1. QUALITY SYMPOSIUM FEBRUARY 24, 2012 Mary K. Ousley

2. Improving Our Relationship with CMS History  Medicare 1965  Institute of Medicine 1986  Omnibus Reconciliation Act of 1987 Stronger Federal role in improving quality; Revision of performance standards, inspection process, and remedies to improve nursing home services; Better training for staff; Create a dynamic and evolutionary survey process. Enforcement provisions apply to those who are unwilling or unable to achieve and sustain compliance.

3. Improving Our Relationship with CMS Omnibus Reconciliation Act of 1987  Eliminate hierarchy of conditions, standards and elements (nursing facilities compliance, expectations would forever be different)  If a State finds, on the basis of a standard, extended, or partial extended survey under subsection (g)(2) or otherwise, that a skilled nursing facility no longer meets a requirement of subsection(b),(c), or (d), a  Compliance determined according to the degree or likely degree of harm.  Resident assessment and plan of care sets the standard of expectation of facility performance.  Quality Assessment & Assurance (facility internal controls) becomes a requirement.

4. Improving Our Relationship with CMS

5.  Current Environment  Affordable Care Act  Deficit  Customer/Stakeholder Expectations Value  End Old Debate  Regulatory Model Cycle  No, because!  Silo Operation

6. Improving Our Relationship with CMS  Current Environment  Affordable Care Act  Deficit  Customer/Stakeholder Expectations  Value  End Old Debate  Regulatory Model Cycle  No, because!  Silo Operation

7. Improving Our Relationship with CMS Achieve & Sustain Compliance  Proactive  Continuous  Data Driven Management Quality Control Improvement Opportunities Improvement Plans Improving Core Process/Outcomes  Share Best Practice

8. Improving Our Relationship with CMS Achieve & Sustain Compliance  Proactive  Continuous  Data Driven Management Quality Control Improvement Opportunities Improvement Plans Improving Core Process/Outcomes  Share Best Practice

9. Improving Our Relationship with CMS Internal Controls, Quality Assurance Ensures:  Organization  Early Identification of low performers Outcomes of care, turnover, customer satisfaction, regulatory results, financial. Aggressive sustainable comprehensive plan

10. Improving Our Relationship with CMS Internal Controls, Quality Assurance Ensures:  Organization  Early Identification of low performers Outcomes of care, turnover, customer satisfaction, regulatory results, financial. Aggressive sustainable comprehensive plan

11. Improving Our Relationship with CMS  Collaboration at All Levels:  State “All Politics is Local” Community Outreach State Association Advancing Excellence Quality Improvement Organization  Region  Central Office

12. Improving Our Relationship with CMS  Collaboration at All Levels:  State “All Politics is Local” Community Outreach State Association Advancing Excellence Quality Improvement Organization  Region  Central Office

13. Improving Our Relationship with CMS A New Health System for the 21 st Century  Six Aims:  Safe  Effective  Patient-Centered  Timely  Efficient  Equitable  Values and Principles  CARE: High quality, person-centered care that respects individual choice and nurtures the physical, emotional and spiritual.  STAFF: Value, respect our staff, ensure the training and resources necessary to deliver highly skilled compassionate care.  LEADERSHIP: Empower our staff to embrace innovation and to create a rich environment for those in our care.  TRUST: Communicate with honesty and clarity and to treat each other with respect.  TRANSPARENCY: Accountable to meet the needs of our residents, patients and families and to share this information freely.  STEWARDSHIP: Managing our resources in accordance with the needs of those we serve and our surrounding community. Crossing the Quality Chasm: AHCA MEMBER COMMITMENT

14. Improving Our Relationship with CMS A New Health System for the 21 st Century  Six Aims:  Safe  Effective  Patient-Centered  Timely  Efficient  Equitable  Values and Principles  CARE: High quality, person-centered care that respects individual choice and nurtures the physical, emotional and spiritual.  STAFF: Value, respect our staff, ensure the training and resources necessary to deliver highly skilled compassionate care.  LEADERSHIP: Empower our staff to embrace innovation and to create a rich environment for those in our care.  TRUST: Communicate with honesty and clarity and to treat each other with respect.  TRANSPARENCY: Accountable to meet the needs of our residents, patients and families and to share this information freely.  STEWARDSHIP: Managing our resources in accordance with the needs of those we serve and our surrounding community. Crossing the Quality Chasm: AHCA MEMBER COMMITMENT