Taking Healthcare by Storm: Industry Insights with Heather McGowan & Debra Wright

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 Heather McGowan, President of the Pennsylvania Association of Nurse Assessment Coordinators (PANAC), and Debra Wright, a Quality Improvement Specialist at Quality Insights.

Heather and Deb Wright touch on their responsibilities, challenges, and professional development, especially in the context of the COVID-19 pandemic and staffing shortages. They also explore the impact of accurate assessments on care plans, regulatory compliance, and how organizations like PANAC support NACs.

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

Publication number QI-050925-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.

Subscribe now, and together, we can take healthcare by storm.

Hello everyone and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, Medical Director of Quality Insights and today I am excited to be joined by Heather McGowan, the President of the Pennsylvania Association of Nurse Assessment Coordinators or PANAC. We are also joined by our own Debra Wright, she is a quality improvement specialist here at Quality Insights and she also is MDS certified, which is why she is here to add to the conversation.

So Heather is a director of clinical reimbursement with CHR Consulting Services. She has more than 25 years of experience in long term care with over 20 MDS clinical reimbursement experience. She has held many roles in her career. which include unit manager, ADON, DON, MDS coordinator, regional clinical reimbursement consultant, and division clinical reimbursement.

So she has been all over the long term care environment. Her career in long term care has provided an opportunity to provide support to MDS coordinators in Pennsylvania as well as multiple other states. Heather graduated from Penn State University School of Nursing. She is a AAPACN certified ARNAC, which is R N A C, R A C slash C T.

And MDS section GG, Train the Trainer. And MDS section GG, I looked up, is Functional Abilities and Goals. And maybe when we start, Heather can just  touch on that.  And current, she's the current president of the PANAC board. She has deep expertise in long term care. Heather will share insights into the vital role of nurse assessment coordinators or NACs and how they ensure residents receive the best possible care.

And skilled nursing facilities. We're also going to be exploring how the role has evolved through the challenges of the COVID pandemic, the ongoing staffing issues in long term care, and the impact of vaccine misinformation. It plays a huge role, especially in long term care. We're also going to be talking about the challenges and opportunities facing these healthcare professionals.

I'm going to just say, I feel like they are the hidden heroes in long term care, and I just wanted to share the story of anyone who's maybe not understanding the importance of the nurse assessment coordinator in the long term care facility. I came across a story in researching this podcast and it was a facility that had two MDS coordinators and unfortunately they were together after hours and they were involved in an accident and they were hospitalized very unfortunately and no one in the facility had passwords to any of the software or Casper.

And the building lost 300, 000 while the staff waited and hoped and prayed that the nurse is recovered. So these individuals who are in these roles are just crucial in long term care facilities and that's what we're going to be talking about today. So Heather, Deb, thank you so very much for joining us today.

Thank you, Jean. It's a pleasure being here and uh, we love your intro on the hidden heroes.  That's a great intro. It is. And I just did go back that MDS section GG. Is it functional abilities and goals? Is that what that? It is, yes, it is functional abilities and goals. So really  it's  how that resident's able to  complete those tasks to take care of themselves on a day to day basis.

And I will say, I think that is so, so very important because we know when people stop moving, which is  essentially you're tracking their ability to perform tasks and people stop moving.  Typically have a less lower quality of life and shorter life. So yes, super important. So tell us what are the primary responsibilities of the nurse assessment coordinator in long term care facilities and how do they contribute to ensuring high quality care for residents?

Well, Jean, I think the primary responsibility of the NACs are to ensure that the MDS is completed timely and accurately  based on the regulatory requirements.  They also are really key in ensuring that all departments That are participating in completion of that MDS are educated on the accurate completion.

They also help to ensure the facility is following the Medicare a coverage guidelines. They monitor nursing documentation. And when you take a step back and consider all of those pieces all of those come together to make sure that every resident. That we're caring for is receiving the care and services they need which improves their quality of life.

Yeah. So very essential to make sure you know where people are so that you can track what they need and where they need to be. So can you tell us briefly about the resident assessment instrument, which is abbreviated RAI and the minimum data set MDS and the difference between the two?

Well  I think I'll start with the MDS.  Even though it's called the minimum data set  it's really not minimum at all.  This is a standard data set that was developed by CMS, the Centers for Medicare and Medicaid that is completed in every nursing home that receives payment from Medicare or Medicaid.

And it really covers a holistic approach for the resident asking questions  as we mentioned about their functional ability psychosocial memory bound bladder incontinence diagnosis. So  it's really this comprehensive data sets. And then, conversely, the REI, or the Resident Assessment Instrument  is our manual or really the guide on when do we complete the MDS what data set do we use.

And then how to accurately complete each of those questions on the MDS. Gotcha. So, we shift a little bit to PANAC, and maybe Deb, you can also chime in  in this question. So, the Pennsylvania Association of Nurse Assessment Coordinators, or PANAC, plays a vital role in professional development and advocacy for NACs. So how does this association support NACs and navigating complex regulations? We know the nursing home has the most complex regulations in health care, such as those associated with the patient driven patient model and the Medicare, Medicaid reimbursement systems.

Well  I'll go ahead and start, Jean. Really, education is  the key to supporting the NACs. And what we do, the PNAC board, we work collectively to ensure we're monitoring all the communications relating to those changes, whether that's in the MDS data set itself or changes that impact reimbursement.

As an organization, we provide monthly education sessions via the webinar not just to our members but really anybody who would like to participate.  I will say though, as a member of PANEC those educations are free.  And then we also host an annual conference where we provide education on topics not just specific to Pennsylvania.

But relevant to any of the federal changes in regulation, reimbursement or areas impacted by the MDS, like PDPM and quality measures, we're there to let the next. No, they're not alone. And we support them. And we want to make sure that they're getting the education and information they need. And I just think that's so true.

And the other thing that I will say about PANAC and the PANAC board is just like everything else. They really have shifted since the pandemic and realized what the facilities need with the ever changing turnover in the NACs that we have seen since the pandemic. And I think one thing that really makes PANAC so successful.

Is there subject matter experts that they have presenting this information? Because just like you said, this is a it is a very unique role and one that you don't learn in nursing school. You don't learn in college. It's you learn it on the job and from those that have done it or from a Researching and gaining all that information by diving into that RAI manual.

So having those expert subject matter experts and those that are really great in this field just, I think, makes PANAC stand out because they get those. Those qualified individuals that can really relate to the RNACs in the facility and everything that they're dealing with and going through.

Yeah, I think it's so important to have an organization with individuals who are doing the same thing you are. So, how has the role of the NAC evolved over time? We just have gone through the COVID pandemic and I think  COVID is still happening in facilities, but it obviously impacted the healthcare sector tremendously, especially long term care facilities.

So were there specific challenges or changes in responsibilities that you've observed or managed, Heather? Yeah, well let's start with the evolution of the role. I think over time any of the nursing assessment coordinators that have been in the industry has seen where CMS has made changes.

To the MDS and really put it at the center of many changes over the years, not just from being a standardized data set to resident care planning, and then it branched into reimbursement, quality measures, and then  the five star rating system. So, really, that NAC had to become the expert, essentially, in all of those areas.

And then in terms of the evolution during the pandemic obviously NACs were asked not only to manage the MDS process, but many had to provide hands on support to the nursing departments that were struggling with staffing at the time and departments that continue to struggle now.

So getting those assessment coordinators doing their day to day, but also then  out providing hands on direct patient care just to ensure the residents were getting the care they needed. Another piece of that was that  we had these federal waivers. That were coming down from CMS.

So the nursing assessment coordinators had to review and interpret those waivers and then apply them to the Medicare coverage guidelines and appropriately implement those waivers. And it was really unfortunate, but a lot of facilities saw a significant loss of assessment coordinators that had been in the role for a number of years.

It was just very overwhelming, and quite frankly, very scaring for some of those folks. I bet. And I'm going to say I was in the nursing home during COVID as medical director attending physician. And I think I spoke with a nurse assessment coordinator on a daily basis about those waivers. And so it  I would hope that  they receive support  and they have to, I mean, I hope, would hope  that medical directors, as a medical director, I would hope that all medical directors are working collaboratively to  ease that burden  as, as they can.  So can you describe how the NAC and the minimum data sets, the MDS, are critical in determining the care plans and ensuring regulatory compliance in nursing facilities?

Of course  as I mentioned earlier, that assessment coordinator is really tasked with making sure the MDS is completed timely and accurately. So, by doing an accurate MDS, the assessment coordinators, in conjunction with the entire interdisciplinary team, take a holistic resident picture to develop a plan of care that meets those resident specific needs.

It's not just  the nurse assessment quarter coordinator, it's not just therapy. It's really a holistic approach with an entire team. And then  we'll take it a step further outside of care planning that MDS is utilized in the survey process. So, by making sure we're completing it accurately.

We also ensure that surveyors have a clear view of the quality care happening in the facility and can easily determine regulatory compliance. At the end of the day, everything comes down to just making sure we've got an accurate assessment of the resident. Yeah, it's so very important. Yeah, that holistic picture.

So, I just want to touch briefly on vaccinations.  Huge thing issue now in when we think about long term care, we know that vaccinations play a role in preventing severe illness in our very vulnerable resident populations of advanced age. chronic medical conditions, making sure that if they do develop illnesses like influenza  COVID, pneumonia, that these illnesses aren't severe and that they can be treated in the facility because we know when residents get sent out to the hospital that they actually have sometimes worse quality of life.

Sometimes their lives are shortened. So we want to make sure that they're stay as healthy as possible. So. We know that misinformation and hesitancy have been significant issues since the pandemic, and so I would love to hear your perspective. How do you and your colleagues navigate these challenges, particularly when it comes to staff and resident vaccinations?

Yeah, I mean, I think it's definitely not a one and done conversation. It's got to be ongoing education and discussions, and even talking through some of the misinformation that is out there can be critical  providing information from accepted sources, the CDC reapproaching residents and staff about the vaccinations periodically I think will help to increase the acceptance.

Of those vaccinations. Yeah, it continues to be an evolving issue, I think. So, staffing shortages. huge during the pandemic. They've really worsened since. And I think I read a statistic that like 99 percent of long term care facilities in the country are facing staffing shortages. So I don't know if the role of the nurse assessment coordinator help address these issues.

And I'm I'm hoping you're not saying that these nurse assessment coordinators are maybe pulled to double duty off their regular  positions  and what strategies, I guess, have you seen to combat these staffing challenges in the facilities you've been in? Yeah, I mean, as I stated earlier there were times that the NACs had to jump in and be those additional caregivers.

and support those direct care nursing staff. At the end of the day, we got into nursing because we care. And so for many of us, it wasn't about, well, if I do this, I can't do my job. It was because we cared and we wanted to help the residents and our buildings, as well as the staff that we work with on a day to day basis.

In terms of combating those challenges going forward what I've personally seen is organizations having a really honed in focus on strong recruiting and retention efforts. Looking at our orientation process, how our new staff welcome to the facility, what interactions is management having with those new staff from day one when they're coming to orientation and then frequent touch bases as they become more oriented to the facility.

I just think it's critical to.  Wrap your arms around those new staff and be as supportive as you can, because they know they can go right down the street to ABC nursing home and get the same job. So, it's really you how do we embrace these new folks? Yeah, I agree. You go down, you drive by any nursing home and they usually have a big flag or a big sign that says hiring nurses immediately come in, walk in interviews so yeah, I would agree.

You really have to wrap your arms around that, those new staff. Yes. Deb, I was going to say, Deb, I don't know if you've seen anything different or have anything else to add. Yeah, I think that the The NAC plays that crucial role in helping the new staff because we're reviewing the resident's medical record, right, to complete that accurate assessment.

So there was a lot of things that we noticed during the pandemic and we continue to notice not only with the changeover in the NACs, but the changeover of the nursing staff. So how can the NAC not only Organizations are working with the new NACs, but how can the NACs work with the new staff?

And I think that they  they play that crucial role because they're the ones that are reviewing the medical record and all the documentation that's in that record from start to end. So there's many times that as the NAC we can discover and alert the nursing staff to potential areas of concern.

Going back to those regulatory compliance issues and in, in many ways, the NAC serves as that chart reviewer, or if you will, like that DOH surveyor. I  many times had people say, oh, Deb's got her surveyor hat on again, because I was doing an MDS and I was in that chart and I was reviewing. What was charted and really sometimes what wasn't charted, but you knew that they had done.

So it's making sure that  as the saying goes, you're dotting your eyes and crossing your T's, but also that the resident is not only receiving. So  it's not receiving the best care  that they can at the facility, but that the staff are documenting that care. So it  they do have to work hand in hand with that IDT team to help and support each other.

Yeah, I agree 100 percent documentation is challenging but so very important. What do you see as the biggest challenge and opportunities for NACs and long term care facilities in general? So, what should the industry focus on to improve resident care and operational effectiveness? The million dollar question.

Yes, that is. And if I had the answer, I think everybody would love to hear that.    I think because of the significance the MDS has in reimbursement the challenge for the NAC is just time management. Not only to make sure that we're completing the MDS accuracy accurately but perform all the other duties that come with the role understanding diagnosis, coding, understanding the timing that can have a huge impact to your reimbursement time to  get back with the hospital and maybe get additional documentation.

So we fully understand the care needs of that resident.  I think another challenge that we're seeing is just the increased number of Medicare beneficiaries that are enrolling in Medicare Advantage plans or managed care, because then oftentimes that facility NAC serves as the case manager and has to frequently provide those updates to those managed care organizations.

So that we can make sure that resident continues to receive the benefits they're entitled to. That's interesting. I'm sorry to  jump in, but I mean, I think then there's a really expanded role like that really proves how important the NACs are with those Medicare Advantage plans. You know now and moving forward.

Absolutely. And I really don't feel that all the long term care facilities or organizations truly understand the complexities of the role, and it's a huge opportunity for long term care to make sure not only that we've got that accurate assessment and care plan, but from a reimbursement perspective that can feed back to that center and be used to improve resident care.

  I think our focus as an industry and I think in Pennsylvania, we're fortunate we do have a very a lot of supportive organizations that are going back to our federal and state governments. And  having that conversation about the need for funding so that we can continue to do what we do in long term care and understand the value of what we do.

Absolutely. So, I would love to get your perspective and, uh, your answer to this question and probably Deb's as well. What advice would you give to an individual who's thinking or looking to become a nurse assessment coordinator? Well, the first thing I would say is you've got to be patient with yourself, just because there are so many areas where the nurse assessment coordinators are expected to be experts.

You've got to be patient because that knowledge is not going to come in a few months or several months. Even coordinators that have been in the role for multiple years still have questions and need support. So  be kind to yourself because it's really going to be a journey to becoming a nurse assessment coordinator.

Don't be afraid to ask questions, be open to learning. And if there was one term I would use to describe this role  it truly is ever changing the new guidance, new regulations that routinely come out.    Honestly, if you're a person that really struggles with change not to discourage anybody, but this may not be the role for you.

But if you're an open minded. person that loves a good puzzle very detailed oriented this definitely could be something that you would enjoy and truly that you're a nurse assessment coordinator at heart when you truly love doing what you do every day.  Outside of all the challenges,

Deb, yeah, I'd love to hear your perspective. Yeah  I really, I couldn't agree more. I mean, I have held just about every type of position you can hold in long term care, but being the RNAC is by far my most favorite  You'll have a lot asked of you. And as Heather said you just want to keep learning and learn who you can trust to give you the best educational experience.

I think that's one thing I found throughout my journey of being an RNAC is. There is a manual. You have to follow that manual. For all the things that Heather talked about the MDS the Casper, the five star quality measures, all of that has manuals. And you just learn who, who are you going to grasp the most education from, whether it's your mentor, a certain consultant that you've had over the years, a webinar speaker that you like and who are we?

We're PAYNAC, so we will always be here to support anyone that wants to take this journey with us. That's fantastic, and Heather and Deb  thank you so much for being with us today. If people want to learn more about PAYNAC, how can they do that? So  we do have a website. It is www. p. A N A C dot net.

So that's pain neck with an extra a dot net.  We also have a gmail account. So if you're interested in learning more or just reaching out to the pain neck board in general, it's a pain neck board at gmail dot com. Very easy. So  we'd love to hear from everybody. Yes, and I encourage anyone who is at all interested, I will say, if I was a nurse, I would want to be a nurse assessment coordinator.

I feel like it's, like, it's very fun. It is. That'll be my next slide. Heather McGowan, Deborah Wright, thank you so very much for joining me today for this conversation. I really enjoyed it. Thank you, Jean. 

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.