August 6, 2020 | Net Health

5 min read

The Process Paradox: Improving SNF Access without Regulatory Risk

Evolving compliance regulations for skilled nursing facilities (SNFs) create a potential paradox. While the data-driven nature of skilled care — especially during the current global pandemic — demands increased access to digital information that helps inform patient treatments, improve outcomes and implement effective cost-management strategies, these new processes also introduce the potential for compliance compromise.

Here’s why: As SNFs streamline staff access to critical assets, risk rises in equal measure. From accidental misuse or disclosure to improperly stored or secured data, the agility now required for SNFs to succeed at scale can create more problems than it solves.

This challenge is a process paradox that can be addressed in these three ways: raising regulatory rigor, addressing access requirements and building a better balance between security and speed.

Raising Regulatory Rigor

The SNF compliance landscape is continually — and rapidly — evolving. As noted by the National Law Review1, previously-issued compliance mandates from The Centers for Medicare & Medicaid Services (CMS) came into full effect on Nov. 28, 2019, after a three-year grace period for SNFs to align existing procedures with new expectations. Skilled nursing facilities that don’t meet these requirements are unable to participate in any Medicare or Medicaid programs, and with CMS surveys occurring unannounced and at any time2, SNFs are faced with the challenge of having to ensure that day-to-day processes continually align with CMS requirements.

And that’s not all — regulatory challenges around PDPM, MDS 3.0 and PBJ Reporting now demand increased data oversight that delivers auditable records of use, storage and modification without negatively impacting patient care. The result? For many SNFs, existing process frameworks simply aren’t designed to handle the regulatory rigor of existing requirements, let alone account for evolving expectations. Here, the shortest path between problem and process typically rests with specialized software capable of improving current documentation compliance while also preparing for future regulatory expectations3.

Addressing Access Requirements

Limited access to information poses problems for patient outcomes. As noted by research from NCBI4, while SNF facilities and those with skilled support represent the fastest-growing segment of post-acute care, the transition between acute and SNF settings is often “fragmented with incomplete clinical information necessary to provide care safely,” in turn creating adverse patient outcomes.

While improving patient prognosis starts with improved interactions between SNF and acute care operators, there’s also an increasing need for adaptable tools capable of improving care operations — such as admissions and scheduling — that also enhance point-of-care processes with actionable patient data. Put simply, the right people need the right access to the right data at the right time.

As a result, addressing access requirements is key. As data storage, handling and reporting expectations evolve, SNFs may want to ensure front-line workers and management staff leveraging patient data have a care-driven reason for doing so — while also making sure these information interactions are captured, secured and available upon request by compliance auditors.

Here, role-based access tools are critical: Granular solutions that allow SNFs to individually assign — and adjust — access permissions on a per-patient basis.  

Building Better a Balance

Rapid response is key to SNF success, especially in the era of COVID-19. As noted by Skilled Nursing News, skilled care facilities are much better prepared to face potential pandemic challenges with access to rapid testing results5 and highly-skilled health professionals6 capable of quickly acting on new data to reduce patient risk.

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This need for speed, however, can introduce the potential problem of data security. If quick access isn’t properly controlled or data sources properly configured to match current SNF frameworks, the results could be doubly disastrous: Negative outcomes for high-risk patients paired with non-conforming use of resident data to support decision-making processes. 

Given their tendency for logistical loggerheads, security and speed are often seen as two sides of the same coin for SNFs. Choosing one negatively impacts the other. But this is a regulatory red herring. These seemingly operational opposites are actually part of a larger compliance continuum that requires balance, not barriers. 

But what does this mean in practice? It starts with transparency: technology tools that give SNFs the insight they need to determine where current processes aren’t entirely secure, where procedural slowdowns are causing patient problems, and where this paradox is most problematic. Skilled nursing facilities also need configurable, customizable tools7 that allow organizations to find functional balance rather than forcing them into one-size-fits-all frameworks. 

The New Skilled Normal

Evolving regulatory, access and security requirements create a process paradox for SNFs. How do they proactively meet protective standards while reducing data fragmentation and enhancing overall security?

While this starts with a recognition of the “new normal” — that both current and post-COVID processes must adapt to improve patient outcomes at scale — there’s now a need for more fundamental change: End-to-end technology solutions paired with improved in-house best practices are essential to ensure skilled staff deliver maximum value to patients without introducing regulatory risk that could put both facility ROI — and operational reliability — at risk.

References

  1. The National Law Review, “How to Prepare for the 2019 Nursing Home Compliance Program Mandate,” December 3, 2018.
  2. Centers for Medicare & Medicaid Services, “Quality, Safety & Oversight – Certification and Compliance for Nursing Homes,” June 24, 2020.
  3. Net Health, “Optima Therapy for SNFs: EMR & Billing Software Overview Video,” 2020.
  4. Simmons S, Schnelle J, Slagle J, et al, “Resident Safety Practices in Nursing Home Settings,” May 2016.
  5. Skilled Nursing News, “Slow Turnarounds Top Nursing Homes’ List of COVID-19 Testing Issues,” July 6, 2020.
  6. Skilled Nursing News, “Researchers Find Link Between RN Staffing, Severity of COVID-19 Outbreaks in Nursing Homes,” June 21, 2020.
  7. Net Health, “Optima Therapy for SNFs — Leading Solution for Therapy Providers for Over 25 Years,” 2020.
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