CMS-10246 CMS-10246.interview_inst_mgmt

Form IMGT-20071116

MEDICARE POST-ACUTE CARE PAYMENT REFORM DEMONSTRATION

Institution/Facility Nursing & Therapy Management Interview Protocol
Acute Hospitals, Long Term Care Hospitals, Inpatient Rehabilitation Facilities &
Skilled Nursing Facilities

[Provider Name]
Medicare Provider ID Number: [XXXXXX]

Names and Titles of Interviewee(s):
[Name 1 (Title 1)]; [Name 2 (Title 2)]; etc.

The focus of this study is to understand the variation in patient care resource use and costliness both within a particular setting as well as across settings. Ultimately, the purposes are to better understand the characteristics, care, expense and outcomes of different types of patients seen in different post acute settings; identify the variable cost for providing appropriate, high-quality care to each type of patient, regardless of setting; and identify fixed costs unique to each setting.

The goals of this interview are for us to: (1) understand the range of services provided on the study unit(s) as well as patient characteristics that influence the need for those services; (2) understand the number and range of staff on the participating unit(s); (3) determine whether nursing and therapy staff are generally “assigned” to units or rather routinely work across units (e.g., assigned to patients, and the patients are in many units); and (4) clarify language used in training sessions and on forms so that it is consistent with your facility’s practices.

Section A: Organization Overview

1. Please describe the participating unit(s) and their patient populations. For each participating unit, please provide:

   1. The unit’s name (e.g., Ventilator Unit, 6th Floor, etc.).

   2. The number of beds on the unit.

   3. The unit’s average daily census (ADC) for the past 6 months. What is the typical range of the unit’s census?

   4. The unit’s average length of stay.

   5. The type of patients treated on the unit, such as the patient’s diagnoses (e.g., musculoskeletal trauma) and service needs (e.g., ventilator). What is the nature of the services provided to these patients?

Section B: Staffing

2. Please describe the staffing of each of the participating unit(s):

   1. What is the length of each nursing shift? Do therapy staff typically work nursing shifts? If not, what is the length of a typical therapy staff day, and when does it begin and end? Do shift lengths and amount of therapy services differ between weekends and weekdays?

   2. Are nursing and therapy staff generally “assigned” to units or rather routinely work across units (e.g., assigned to patients, and the patients are in many units)? How does this differ by type of therapist or other factors?

   3. How frequently do nursing and therapy management and other administrative staff (staff whose primary duties are administrative, not direct patient care) provide direct patient care on the unit? How frequently do such supervisory staff meet one-on-one with their direct reports to discuss patient care? How frequently do they attend team meetings?

   4. Do any of the participating units have teaching/training programs for residents, medical students, nursing students, therapy program students, etc.? If so, what staff take part in these training programs as teachers/preceptors/mentors? Do students provide direct care?

   5. For each participating unit, how many of the following staff typically work on the unit for each shift? How does this differ for weekends or holidays? Please provide the following information for each unit separately.

      Staff Category	Staff Type	Number Working on Weekday Day and Evening (8-hour) or Day (12-hour) Shifts	Number Working on Nights	Number Working on Weekends	Regularly on Unit, or Only as Needed?
      Nursing Staff	RNs
      	LPNs/LVNs
      	Nursing Assistants/Aides
      	Advance Practice Nurses/NPs
      Therapy Staff	Physical Therapists
      	Occupational Therapists
      	Respiratory Therapists
      	Speech/Language Pathologists
      	Therapy Assistants
      	Therapy Aides
      Social Work/Case Management	Social Worker
      	Case Mgr./Discharge Planner
      	Utilization Review
      Other Professions	Physicians
      	Physician Assistants
      	Pharmacists
      Managerial Staff	Nurse Manager
      	Therapy Staff Manager
      	Discharge Planning Manager
      Other	Unit Secretary/Clerk
      	Other (please describe)

   6. What are the nursing ratios (nursing staff per patient day, by staff type/discipline) by shift for this unit(s) and how are the ratios determined?

   7. What are the therapy staffing ratios (therapy staff minutes per patient day, by therapy staff type/discipline) for the unit(s) and how are the ratios determined?

   8. Does your facility have nursing staff whose exclusive duties are assessment data (e.g., IRF-PAI, MDS) collection? If so, are they assigned to specific patient care units?

3. Does your facility use a patient acuity and/or functional scoring system? If so, which one? Please provide a copy. Also:

   1. For how long have you used it?

   2. Do you use the same tool for all units?

   3. Why do you use this particular system and what are its strengths and weaknesses?

   4. If you do not use an acuity scoring system, how do the nurses and therapists communicate patient and unit acuity across shifts?

4. Are there other factors beyond patient acuity and census that influence your staffing? For instance, are there state regulations on nursing ratios or restraint use; union collective bargaining agreements specific to your facility; hiring freezes due to budgetary concerns, etc.?

Section C: Ancillary Services

5. We will also collect information on ancillary services (imaging, tests, dialysis, etc.) provided to patients in the study unit(s) by the facility. Please refer to the list on the following page.

   1. Please indicate which of the following list of services are either provided in your facility or would require transfer to another facility if they were necessary.

   2. Are there any high-cost ancillary services that you provide in this facility that are not listed in the table on the following page?

   3. Are there any high-cost services for which you transfer patients to another facility to receive that are not listed in the table on the following page?

Imaging/Radiology	Other Diagnostics	Complex Treatments
Angiogram	Arterial Blood Gas	Complex Bowel
Aortogram	(ABG)	Management (specify)
Arthrography	Bedside Bronchoscopy	Continuous Cardiac
Bone Densitometry	Complex Pharyngeal &	Monitoring/Telemetry
Cholangiography	Speech Evaluation	Hemodialysis
Cisternography	Other Diagnostics	Intermittent Bladder
Diskography	(specify)	Catheterization
Echocardiogram		Multiple IV Antibiotic
EKG		Administration
GI Series (Upper or		Negative Pressure
Lower)		Wound Therapy
Lymphangiography		Peritoneal Dialysis
Mammary Ductogram		Total Parenteral Nutrition
Modified Barium		Ventilator Management
Swallow		(Weaning Only)
MRI		Other Complex
Myelography		Treatment (specify)
Ultrasound (specify)
Urethrocystography
Urography
Venography
X-Ray
Other Imaging (specify)

6. Is there anything else you feel that RTI should know about the organization or staffing of the participating unit(s) for the purposes of either setting up data collection procedures or better analyzing and interpreting the data collected?

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