June 2020
Opinion: Survey and Documentation Requirements Present Challenges to LTC During Pandemic
Daniel Haimowitz, MD, FACP, CMD
Paula G. Sanders, Esq.
It is frequently said that the nursing home industry is the second-most regulated industry, only behind the nuclear power industry. The reason for this governmental oversight is easily understood as an attempt to ensure quality and accountability. Collection of data is an important aspect of these efforts.
However, in this time of unprecedented crisis, what has worked previously may not only not work, but might even be harmful to residents and staff.

The reality is that when COVID-19 strikes a long-term care facility--nursing homes and assisted living/personal care communities--there are suddenly large numbers of seriously ill residents, shortages of staff, personal protective equipment (PPE), and testing; those able to work are overwhelmed with staff education and anxious family members. The usual process of surveys, fines, blame and lawsuits is entirely unnecessary, counterproductive and inappropriate for this pandemic. To rub salt in the wound, the fears of long term care facilities that premiums for liability policies may be going up by 80% – 200% are proving warranted.

State and federal governments have made many admirable efforts to help health care providers focus their attention where it belongs—on patient care and not paperwork. Many regulations have been loosened, temporary waivers implemented to remove barriers, and most surveys temporarily suspended -- except for focused infection control inspections and instances of alleged immediate jeopardy.The Centers for Medicare and Medicaid Services CMS is developing the Coronavirus Commission for Safety and Quality in Nursing Homes. Several governors and legislatures around the country are attempting to address liability concerns.

Problems still remain. The CMS have stated that they intend Infection Control surveys to be “streamlined … to minimize the impact on provider activities, while ensuring providers are implementing actions to protect the health and safety of individuals to respond to the COVID-19 pandemic.” QSO-20-20-ALL (March 23, 2020). Unfortunately, this has not been the experience for many nursing homes to date. Worse, CMS describes their desire to “enhance federal and state enforcement strategies to improve compliance with infection control policies” in punitive terms. On June 1, 2020,CMS directed every state to complete on-site focused infection control surveys by July 31, 2020 to avoid putting the states’ CARES Act supplemental funding at risk. QSO-20-31-ALL (June 1, 2020). CMS has indicated they will increase Infection Control surveys in order to increase fines and deficiencies. Unfortunately CMS continues to articulate its motives in terms of “enforcement,” rather than emphasizing ways to improve resident care.

PMDA Relaunches Popular PALTC Practitioners' Forum
The Pennsylvania Society for Post-Acute and Long-Term Care Medicine (PMDA) is relaunching the PALTC Practitioners’ Forum, a listserv designed to enhance communication and collaboration among PMDA members. The email only forum can only be accessed by PMDA members,

“The intent of the forum is to foster discussion and information sharing regarding administrative, clinical, and best practices issues related to LTC medicine” noted President Brian B. Kimmel, MD, CMD.  “PMDA Members can join the forum by emailing a request to pmda@pamedsoc.org .”

Here’s how it works. PMDA members submit questions or topic issues to PMDA at: pmda@pamedsoc.org . The forum manager reviews the question for appropriateness, content, and clarity. If approved, the message, minus the sender’s name, is posted to the forum. Forum members can then reply to the posted message at their discretion, by responding to “all.” To opt out of the forum at any time, members simply send an email to pmda@pamedsoc.org with UNSUBSCRIBE in the subject line and their full name in the body of the email. The request will be processed within two business days.

Forum guidelines and participation rules including important disclaimers regarding the control and accuracy of the content and the nature of the opinions expressed can be found here .
The PMDA Trainee Education Fund supports PMDA’s efforts to educate, recognize and inspire post-acute and long-term care clinicians in training in the benefits and rewards of a career in the PALTC continuum. Your contribution will allow us to continue to offer complimentary registration to the Annual Symposium for fellows, residents and students and support PMDA’s contribution to AMDA’s Futures Program. Help us invest in the future of practice in PALTC medicine.
Upcoming PMDA Events

  • Regional Meeting - 9/15/20 - Six (6) locations and individual virtual attendance. Registration fees: $25 PMDA Members; $30 non-members.
  • Fall Board Meeting - 11/5/20 - Hotel Hershey, Hershey, PA
  • 2020 Annual Business Meeting - 11/6/20 - Hotel Hershey, Hershey, PA
  • 28th Annual Symposium - 11/6/20 - 11/7/20 - Hotel Hershey, Hershey, PA
PMDA COVID-19 (Coronavirus) Update:
PMDA is very aware of the concerns with the spread of the coronavirus. The PMDA board and staff are closely following and monitoring the situation on a daily basis. We will provide regular updates to the attendees and PMDA members. 
PMDA's Archived Webinars
COVID-19 in Your Facility: Getting Ready & Getting Through
Presented by Sabine von Preyss-Friedman, MD, CMD
Associate Clinical Professor of Medicine, University of Washington
Chief Medical Officer, Avalon Health Care Inc., a provider of Skilled Nursing Facilities and Assisted Living

The one-hour webinar reviews current epidemiology, describes when to test and lists best practices for both COVID-19 naïve and COVID-19 positive facilities. 
Upcoming Webinars
Unifying Risk Assessment Strategies Across the PALTC Care Continuum
Date: June 17, 2020
Time: 2:00PM – 3:00PM

A Proven Formula for Improving Outcomes, Increasing Medication Safety, and Reducing Healthcare Costs: Demonstrating the Value of Integrating Clinical Pharmacy Services into the Patient Care Team
Date: June 24, 2020
Time: 2:00PM – 3:00PM
Recently Archived Webinars
AMDA, ADVault Partner on ACP Toolkit

The Society has partnered with ADVault to offer the AMDA Advance Care Planning (ACP) Toolkit to providers utilizing ADVault's Facilitated ACP Collaborate™ solution. Both products provide interactive dashboards that present detailed ACP activity, an audit trail and tracking of time spent rendering ACP activity, optional practitioner review of the ACP documents, reporting to support up-to-date management of ACP activity, and more. They also offer the ability to view, print, and download to PDF or CCDA; record an optional practitioner review; and provide feedback and confirmation of the ACP alignment with the resident's stated goals. 
AMDA On-The-Go
Podcast Series
AMDA COVID-19 Grand Rounds

AMDA is hosting a FREE series of moderated discussions on current clinical topics and controversies in the treatment of COVID-19 in PALTC. Join us for AMDA COVID-19 Grand Rounds: Pearls from Your Colleagues on June 4, 11, and 18 at 6 PM ET.