adults live at home, and 4) how a state is making accountable care organizations and incorporating LTC into the medical system.

Learning Objectives:
(1) Describe how different states are changing how long term care services are delivered and financed.
(2) Discuss how high risk patients are being managed more in the community with waiver programs.
(3) Explain how one state is using a social justice model to help older adults live at home.
(4) Review how one state is making Accountable Care Organizations and incorporating LTC.

This session will provide a clinical introduction to caring for adults with intellectual and developmental disabilities in PA/LTC settings, based on literature review and the presenter's 25 years of experience as a clinician, medical educator, and researcher in developmental disabilities medicine. The content material presented will be applied to four case scenarios which exemplify the breadth and complexity of health care in this population. Participants will develop and share proposals for a quality improvement initiative aiming to improve care of this population, tailored to the facilities where they practice.

Learning Objectives:
(1) Describe how the etiologic diagnosis for the developmental disability guides clinical care of this population.
(2) Apply a literature-based, culturally- sensitive model of health care to persons with IDD in PA/LTC.
(3) Outline key elements of a quality improvement initiative addressing the health care for persons with IDD in facilities where they practice.