Taking Healthcare by Storm: Industry Insights with Kristy Elder

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Kristy Elder MS, RN, Founder and President of Apricity Healthcare Solutions.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-081624-GK

Transcript

welcome to Taking Healthcare by Storm, Industry Insights.

The podcast that delves into the captivating intersection of innovation, science, compassion, and care.

In each episode, Quality Insights Medical Director, Dr.

Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.

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Hello, everyone, and welcome to Taking Healthcare by Storm.

I am Dr.

Jean Storm, the Medical Director of Quality Insights.

And I am just going to say, I learned so much from the guests that we have with us today.

It is something as a clinician that I have done, that is kind of been, you know, something that I did on a daily, near daily basis, which was complete documentation.

You know, when you see a patient, you have to document on what your thinking is, what your findings are.

And I will say, I don't think a lot of people think a lot about medical documentation.

And it is something that affects so much.

And it almost is like it's hiding in plain sight.

It's like running everything.

So I learned a lot about the importance of medical documentation during my conversation with Kristy Elder, who she is MSN RN.

She is the founder and president of Apricity Healthcare Solutions.

And I am looking forward to our conversation today.

Kristy, thank you for joining us.

Yes, thank you for having me.

So let's just go ahead and get started.

Tell us about your healthcare background and journey to get where you are now.

Yeah, so that is a long journey, I will say.

But we'll try and keep it short.

But I actually started in the healthcare world as a CNA at the age of 17.

And so I was fortunate to get a position in a, it's a critical access hospital, not close to where I live, and worked there as a CNA while I went and became an RN and worked there several years.

And there was a nursing home that is affiliated with that hospital.

So after several years of working school or nursing, I took on the role of DON at that nursing facility, which is actually where my grandpa would later reside.

So it was great having that background later on too.

But then I, after I did DON for a couple of years, I moved into clinical education and worked for a corporate nursing home company and did clinical education for all 35, I think there was 35 of those homes, and did a lot of their policies and procedures in the clinical realm.

Like, I've always been one of those people who loves good policy and procedures.

So I took that on while I was with them, and then moved into the hospice world of, as a regulatory coordinator and reviewing documentation by the providers and the clinicians to make sure the patient was appropriate for hospice, making sure that they were in the right level of care, that all the documentation was in order for that.

So, always had a love of documentation and meeting the rules.

And then I went back into the hospital world very briefly in 2019, at the end of 2019, as a regulatory coordinator, like so responsible for all those joint commission surveys, that in two different hospitals within the system.

But then COVID hit, and, you know, so 2020, March 2020, you know, no one was coming into the hospital except for COVID patients.

There was no surgeries or anything like that.

So, I was the first one, because I was the first one, or the, you know, last one hired, I was the first one furloughed, because I was not in a patient-facing position.

So, that was quite devastating.

But at the same time, I heard about this position of another hospital that was starting a clinical denials management position within the revenue cycle that was all about appealing insurance denials.

And so, definitely had a payer policy aspect to it.

So, I took that on and like found my true love of appealing denials, making sure documentation met criteria.

And during that time, my leaders of that position, I was fortunate enough, they were kind of allowed me like, just go with this.

We don't know what this looks like, but we know we have a problem.

And so, I was able to not only appeal and overturn a significant amount of denied claims, because I could dig into that documentation and prove that medical necessity was met, but also trend the data and tell the hospital, you know, we have a problem with this problem, you know, with this area.

So, yeah, that, I started to think about that in 2023 and was like, I could do this for a lot of different hospitals.

Like, you know, the hospital I'm at is not the only one that has this problem.

So, I left and started my own business.

That's where we're at.

That's really, really interesting.

And like, it's so very important.

And so few people really appreciate the importance of appropriate documentation, not just to get paid, but to really give an accurate picture of where the patient is.

So, tell us about Apricity Healthcare Solutions and what they do.

And we're going to talk about the word Apricity, which I think is a really interesting word.

So, let's start with just telling us basically what Apricity Healthcare Solutions does.

Yeah, so we partner with hospitals and long-term care providers to bridge that gap of the payer world and sometimes the regulatory world with the people who are actually giving the care.

So, what that really looks like is us, when there's insurance denials, we actually go in and fight those on behalf of the hospital or long-term care facility, or independent clinics, whatever they may be, and pull out their documentation, because oftentimes it's just, they're not documenting for the payer, right?

They're documenting what their medical brain.

And so, typically, it's all there.

It just takes a medical-minded person to say, this is here, and here's where it is.

So we do those appeals, but also educating the providers on the criteria, help them build templates and processes, so their documentation is not so tedious, but it does incorporate all of the payer's requirements.

And then on the hospital side, we also definitely help with authorization and utilization management issues, appropriate status, those issues with transfers to a SNF are becoming increasingly challenging, especially in the payer world.

They're like, we're not going to pay you, this patient doesn't meet criteria, but nursing homes can't just immediately take a patient.

And so, strategies around that.

Yeah, all important stuff.

So, Apricity, what does the word Apricity mean?

And I asked that question when we were initially talking, and I loved the story around it.

Yeah, yes.

So it was not something I knew what it meant, like in the last couple of years, but the definition of it is the warmth of the sun in winter.

And so, we kind of, you know, looking for names of our business, we were kind of like, what do we, you know, what is, I wanted something that enveloped, you know, what we do and how, you know, how it makes us feel.

And so, my last name is Elder, and certainly if I, you know, used that, it looks like I'm specifically focused on the geriatric population.

So, I was looking through were, you know, just, I think I was actually reading something, and I saw the word, apricity, and I was like, I don't know what that means.

And so, I'm one of those people who words up that I don't understand or don't know.

And I saw that and I was like, oh, I love that.

And it immediately brought me back to a story that had happened.

And so, I guess like that story would be that I, I have a nurse colleague and friend who I was working with closely one day, and we were actually like side by side doing something.

And she got a text and she started crying.

And I was like, Oh, you know, what's going on?

And she had, she told me this story.

So a little backstory on her is that her daughter actually died of, it was her 10-month-old daughter died of acute myeloid leukemia in 2001, I believe.

And so, you know, she was kind of going through that after, this was a year or two later after her daughter died.

But somebody had texted her that it was another mom who had a child who was going through cancer treatment and had been doing very well and was clear.

And so she was going back for scans and they allowed her to get a stuffed animal at the gift shop.

And the mom said that her daughter named the stuffed animal Lenny, which was my friend's daughter's name.

And so she loved that.

And then going to preschool, the teacher had said to the child, like, oh, let's leave Lenny with your mom.

You need to go.

And she said, no, this is Lenny and she keeps me warm.

And so my friend and I were talking about, like, through tears, because, gosh, that story just kind of broke our heart, like how children, you know, don't know the word, like, safety.

Like, that makes me feel safe when I have the stuffed animal that is Lenny and how she used the word warmth.

Like, you know, Lenny kept her warm.

And so, like, I remembered that and thought, that's exactly how I want our customers to feel, like, our clients to, like, we are those people who will help you when things seem bleak, because providers in general don't understand documentation.

And so as soon as I read the definition of that word, I'm like, that's it.

That's the name of our company.

So that's a very long story to tell you.

That's why we named our company something that no one knows the definition of the word.

Right, and so it's the warmth of the sun in winter.

In winter, yes.

And just beautiful.

I mean, you can, and when you hear that definition, I don't know about everyone out there or you, Kristy, but I feel that like when you go outside and it's cold and it's like, you're walking on ice and whatever and you put your head up and you feel that warmth.

Like that's amazing feeling.

Yes, yeah, definitely in Central Illinois, we understand that feeling very well in our long winters.

Yes.

So we talk a little bit about proper documentation.

I will agree that a lot of providers don't understand what proper documentation is.

So do you think proper documentation can actually help pave the way for better patient care?

Oh, for sure.

Yes, we talk a lot about, you have to document for legal reasons.

And I think that the better patient care is always at the bottom of that list of why we need to document well.

And certainly, I love the legal aspects of it.

But at the end of the day, it is about better patient care, right?

That's why we do everything that we do.

And so, I think, you know, certainly it prevents delays and like, and denial or off issues.

So, you know, typically when you're doing a prior off, you're going to send clinicals.

And if they don't meet criteria, it gets denied.

And then the provider has to go back and, you know, if appropriate, add that right documentation or see the patient again, make sure that they did this.

You know, a lot of surgeries require therapy before.

And so if that's not in the note, it will get denied.

And so telling the story of the patient in the note certainly prevents delays in care.

And then also patients are so complex these days.

And so the notes from one provider to the next are critically important for, you know, a cardiologist to see in the patient.

They need to be looking at the endocrinologist's notes too.

And so having succinct but, you know, very clear notes can help everyone do what's best for that patient.

100%.

Yeah, 100% agree.

Yeah.

So I know, you know, as a provider who's done many, many notes and done a lot of documentation, I would say, I don't think providers overall enjoy documentation.

But do you, I mean, how can it, can a documentation be made easier and more enjoyable?

Yes.

I've never had somebody say, man, my favorite thing about caring for people is all the documentation that I had to do.

Certainly.

So how to make things easier.

I'm a huge fan of templates, so the provider doesn't forget all the right things that they need to ask or do for that patient, and help kind of guide them, I think, and makes things a little easier now.

And I like to, like, if I'm building somebody's template, I think, and it's a suggestion I give to everyone, if you're building template, like, don't forget about putting the patient in there, right?

Like, I don't want to just have you checking off boxes.

That's great.

Like, yes, they did PTOT and they failed.

Yes, we've had an x-ray.

Yes, then we did a CT, you know, all those things.

But also talking about the patient, right?

So how is this affecting the patient?

You know, are they're live-living and all that.

And I think that definitely starts to make things a little bit more enjoyable when you see a person in a record, right?

It's not just checking off boxes where I have no clue, but you checked off boxes.

It's like I don't see the patient when I'm reading the chart visually.

So being able to do that for me, I think it is huge.

And I think for other providers too, when you're reading somebody else's note and you're like, okay, I get it.

I get what you are seeing too, as far as the patient.

And I think the other thing that I really like to do because oftentimes, I think the provider has no clue how it affects the pay.

When I joined the revenue cycle for the first time, I was like, oh, there's just a huge disconnect, right?

We just always write that out.

I was just dumbfounded at how much they write off because the documentation is not there, and they just assume the doctor isn't doing the right thing, or they just do that all the time.

I'm like, they just don't know, right?

So I like to give shout outs.

Like when I'm reading a really good note or using it to defend, like, I appealed this denial based on your notes and used it, and we got it overturned, and the patient got the care that they needed.

Like, I will send up that provider note and say, hey, great job, this is what happened, and I was able to use your documentation because otherwise, they don't know like, hey, when I document well, it actually is benefiting the patient and the company that I work for.

So I think that's important too, and I think that certainly makes things more enjoyable of bridging that gap of the revenue cycle.

Like we used your note to improve what you.

Yeah, I agree.

You know, yeah.

You give the provider almost like, look, you have meaning because you're really a patient advocate then.

Yeah, absolutely.

So you mentioned your grandfather, and so he had a nursing home stay.

So how did his stay in a nursing home influence you?

Oh, yeah.

So he, I mentioned that the nursing home that I was a DON he eventually resided there.

So yeah, that journey was was tough.

And, you know, I've worked in long-term care around or directly in long-term care for years.

But it's different when you're with your loved one, right?

And so my grandpa never wanted to go to a nursing home.

He wanted to stay home.

But as far as like, you know, when he was in his late 70s, early 80s, we were like, oh, either dementia is happening here.

And so we kept him home as long as we could.

His wife, my grandmother had passed away several years before.

And so it was just him living home alone.

And he has he had a big family, 10 brothers, two sisters.

So and a lot of them lived pretty close, the ones who are still surviving.

But so he wanted to, you know, grow old and die in his home.

And it just became to the point where he was very unsafe.

So I think the biggest thing for us was advocating for him over and over and the nursing facility.

And I realized, you know, those...

We saw it over and over, you know, when I worked in a nursing home, as the family saying, I wish you would have known him when he didn't have dementia or oh, my gosh, you know, you get called about something they did, which is mortifying, or they said something very inappropriate.

And you go, he never would have done that when he was of his right mind.

And so then being that person to say that, you're like, I get that feeling now.

You know, we always kept saying, like, you don't need to tell us that we completely understand.

And then here I am saying it.

And so that was interesting to me.

But I got to say, he was at a facility, you know, one of the great things was, is, you know, that was a 10 year difference of me being DON to him being admitted there.

And there were several nurses and CNAs who still worked there.

You know, so I knew them.

And, you know, we can't say enough great things about the care he got.

You know, the nurses really advocated for him clinically and were very helpful.

And I would say, like, my grandpa was a huge, he loved music, played guitar, played in bands for all of his life.

And so they really, in addition to us advocating and saying, like, these are his loves anyway, like the activities director who was just lovely, advocated for him and put together little gigs for him on Sundays so he could play for all the the residents there.

And even community members came that knew my grandpa and, you know, were part of the band.

So I think that was, yes.

So lovely that, you know, I know there's stories and I've been part of other facilities that were not, you know, so agreeable.

And certainly I think it probably helps that most of the people that worked there knew me.

But I think what I tell people over and over is you have to be their advocate when they don't have a voice that can speak for themselves.

Like, it's hard, but advocating for your loved one.

And certainly it's a huge godsend when you go, when you leave that facility and you know those nurses and the providers and all the staff there are going to be advocating for him too.

You know, that's a perfect scenario, right?

Absolutely.

So you were, I mean, you were a DON., you were a, you did education in a nursing home.

So you must have learned a lot about proper documentation and all things complex medical conditions, because every resident has multiple complex medical conditions and residents at risk of repeat hospitalizations.

I mean, that's what we're really focused on now.

CNS is focused on really reducing these repeat re-hospitalizations and in nursing home residents, not only everyone says to keep costs down, but honestly, the research shows that patients that go to the hospital a lot have poor quality of life and they're at greater risk of dying.

So we really do want to try to reduce those repeat hospitalizations.

So you must, I mean, so do you feel like proper documentation can help reduce these repeat re-hospitalizations?

I do.

Yes.

That's a great question.

I will say that my very first day as a DON., I literally walked in an hour before this happened, but we had a federal oversight survey.

So I arrived at eight and they arrived at nine.

So that was a huge wake-up call to me of proper documentation, having the right policies and procedures in place.

And then certainly, it's not all about surveys and things, but regulatorily, and, you know, regulatorily speaking, I would say, clinical, the documentation, you know, is your best friend, right?

So I definitely think on that side of it, your documentation has to support what you're doing and why you're doing it.

And then as far as like the readmission rates and hospitalizations, for sure.

And I saw that so much.

As an educator, I would get the administrators, you know, as calling and saying, you know, we have a high readmission rate.

I don't have any clue.

Can you just come teach, teach the nurses how to do better?

And I'm like, do better at what?

And they're like, I don't know.

Just do better.

And so what I would do, what I started to do was, I'm going to look at your trends and look.

And so I would just pull all those patients who are readmissions or recently admitted and just kind of start training the data and say, why, why did they leave?

And why did they, you know, when they came to the hospital or came to the facility, why did they go back to the nursing home?

And seeing those trends.

And I think not only is it the provider, you know, one, I will say, transitions of care need a whole lot of work, right?

From hospitals to nursing homes.

The whole revamp.

A whole revamp.

And definitely more eyes on all the craziness that happened in the hospital and what we need to do in the nursing home.

And I'd say that when I'm talking hospital side too, like, we need to, everyone needs to do better.

And I think that goes to documentation and communication, usually.

But certainly, I could start seeing trends when I was trending the data of why did this patient go back.

And I think proper assessment, but also documenting and relaying that information up for the providers to review certainly makes a huge decrease in that, preventing the re-hospitalization.

Hundred percent.

We don't talk to each other anymore as providers, so we got to communicate through our words.

Yes.

Through our documentation.

So on that vein, advanced care planning.

So advanced care planning is documentation of somebody's wishes.

You know, there's many patients who don't want to be, they don't want CPR, so they don't want to be resuscitated if their heart stops or if they stop breathing.

They don't want to be put on a ventilator.

There are many nursing home residents that say, my primary concern here is comfort.

I just want to be comfortable.

I don't want to go to the hospital anymore.

And so, you know, that's called advanced care planning is having that, those conversations.

So do you think advanced care planning can improve patient care and actually reduce hospitalizations and rehospitalizations for nursing home patients?

Oh, for sure.

I am a huge advocate of advanced care planning.

And I think those conversations, although sometimes difficult for certain providers to have, certainly not me.

I have those conversations all the time with my loved ones, telling what I wish.

But it's a critical aspect.

It's a critical point of what we need to do to provide the best care for that patient.

And so, even when I was talking about my grandpa, like advocating for him, his goal was comfort, 100 percent.

And he was really good about saying that to us, too, before his dementia was so profound.

And so, it was great that we knew exactly what he wanted, and we could advocate for him.

And I think when we don't have those conversations as providers or with our family, we're led down a road of we don't know what he wanted or she wanted, and so we're going to just do it all.

And that's not, rarely is that in line with what people actually want.

Like, no one's ever said, I would love to just be in a hospital for 20 out of the 30 days of the month, and then keep going back and back and get a bunch of IVs and fluids, and then drain the fluid.

And then, you know, like, yes, it's not what people say.

And so just discussing with, you know, as providers, I say, discuss early, discuss often, you know, we shouldn't be waiting until the patient is critically ill.

And I know sometimes we, that's the first time we get them.

And that's, you know, that is what it is.

But early discussions on that before either having active chest pain and as do we send them to the nursing or send them to the hospital or not.

It's very critical in getting them, the care that they want.

And certainly, yeah, if they don't want worked up in all that care, like let's keep them comfortable where they are.

Agree, yes, very important.

So, I'm sure you've done a lot of chart audits.

So, can you tell us maybe one or two interesting insights that you've learned from chart audits?

Oh, chart audits, yeah.

I trend a lot of data, and certainly we see a lot of like care transition gaps.

And, you know, I mentioned that before, but I would say, in general, like the biggest thing I see is that siloed health care.

And, you know, I'm getting these charts, you know, one, if they're denied, or two, if the facility says, can you audit these?

And I see like the silos, like, I'm only focused on the cardiovascular part of the patient.

I'm only focused on the wound part of the patient, or, you know, and sometimes I get that.

But at the end of the day, I'm always like, it's a patient, right?

If there's one person here, and so even though while you're focusing on one thing, focus on the patient, right?

It's not just a heart problem, it's a patient with a heart problem.

And so, yeah, I would just say that that is one of those biggest things that I see as a problem.

When I'm, when I'm auditing, I get that.

I mean, that's, yeah, that's a huge thing.

I mean, siloed and, you know, getting away.

We need to just patient-centered care.

That's what we really need to be doing.

And I think when I see that, I, you know, the silos tend to lend them, blend it to readmissions in the hospital.

And when I see that collaboration and to take into account, and again, I think it goes into that documentation of, did that other provider document well, so they, the, you know, whoever it's just the primary care provider, or, you know, a nurse practitioner that's seeing that patient acutely, like if they can easily review those notes and say, oh, here's what's going on, and here's how I can help that patient, you know, I think that's when great care can happen, right?

But if they don't know what they don't know, it doesn't, it doesn't bode well for the patient, yes.

I agree, yeah.

So last question, if you were in charge of healthcare in the United States, what is the first thing you would do?

Yeah.

Oh, so the, my, my biggest thing that I think I would focus first on, if it could be done, is consistent criteria for all the payers.

So, you know, I think evidence-based practice should be evidence-based practice, right?

So, it's very frustrating, and I understand it certainly from the providers, is that while one insurance company wants this, another insurance company wants something else or because you have, you know, I don't want to speak of, you know, certain payers, but, you know, because you have this payer, you can have this service.

But if you had a different payer, that's going to be denied.

And so I think that's something I would love to see is even with the Medicare Administrator Contractor, Administrative Contractors, like having the same criteria of what is going to be, get the care authorized would just be lovely.

I agree.

It's like some people can only order off the fast food menu and other people can have the steakhouse menu.

Yes.

Yes.

Kristy, thank you so much for joining me today.

It was enlightening.

I learned so much.

And I really appreciate you being with us.

Oh, my honor.

Thank you so much for having me.

Okay.

Take care.

Bye-bye.

All right.

Bye-bye.

Thank you for tuning in to Taking Healthcare by Storm, Industry Insights with Quality Insights Medical Director, Dr.

Jean Storm.

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