AMDA On-The-Go Podcast:

1. AMDA On-The-Go Podcast: A Review of 2018

2. What is it? • AMDA On-The-Go Podcasts are 20-30 minute long discussions with Dr. Wayne Saltsman that include expert interviews, journal article reviews, policy updates, and innovation news. • These podcasts are eligible for ABPLM medical director credits. • New podcasts are released approx every 2 weeks.

3. Where can I find it? Find it online at https://paltc.org/podcast Find it on Pod Bean at https://paltc.podbean.com/ Find it on iTunes Find it on Google Play

4. Topics of 2018 • Through the Eyes of an Administrator • DM Management in LTC • Optimistic Project • Opioids and Pain Management • UTI Prevention and Management • Fall Risk Reduction • Policy Updates x 3 • Physical Therapy in PA/TC • SNF/ER Transition Process • The Care of LGBT Persons in PA/LTC • Effects of Legal Access to Cannabis • Burnout • Home Based Primary Care • Antibiotic Stewardship • Deprescribing • Telemedicine • Frailty • Core Competencies • Innovation Updates • Predictive Models of Care • Management of Sepsis

5. Topics of 2018 • Through the Eyes of an Administrator • DM Management in LTC • Optimistic Project • Opioids and Pain Management • UTI Prevention and Management • Fall Risk Reduction • Policy Updates x 3 • Physical Therapy in PA/TC • SNF/ER Transition Process • The Care of LGBT Persons in PA/LTC • Effects of Legal Access to Cannabis • Burnout • Home Based Primary Care • Antibiotic Stewardship • Deprescribing • Telemedicine • Frailty • Core Competencies • Innovation Updates • Predictive Models of Care • Management of Sepsis

6. Topics of 2018 • Through the Eyes of an Administrator • DM Management in LTC • Optimistic Project • Opioids and Pain Management • UTI Prevention and Management • Fall Risk Reduction • Policy Updates x 3 • Physical Therapy in PA/TC • SNF/ER Transition Process • The Care of LGBT Persons in PA/LTC • Effects of Legal Access to Cannabis • Burnout • Home Based Primary Care • Antibiotic Stewardship • Deprescribing • Telemedicine • Frailty • Core Competencies • Innovation Updates • Predictive Models of Care • Management of Sepsis

7. Deprescribing Aired 5/7/2018, Dr. Wagle, Dr. Mahajan, John Derr, RPh • A major driver in system costs were pharmaceuticals at 1.5-3x that of other countries • No other category of spending accounted for as much of the cost difference in total per capita healthcare as pharmaceuticals • Medication Reconciliation is a necessity! • 1 out of 5 ED visits by elderly are for adverse drug reactions • The potential for medication reactions (either positive or negative) for elders taking 7+ medications is 100%

8. Deprescribing Aired 5/7/2018, Dr. Wagle, Dr. Mahajan, John Derr, RPh • In a 1997 Western Journal of Medicine article titled “Optimal medication use in elders. Keys to successful aging”, they state “the proper use of medications was the single most important medical strategy in care of elderly”. • Multiple comorbidities will require multiple medications...or is it a prescription cascade? • Geriatrician should be managing entire scope of prescriptions, in partnership with pharmacist (can use specialists but be involved in the prescribing!!!!) • Don’t forget to look at OTC!

9. Deprescribing Aired 5/7/2018, Dr. Wagle, Dr. Mahajan, John Derr, RPh Barriers: • Patient and Family • Interdisciplinary Team • Providers

10. Deprescribing Aired 5/7/2018, Dr. Wagle, Dr. Mahajan, John Derr RPh What can we do? • There are validated tools for this available (STOPP and START, BEERS Criteria) • Use process mapping (where in the process can we intervene and how? Team rounds, QAPI, DC planning? Who can take ownership of meds?) • INVOLVE patient and family, reassure them you will be present for the entire process (titrations, discontinuations, follow up)

11. Topics of 2018 • Through the Eyes of an Administrator • DM Management in LTC • Optimistic Project • Opioids and Pain Management • UTI Prevention and Management • Fall Risk Reduction • Policy Updates x 3 • Physical Therapy in PA/TC • SNF/ER Transition Process • The Care of LGBT Persons in PA/LTC • Effects of Legal Access to Cannabis • Burnout • Home Based Primary Care • Antibiotic Stewardship • Deprescribing • Telemedicine • Frailty • Core Competencies • Innovation Updates • Predictive Models of Care • Management of Sepsis

12. Innovations Aired 07/16/2018, Dr. Steven Buslovich and Adam Sobol Features winners of AMDA’s Shark Tank 2018 Competition Patient Pattern by Dr. Buslovich • Can we identify magnitude of frailty? • Program takes MDS Data and applies to a frailty assessment to predict decline and poor outcomes • Can notify providers of who needs to be seen and who is triggering for poor quality metrics • Scores can be mapped and trended over time

13. Innovations Aired 07/16/2018, Dr. Steven Buslovich and Adam Sobol https://patientpattern.com/

14. Innovations Aired 07/16/2018, Dr. Steven Buslovich and Adam Sobol Care Bands with Adam Sobol • Wearable real time indoor and outdoor tracking technology for patients with dementia • Operates without wifi or cellular technology • Algorithms analyze daily activities for indicators of decline or other complications. • Can create daily activity reports for family members

15. Innovations Aired 07/16/2018, Dr. Steven Buslovich and Adam Sobol https://carebandremembers.com/

16. Topics of 2018 • Through the Eyes of an Administrator • DM Management in LTC • Optimistic Project • Opioids and Pain Management • UTI Prevention and Management • Fall Risk Reduction • Policy Updates x 3 • Physical Therapy in PA/TC • SNF/ER Transition Process • The Care of LGBT Persons in PA/LTC • Effects of Legal Access to Cannabis • Burnout • Home Based Primary Care • Antibiotic Stewardship • Deprescribing • Telemedicine • Frailty • Core Competencies • Innovation Updates • Predictive Models of Care • Management of Sepsis

17. The Optimistic Project Aired 09/24/2018, Dr. Kathleen Unroe - In 2012 CMS created an initiative to reduce avoidable hospitalizations among nursing home residents - They partnered with 7 different enhanced care and coordination providers (ECCPs) across the US - Each ECCP chose a different approach to improve care and reduce hospitalizations, then each were evaluated for its effectiveness - Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care

18. The Optimistic Project Aired 09/24/2018, Dr. Kathleen Unroe OPTIMISTIC had 3 intervention goals designed to reduce hospitalizations • Enhance medical care through the prompt identification and management of acute issues and improve proactive chronic care management • Optimally manage transitions 3. Integrate Palliative care and Advanced Care Planning

19. The Optimistic Project Aired 09/24/2018, Dr. Kathleen Unroe Phase 1 (4 year project, started September 2012) • Placement of 19 specialized RNs in several nursing homes - Use of NPs to see patients acutely for change of conditions and to do detailed transition visits

20. The Optimistic Project Aired 09/24/2018, Dr. Kathleen Unroe Phase 1 showed a significant impact! • Reduced relative risk of potentially avoidable hospitalizations by 32.6%. • Reduced all-cause hospitalizations by 19.3%. • Reduced relative spending for avoidable hospitalizations by 24.9% per resident. • Produced net savings of $3.4 million in Medicare expenditures.

21. The Optimistic Project Aired 09/24/2018, Dr. Kathleen Unroe Phase 2- still underway….. https://www.optimistic-care.org/ In 2016 OPTIMISTIC received another CMS award to explore a new payment model GOAL to incentivize providing higher levels of care on site instead of sending residents to the hospital There are 6 qualifying conditions: PNA, UTI, Cellulitis, COPD, CHF, dehydration

22. Topics of 2019….so far - Ethics - Treating and Preventing C. Diff - Personalized Music Listening for ALF Residents with Dementia - Acute Care Readmissions

23. Have an idea for the next podcast? You can suggest the next topic idea online at https://paltc.org/podcast

24. Thank You!