A Hero Had Three (3) Zeros: One SNFs Journey to Better Patient Outcomes, Cost Management and Zero Deficiencies

Abstract Body: Introduction: In 2014, (CMS) implemented the ‘Improving Medicare Post-Acute Care Transformation’ (IMPACT) Act mandating SNFs providing Medicare Part A care to report quality measures on patient outcomes, processes, and cost1. These measures drive SNFs reimbursement and penalties under the MIPS2. In 2018, CMS fined SNFs $36,152,700.00 with 11,251 payment denial days nationally3. In total, of the 15,600 LTCs providing services to patients nationwide, 86% are SNFs, totaling 1,660,400 certified beds4. Objectives: Empower bed-side staff on a sustainable skin integrity program to improve quality while reducing cost. Methods: In 2018, a 110-bed SNF in St. Louis, MO decided to improve processes around skin care. A NEW and SIMPLE one-page tool based on the SSKIN5 bundle was implemented. The tool integrated KEY policies, procedures, skin assessment and documentation as well as identification of urinary tract infection symptoms6.  On-going education and competencies were built around the concepts of the tool to drive applicability, retention and sustainability with a holistic approach among all bed-side care staff. Results: The SSKIN bundle tool led to a statistically significant reduction in pressure ulcers , UTIs, and incontinence associated dermatitis (IAD), with a mean reduction from 55.4 events to 3 per month (p-value: 0.0001), 37 events to 5.6 per month (p-value: 0.005), and a mean 40.2 events to 3.9 per month (p-value: 0.0225) respectively. This led to the first ever zero-deficiency audit in peri-care in May 2018, and again in June 2019.  A statistically significant reduction in skin care product spend  was also achieved with an average monthly decrease from $2,311.40 to $1,288.50 (p-value: 0.0112) along with a reduction in supplement cost by 18.4%. Conclusion: Consistency proves a strong benefit to patient-centered care when multi-disciplinary  teams work collaboratively to reduce and prevent conditions (PU, UTI, and IAD). Approaches incorporating best practice impacted quality metrics with verified compliance sustainability.