Solutions for Risk Management

LTCQ’s RiskRx™ (Acrobat required to view) is a proven program that accurately measures risk and provides a comprehensive step-by step process for managing and reducing risk. RiskRx goes far beyond “paper compliance”. It gathers and analyzes data to establish whether policies and procedures have actually been followed and whether or not they have been effective.

Click on the boxes below the Risk Management Services box to go to that topic.

Benefits

• Accurate picture of risk level for the facility, division or corporation
• Measurably lower risk
• Potentially lower insurance premiums

Features

• Comprehensive suite of services including web-based feedback and reports, on-site visits, customized consulting, customer satisfaction surveys, event tracker and staff training
• Risk-adjusted incidence-based outcome measures that do not penalize facilities for treating sicker residents
• Analysis based on our unique databases that comprise over 14 million MDS assessments, loss histories representing approximately 1.5 million bed-years of exposure, and comprehensive, cleaned and pre-analyzed files of CMS data

Impact

Clinical

• Measurably impoved clinical outcomes based on improvements in QMs/QIs
• Proper staffing levels based on acuity of residents
• Documentation check-off ensures accurate medical records and appropriate care planning

Financial

• Lower insurance premiums from several national and international carriers who recognize the validity of the program for reducing risk
• Significant savings from decreased survey deficiencies and investigating “false” QM/QI triggers
• Accurate reimbursement for care provided

Legal

• Decreased risk for litigation
• Defensible documentation
• Put claims in a broader context

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Risk Management Services

On-site Assessments for Skilled Nursing & Assisted Living Facilities

LTCQ conducts site visits that are pre-focused by analyzing public data and claims data, plus MDS data if available. The site visit uses a standardized protocol for reliability and validity. The scope of the site visit includes:

• Structured review of policies and procedures
• Physical inspection of the facility
• Staffing-to-acuity assessment
• Assessment of the knowledge, skills, and attitudes of the facility’s leadership
• Special attention to issues that have led to poor or deteriorating quality measures, negative surveys, or claims

The results are provided for each facility as a risk management prescription – a plan of action for improving the facility’s risk. The priorities in the risk management prescription are determined using LTCQ’s validated claims prediction model. The issues that get the highest priority are the ones with the most influence on the facility’s risk of a claim.

Education & Training Programs

LTCQ provides two full-day Risk Management programs. The programs have content designed for both administrators and clinical leaders. Durable educational materials are provided. Program content includes survey preparedness, management of adverse events, and a selection of clinical topics representative of the needs of the majority of long term care facilities.

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Risk Management Event Reporter (RME)

The Risk Management Event Reporter is a Web-based system for reporting Risk Management Events (RMEs), such as incidents and accidents, near misses, records requests, and formal complaints. The system tracks and trends events and guides the facility in its efforts to prevent future RMEs and subsequent losses. A unique feature of the RME Reporter is a “Control Panel” – a single Web page that shows the facility administrator the current status of all RMEs.

Staffing to Acuity Analysis

Based on public access data and MDS data when available, LTCQ determines the minimum staffing levels and staffing schedule needed to provide adequate care and patient safety. In setting criteria for adequacy of staffing, LTCQ uses both expert consensus and statistical analysis of nationwide staffing practices.

At the beginning of a Risk Management engagement LTCQ obtains payroll records, staff rosters, and Form 671 and correlates all of these with each other and with the public access staff report, to ensure that all are consistent. LTCQ assists the facility in correcting errors and advises the facility on where adding or re-assigning staff is likely to improve quality of care, patient safety, or regulatory compliance. Ongoing reviews of staffing can be performed quarterly.

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Event Driven Customer Satisfaction Survey

LTCQ utilizes the MDS to deliver a unique customer satisfaction measurement system. Using the MDS LTCQ identifies specific clinical problems – e.g., falls, wandering, behavior problems, pain – and calls families to ask their opinion about the facility’s care for those specific problems. This approach is complementary to the generic, broad, questionnaire-based approaches that are common in the long term care industry. However, by focusing on potential sources of major dissatisfaction among families, the LTCQ approach provides facilities with early warning of claims risks related to care quality, poor family communication, or setting of appropriate expectations of care.

Data Integrity Audit™

The Data Integrity Audit (Acrobat required to view) is a Web-based tool that audits MDS data before submission to the state or incorporation into the permanent medical record. The MDS Coordinator submits MDS data electronically and gets instant feedback on:

• Coding errors
• Logical inconsistencies
• Clinically improbable situations
• Inconsistency of symptoms with conditions and diagnoses
• Inconsistency of treatments with diagnoses and indications
• Situations requiring special documentation in the clinical record (e.g., justifying ultra high rehabilitation in a resident with only mild functional impairment)

The MDS Coordinator either changes items flagged by the audit or verifies that necessary documentation is present. The MDS is then submitted to the state and incorporated in the permanent clinical record.

Use of the Data Integrity Audit makes MDS data more reliable and valid – and more useful in measuring performance and identifying high risk situations. It also helps ensure fair reimbursement for the facility and greater defensibility of its assessment processes and overall care quality in the event of a negligence claim.

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Performance Portfolio™

LTCQ’s Performance Portfolio (Acrobat required to view) provides comprehensively risk-adjusted insights into your facility's clinical performance. Reports track five (5) quarters of data from your facility benchmarked against regional and national averages. Online QI/QM reports are updated with every MDS submission, giving a current picture of facility performance. Easy-to-use online reports provide early identification of resident risk factors so focused interventions can be used to improve resident outcomes.

The incidence-based, rather than prevalence-based, performance measures "level the playing field" between facilities. There is no longer a penalty for admitting sicker patients or specializing in Alzheimer’s, wound care, etc.

Benefits

• Gives objective performance measurements compared to relevant benchmarks (internal, regional, state or national)
• Tracks compliance to and effectiveness of policies and procedures across an organization
• Client facilities are always survey-ready

Loss Control

LTCQ's MDS-based risk analysis provides the data to help decide which cases should be aggressively defended and which case have merit and should be settled promptly. We use clinical and analytic expertise, in-depth industry knowledge, proprietary databases and innovative predictive models to put claims into a broader context.

Our use of objective analyses accurately assess a facility's performance and then benchmarks it against a set of relevant peers. LTCQ's reports are recognized as valid and unbiased by the CMS Office of the Inspector General, State Attorneys General offices and major liability insurers.

LTCQ can also provide expert witness testimony.

Read Success Stories from our clients.

Please contact us to discuss your specific needs.

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