AMDA – Dedicated to Long Term Care Medicine Statement in Response to OIG Report on Adverse Events in SNFs

March 3, 2014
Perry Gwen Meyers,

The core of AMDA – Dedicated to Long Term Care Medicine (AMDA’s) mission is to improve and advance the quality of care provided to post-acute and long-term care (PALTC) patients. Much has improved in this setting over the years, and the recent Office of the Inspector General (OIG) Report on Adverse Events in Skilled Nursing Facilities reinforces that there is still much to be done. 

The combination of complex comorbidities of this patient population and a complex regulatory environment make caring for patients in this setting a challenge unlike any other setting. AMDA welcomes the OIG report for its thoughtful assessment of the PALTC environment of misadventures. There has been a lack of data surrounding harmful events specific to this setting, and this report should serve as a springboard for a national discussion on the care of frail elders and how it can be improved. Also absent have been educational and quality measurement tools specific to the setting. 

AMDA is already working on many initiatives that aim to reduce the rate of adverse events in PALTC settings.

  • In 2013 AMDA finalized competencies to provide attending physicians practicing in PALTC with an evidence-based framework for the unique set of knowledge and skills necessary to facilitate quality outcomes in this setting. AMDA developed these competencies in collaboration with a large number of health care groups and they have earned the support of the key organizations in PALTC. AMDA is now developing a training curriculum to support these competencies.
  • In an effort to appropriately measure quality of care in PALTC, AMDA has submitted Physician Quality Reporting System (PQRS) measures to the Centers for Medicare & Medicaid Services (CMS), which align with quality goals for skilled nursing facilities and other PALTC settings. AMDA continues to be actively engaged in defining and promoting clinical quality measures that are appropriate to the PALTC patient population.
  • In 2013, the National Quality Forum approved two quality measures on dementia, “Persistent Indicators of Dementia without a Diagnosis,” for long-stay and short-stay respectively, submitted by AMDA. These measures are designed to be used by facilities as standards to set goals and pursue performance improvement for persons with dementia.
  • As part of the ABIM Foundation’s Choosing Wisely campaign, AMDA identified five tests or procedures common in PALTC that may be unnecessary or even cause harm. The list encourages communication between health care providers, patients, and families.
  • AMDA has an extensive collection of educational and informational resources focusing on prevention, diagnosis and treatment of many adverse events, including its Clinical Practice Guidelines (CPGs), a series of 22 evidence-based, standard care processes for PALTC patients, and a growing number of CPG implementation manuals.
  • In late 2013, with funding from AHRQ, AMDA released a free interactive professional development program aimed at improving care for dementia patients. With a goal of decreasing the inappropriate use of antipsychotic medications for nursing home residents and improving the overall quality of care given to persons with dementia, the program includes one course for prescribers, and one for non-prescribers.

AMDA members – trained and credentialed medical directors and attending physicians – work diligently and passionately every day to provide quality care and to improve the quality of care in the nursing home. The challenge posed by the results in this report will be to determine where care can be improved, create the programs to do so, and then to implement them. The specific findings in this report provide a useful framework for us to do so. 

AMDA looks forward to partnering with other organizations and agencies as we continue to advocate on behalf of PALTC practitioners and patients; to promote clinician education; to create resources and tools specific to the PALTC continuum; and above all to improve the quality of care provided to the nation’s frail elders.