PALTtalk

AMDA On-The-Go | Impact of Delirium in PALTC

Dr. James Rudolph
Dr. James Rudolph is a Professor of Medicine at the Warren Alpert School of Medicine at Brown University, Director, Center of Innovation in Long-Term Services and Support at the Providence V.A. His area of expertise is the relationship of atherosclerosis to functional (cognitive and physical) deficits in older persons, particularly after surgery. His research accomplishments include: identification of which patients will develop delirium (acute change in cognitive function) after surgery, survival of nursing home patients who are admitted to the Intensive Care Unit, and the development and validation of the Anticholinergic Risk Scale. He has authored more than 20 publications on this topic.
References:
Rudolph, J.L. et. al., "Dissecting Delirium", Clinical Geriatric Medicine, 2017.
Forsberg, M. "Delirium Update for Post-acute Care and Long-term care settings: A narrative review". Journal of the American Osteophathic Assoc., 2017.
Rudolph, J.L. et. al., "Postoperative Delirium: Acute Change with Long-Term Implications", Anesthesia & Analgesia, 2011.

AMDA On-The-Go | The Evolving Role of the APP in PALTC

Dr. Debra Bakerjian is a clinical professor, at the Betty Irene Moore School of Nursing at UC Davis and the former senior director for nurse practitioner and physician assistant clinical education and practice. She currently teaches interprofessional education and team-based care in areas of quality improvement, geriatrics, and patient safety. Previously, Dr. Bakerjian was a Betty Irene Moore School of Nursing Postdoctoral Fellow with specialties in health policy and system change.
References:
Bryant-Lukosius D., et. al.; "Advanced practice nursing roles: development, implementation and evaluation.", PubMed, 2004.
Bakerjian, D. (2008). "Care of nursing home residents by advanced practice nurses: A review of the literature. Research in Gerontological Nursing", 1(3), 177-185.
Bakerjian, D., & Harrington, C. (2012). "Factors associated with the use of advanced practice nurses/physician assistants in a fee-for-service nursing home practice: A comparison with primary care physicians". Research in gerontological nursing, 5(3), 163-173.
Bakerjian, D. (2018). "Nurse practitioners and primary care for older adults. In Primary care for older adults", (pp. 159-172). Springer, Cham.
Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation, "The Future of Nursing, Leading Change, Advancing Health", National Academies Press (US); 2011.
K. Melillo, PhD, A-GNP-C, FAANP, FGSA, et. al.; "Comparison of Nurse Practitioner and Physician Practice Models in Nursing Facilities", Annals of Long-Term Care: Clinical Care and Aging. 2015
John Iglehart, “Expanding the Role of the Advanced Nurse Practitioner—Risks and Rewards", NEJM, 2013

CMDA Journal Club | June 6

Serotonin Risk / Lee Anneberg
Use of Statin in LTC / Dr. Bruce Smith, & Dr. Gregory Gahm
Journal Club Resources:
Detecting and Managing Serotonin Syndrome PDF
Reexamining Recommendations for Treatment of Hypercholesterolemia in Older Adults PDF

AMDA On-The-Go | Suicide Prevention in Long-Term Care Facilities

Elizabeth Conti, Ph. D.
Dr. Conti is staff Psychologist at the Michael E. DeBakey VA Medical Center, and Assistant Professor at Baylor College of Medicine. She is licensed psychologist in the state of Texas and the embedded psychologist in the Cancer Center and outpatient palliative care at the Houston VA. She is passionate about suicide prevention (particularly for older Veterans), late life mental health, and improving the well-being of medically ill populations. Her post-doctoral training included health services research and quality improvement in large healthcare systems.
 
References:
U. S. Surgeon General Report;"2012 National Strategy for Suicide Prevention: Goals and Objectives for Action", PubMed, 2012.
Stanley, B., et. al. "Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk", Cognitive and Behavioral Practice, May, 2012.
Choy, C., "Suicide in palliative care setting", Annals of Palliative Medicine, Dec. 2017.
Mezuk, B., PhD., et. al."Suicide Among Older Adults Living in or Transitioning to Residential Long-term Care, 2003 to 2015", JAMA, June, 2019.
Miller, D, “When a Patient Dies by Suicide—The Physician’s Silent Sorrow”, NEJM, 2019
VA / Mental Illness Research, Education and Clinical Centers
* Opinions expressed are solely the responsibility of Dr. Conti and do not necessarily represent the views of the Department of Veterans Affairs or the U.S. government.

AMDA On-The-Hill | Volume V

 
 
The latest policy news from Director of Policy and Advocacy Alex Bardakh.
Questions? Email Alex at abardakh@paltc.org
Related Resources:
Navigating PALTC: The Need for Trained and Engaged Medical Directors
Advancing Excellence in Long-Term Care Collaborative letter to CMS
CMS response to Advancing Excellence in Long-Term Care Collaborative letter
Article: Society Urges Congress to Further Improve MACRA
Letter to members of Congress on MACRA
* AMDA-On-The-Hill podcasts are not eligible for CMD credits   
 
 

AMDA On-The-Go | Are SNFs Dealt an Impossible Hand?

Arif Nazir, MD, FACP, CMD, AGSF
Arif Nazir is Chief Medical Officer, Signature Healthcare; President, SHC Medical Partners, and is the president of AMDA – The Society for Post-Acute and Long-Term Care Medicine. Dr. Nazir is also the past chair of its Innovations Platform Advisory Council. He has received many professional awards, most notably the Louisville Business First’s 20 People to Know: Healthcare award in 2018, and the Indiana Hulman Health Achievement Award for Public Health in 2015. He has published his research in several peer-reviewed journals and frequently presents at regional and national platforms on geriatric care issues.
 
References:
Walshe, K., MD, "Regulating U.S. Nursing Homes: Are We Learning From Experience?", Health Affairs, Nov, 2001.
Nazir, Arif, "Time to bet on SNF providers", McKnights Long-Term Care News, March, 2019.
Nazir, Arif, et. al., "No One Cares When Planes Don't Crash: The Message for Long-term Care", JAMDA, May 2019.

AMDA On-The-Go | Patient Driven Payment Model

Rajeev Kumar, MD, FACP, CMD
Dr. Kumar, an honors graduate from Bangalore Medical College in 1993, is the Medical Director for Transitions Hospice (Illinois Region) since April of 2017. Board certified in Geriatric Medicine, Palliative Care as well as Internal Medicine. Doctor is also the President of Midwest Geriatrics, LLC, a physician group that provides medical leadership and clinical services to 40 nursing homes, 20 assisted living facilities and 5 outpatient clinics located in the western suburbs of Chicago. Dr. Kumar is chief medical officer for Symbria, providing pharmacy services for 150 nursing homes across America. Dr. Kumar is also a Certified Medical Director from AMDA and is the immediate past president of Illinois Medical Directors Association. He serves as the medical director for two skilled nursing facilities and is AMDA’s representative on the Professional and Technical Advisory Committee to the Joint Commission and serves as AMDA’s Secretary.
References:
Kumar, R., MD, "SNF Medical Directors and Clinicians in PDPM Have Vital Role", Caring for the Ages, May. 2019
Spanko, Alex, "Cheat Sheets and Timely Visits: How SNFs Can Support Doctors’ Larger PDPM Role", Skilled Nursing News, May, 2019

AMDA On-The-Go | Leadership in Skilled Nursing Homes

Michael Wasserman, M.D.
Michael Wasserman, M.D., is president of the California Association of Long Term Care Medicine (CALTCM). He recently served as CEO for Rockport Healthcare Services. He was formerly the Executive Director, Care Continuum, for HSAG, the QIN-QIO in California. Dr. Wasserman is a graduate of the University of Texas, Medical Branch. He completed an Internal Medicine residency at Cedars-Sinai Medical Center and a Geriatric Medicine Fellowship at UCLA. He spent five years with Kaiser-Permanente in Southern California where he developed a Consultative Geriatric Medical model. Dr. Wasserman was a co-founder and owner of Common Sense Medical Management (CSM2), a case management company that helped manage high risk beneficiaries of Cover Colorado. He is past chair of the American Geriatrics Society’s Managed Care Task Force and presently serves on the Public Policy Committee. He also serves on AMDA's Public Policy Committee, and was formerly a Public Commissioner for the Continuing Care Accreditation Commission.
References:
Wasserman, M., MD "A tectonic shift in nursing homes", McKnights, Feb. 2019
"The Nursing Home Medical Director: Leader & Manager", AMDA, March, 2011
Steven Fuller, DO, PhD, Medical Directors: Why do you Abdicate Your Advocacy with Nursing Homes?", Caring for the Ages, January, 2019
https://twitter.com/wassdoc

AMDA On-The-Hill | Volume IV

 
 
The latest policy news from Director of Policy and Advocacy Alex Bardakh.
Questions? Email Alex at abardakh@paltc.org
Related Resources:
April 18 and May 1 PDPM webinars
Health Policy Advisor article on new payment models
SNF Medical Directors and Clinicians in PDPM Have Vital Role
PALTC Sees Flurry of Legislative and Regulatory Action, but Questions Remain
PDPM White Paper
* AMDA-On-The-Hill podcasts are not eligible for CMD credits   
 
 

AMDA On-The-Go | Appropriate Use of Antipsychotics in LTC Facilities

Lea Watson, MD
Dr. Watson is a board certified adult and geriatric psychiatrist with a lifelong commitment to caring for vulnerable populations, and two decades of academic and leadership experience. Her passion is creating a culture of appropriate psychotropic prescribing in long-term care settings to achieve quality outcomes for all stakeholders. She prioritizes common sense, avoiding harms and keeping the patient’s and family’s goals of care at the heart of all endeavors.  Because of the shortage of geriatric psychiatrists in the United States, she developed a model of consultation and training to extend the reach of this highly needed, but limited specialty.  Dr. Watson is a published author, a recipient of numerous local and national awards for research and teaching, and a multi-year recipient of the Denver 5280 Top Doc award.
References:
Olfson M, King M, Schoenbaum M., "Antipsychotic treatment of adults in the United States.", J. Clin. Psychiatry, 2015
Eva Tan, MD, et. al."Importance of Social Supports Within the Nursing Staff on Agitation in Residents with Dementia", JAMDA
"Reducing Antipsychotic Medication Use in Long Term Care", CFHI, 2014
leawatsonmd.com