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Poodle skirts and rolled up jeans will be in fashion at the Sock Hop during CPO's Spring Convention

 

By Jim Stafford
CPO Content Creator

There was a scene in the 1984 movie Sixteen Candles where a group of nerdy young men attend a school dance, lined up against a wall watching the girls, but too intimidated to ask any of them to dance.

That was me in the 1960s at any activity that included girls and dancing, My fellow nerds and I wiled away the time while talking a big game but never leaving the wall we were leaned up against.

Sigh.

I've written this because Care Providers Oklahoma has scheduled its own version of the 1960s Sock Hop at its annual Spring Convention and Trade Show April 30-May 2.

Our throwback "Twist and Shout" event, sponsored by PharmcareUSA/Oklahoma, will occur from 8-10 pm on May 1 at the Embassy Suites & Convention Center in Norman. It's all part of the Music of the Decades theme of the Convention and all of our major events this year. Register!

We're going to be all poodle skirts and rolled up jeans (someone get me a pack of Luckies!) at the Sock Hop, and encourage participants attending the Convention to dress the same, although it's not required.

We are going to have a costume contest, dance contest, bubble gum blowing contest, and hula hoop contest as well, at the Wednesday night Sock Hop. There will be prizes!

And if you're distracted by the OKC Thunder playoff game that night, we'll have it showing on the big screen, too.

As to the music, a special DJ will be spinning the tunes from the '50s through the '80s, so feel free to request your favorite. Then grab a partner and get out there on the dance floor.

Of course, I'll be watching from the nerd section and feeling some '60s nostalgia creeping up on me. And not making any eye contact with the girls in poodle skirts and bouffant hairdos.

That's a memory that hits a little too close to home.

BONUS: We've also scheduled a special Music Trivia contest from 5:15-6:30 pm on April 30 in the bar area of the Embassy Suites. Come test your knowledge of popular music across the decades of the '50s through the '80s. Did I mention there will be prizes?

Sarah Becker, RN

By Sarah Becker, RN, RAC-CT, DNS-CT, QCP

Clinical Consultant, Proactive LTC Consulting

Let’s delve into what a Plan of Correction (PoC) entails. According to, 42 CFR §488.401 a PoC is a plan developed by the facility and approved by either CMS or the survey agency. It outlines the actions the facility will take to rectify deficiencies and specifies the date by which those deficiencies will be corrected.
Key Strategies for Success:

Start Early: Waiting until the survey concludes and the CMS-2567 form arrives is not advisable. Begin drafting the PoC on the day of exit, using insights from the exit conference. In addition, the facility team should promptly initiate needed corrective actions.

Flexibility: Adjustments to the PoC can be made once the final CMS-2567 report is received. Flexibility is essential to tailor the plan effectively.

Addressing Deficiencies: When responding to deficiencies, consider the following elements:

Regulatory Reference: The CMS-2567 will include the survey data tag number, relevant CFR (Code of Federal Regulation) or LSC (Life Safety Code) reference, and language specifying the noncompliant aspect. Your plan of correction must address how you are correcting your non-compliance with that specific regulatory requirement.

Deficient Practice Statement: The CMS-2567 will describe specific actions, errors, or lack of action constituting the deficient practice. Each of these elements should be addressed through your corrective action plan.

Submission Timeline: After the survey exit, the facility should receive the Form CMS-2567 Statement of Deficiencies within 10 business days (via email). Within 10 calendar days of receipt, an acceptable PoC must be submitted to the Survey Agency. This requirement applies to deficiencies falling within scope and severity Levels B through L.

Taking Action on the CMS-2567

Analyze the Statement of Deficiencies:

Thoroughly read every example cited.
Multiple issues can be written under the citation for one tag.
Each issue requires corrective action.
Perform a Root Cause Analysis to determine why each deficiency occurred.
What systems were lacking or incomplete?
Was there something that staff should have been doing but were not?
Is the issue related to a knowledge deficit?
Is the problem isolated or discreet?
Is the problem system-wide or systemic?

Plan of Correction Requirements

The Plan of Correction consists of 5 Elements:
Element 1: Address how corrective action will be accomplished for those residents found to have been affected by the deficient practice.
What the corrective action was
Date of implementation
Who was responsible for making the corrections (position title)
Element 2: Address how the facility will identify other residents having the potential to be affected by the same deficient practice.
How the facility determined if other residents were affected by the alleged deficient practice (assessments/evaluations, observations, audits, interviews, report reviews, etc.)
The date this was determined.
By whom
It is not acceptable to state “All residents have the potential to be affected.”
Element 3: Address what measures will be put into place or systemic changes made to ensure that the deficient practice will not recur.
Detail the measures/actions taken.
Policy reviews/revisions
Systemic change, if needed, to prevent reoccurrence (based on root cause analysis)
Staff training/education – include specific content of information, training/education method, results of training (written post-test or skills checkoff), who is responsible for conducting the training, training date, required attendees.
How the facility will ensure that all new staff receive the training/education
Provide the dates of measures/actions and the titles of staff completing them.
Element 4: Indicate how the facility plans to monitor its performance to make sure that solutions are sustained.
How the corrective actions will be monitored (audit tools, interviews, record reviews, etc.)
Frequency and quantity of monitoring
How the results will be evaluated and by whom (monitoring method should have a measurable outcome/goal)
How and when will findings be reported to the QAPI committee. Note: Depending on the State or CMS Region, the facility may be required to list titles of QAPI team members.
Actions to be taken if results indicate desired outcome/goal is not being achieved or maintained.
Element 5: Include dates when corrective action will be completed.
The date of compliance for the deficient practice: cannot be a date on or prior to the survey exit date.
The corrective action completion dates must be acceptable to the State. If the plan of correction is unacceptable for any reason, the State will notify the facility in writing. If the plan of correction is acceptable, the State will notify the facility by phone, e-mail, etc.
Facilities should be cautioned that they are ultimately accountable for their own compliance, and that responsibility is not alleviated in cases where notification about the acceptability of their plan of correction is not made timely.

The plan of correction will serve as the facility’s allegation of compliance. SOM Chapter 7 – 7317 Acceptable Plan of Correction

Plan of Correction Tips
When writing a PoC, keep in mind that it is:
A legal document
A formal statement informing the state and federal agency of actions taken to correct deficiency.
Is publicly posted – do not use staff names, only titles.
Hold daily meetings until the survey team has determined compliance (via desk review or on-site visit).
Remember, an effective PoC integrates corrective measures into the organization’s Quality Assessment & Performance Improvement program. By adhering to these guidelines, facilities can achieve an acceptable plan of correction.
Would your team benefit from more survey readiness and response insights? Join us for the Survey Prep and Understanding Post-Survey Elements webinar series continuing weekly through April and May. Contact Proactive for assistance in developing or implementing a survey readiness plan or for help in drafting a Plan of Correction.

 

A prospective employee meets reps from a nursing facility at our Fall 2023 Job Fair

 

By Tanecia Davis
Workforce Ambassador

Care Careers Oklahoma is hosting a Job Fair April 10 at Metro Tech's Springlake campus with a goal to connect those interested in learning about Long Term Care employment with training and job opportunities.

Our Job Fair is a casual, come-and-go event from 9 am to 2 pm in which you are invited to wander among the information tables, meet with the reps from 11 Oklahoma facilities and explore the career possibilities.

So, why are we doing this? Just look at the employment numbers recently reported by the American Health Care Association/National Centers for Assisted Living, the partner organization with Care Providers Oklahoma:

According to AHCA/NCAL's 2024 State of the Sector Report, 99% of all nursing homes are currently hiring.

Ninety-nine percent!

And 90% have increased wages as they work to fill positions.

Here in Oklahoma, nursing home employment tracks along those trends with a virtual 'help wanted' sign posted at almost every facility across the state.

Care Providers Oklahoma, through its Care Careers Oklahoma initiative, is committed to helping increase the pool of trained workers who can fill those positions.

So, the Job Fair is one of those steps.

As CPO's Workforce Ambassador and director of the Care Careers program, and I would love to meet you at the Job Fair and discuss the CMA and CNA training process. You may discover that your passion is leading you down this career path.

The jobs are waiting to be filled.

ICF Day at the Capitol brought residents, staff and displays to the second floor Rotunda.


By Jim Stafford
CPO Content Creator

CPO ICF Day at the Capitol brought smiles and joy to the second floor Rotunda at the State Capitol this week with the presence of more than 100 residents, staff and parents from Oklahoma Intermediate Care Facilities for Individuals with Intellectual Disability (ICF/IID).

My job with Care Providers Oklahoma brought me to the Capitol to capture some of the ICF Day activities in photos and video.

So, I was milling around the Rotunda when I spotted a tall, slender man with flowing gray hair being interviewed by a local television station.

Rick Bozarth, a parent of an ICF resident, shares his perspective during an interview on ICF Day at the Capitol.

When the interview ended, I walked up and introduced myself as a CPO employee. Turns out, the man was Rick Bozarth of Seiling, a parent of an adult child who lives in an Enid facility operated by Oklahoma Homes for the Developmentally Disabled.

Bozarth is an attorney and former District Judge who described the Enid facility as a "godsend" for his son -- and his son’s parents, as well.

"It's a wonderful operation," Bozarth told me. "To be able to sleep at night is worth it, to have your kids be protected, especially if your kid is disabled. So many people don't have a clue as to what that's like, to have to deal with those issues with your child all year long."

For Bozarth, that means knowing that his adult son lives in a safe environment that has 24-7 care.

"These people give you peace of mind," he said.

About 1,800-2,000 people reside in ICF homes across Oklahoma, said Justin McGrew, an ICF operator who was one of three CPO Board Members who served as an advisory group for ICF Day activities.

McGrew said the purpose of the day was to generate attention of ICF homes with legislators as operators seek the maximum reimbursement rate allowed by CMS for residents in their care.

"We're trying to create some awareness of our populations," McGrew said. "As an example, we are getting paid $50 a day less than nursing homes, but large IID centers with a heavy level of care and 24-hour nursing ... it's hard to keep up and not get paid close to some of the other providers. A lot of times we get lost."

ICF Day activities included informational tables and booths set up in the Rotunda, visits to offices of individual legislators, interviews with local media, a luncheon that featured short addresses from three legislators, and opportunity to watch floor debate from the House and Senate galleries.

I sat in the Senate gallery next to Michelle Devauld of Oklahoma City, whose adult son lives at the Billings Fairchild Center. Her son has lived there for 14 years.

Michelle Devauld (waving) among onlookers in the Senate Gallery on ICF Day at the Capitol.

"I've got to tell you that it was the hardest choice to let go of the reins and let him live somewhere by himself," Michelle told me as we waited for the afternoon Senate session to begin. "But I know at night he is very well taken care of with 24-hour nurses there. The staff is great, the caregivers all the way down to the janitor."

Plus, there are learning and social opportunities.

"He's doing things he's never done before, had he lived with my husband and I," Michelle said. "He has a roommate. He is very independent. He goes to classes. He learns things that you and I take for granted, like tying his shoes, hygiene, matching colors, counting money, sorting and putting silverware in a napkin, rolling it up and putting it on a table."

"I don't have any complaints whatsoever," she said. "I'm happy that he's there."

Journal Record photo

 

By: Jeff Elkins//The Journal Record//February 13, 2024

OKLAHOMA CITY – Oklahoma adults with intellectual disabilities, their families and caretakers gathered at the Capitol on Tuesday to speak with lawmakers and advocate for additional support.

Ahead of their trip, at least 125 Oklahomans donned orange T-shirts created through vocational programming at an Enid intermediate care facility that was funded through the legislature two years ago. ICFs are designed to ensure that those with disabilities have access to 24/7 care, socialization and programs that help them develop independence and experience fulfillment.

The shirts read “worth every penny” on the front. That’s the message Consuela Dolezal, longterm care administrator at Oklahoma Homes for the Developmentally Disabled, hopes she left with legislators Tuesday afternoon.

Lawmakers have allocated considerable investments in recent years to community-based services provided by Developmental Disability Services at the Oklahoma Department of Human Services, including $32.5 million to eliminate a waitlist that has some with disabilities waiting more than a decade to receive the services.

ICFs are funded through Medicaid, which allocates approximately $51,000 per resident annually. Dolezal said unlike DDS, ICFs have no waitlist, but they’re being reimbursed below the cost of the comprehensive care they provide.

Disabled Oklahomans, their loved ones and advocates are asking legislators to further invest in the lives of those who live at ICFs. Dolezal submits cost reports in October at the end of the fiscal year that go into effect 18 months later. She said she saw a 26% increase in food costs in the first quarter of last year. Inflation has made budgeting a stressful task.

“You have to look at wages, you have to look at everything you’re doing. You definitely don’t want to cut anything that benefits the residents. You can’t cut food because we have to eat, so what do you cut?” Dolezal said. “Our basic ask is the Centers for Medicaid and Medicare Services doesn’t make up for the next year of inflation that you see in real time, and 112% helps make up that gap.”

According to a pamphlet provided by Care Providers Oklahoma, the increase would cost the state approximately $4 million more than the OHCA’s current year budget request.

During a luncheon, ICF residents and advocates heard from lawmakers about legislation of interest and commended attendees for making their voices heard.
State Rep. Josh Cantrell, R-Kingston, spoke briefly about House Bill 3760, which is designed to address an issue that limits an LPN’s ability to reconstitute medications.

“It simply says if your license allows you to do something, then you can do what your license says you’re allowed to do under the Board of Nursing,” Cantrell said.

Nearly 14 years ago, Michelle DeVault moved her son Bobby into the Billings Fairchild Center, an ICF in north Oklahoma that provides 24-hour care for individuals with special needs.

“That’s probably the best thing I’ve ever done besides getting married,” DeVault said, prefacing her concern that ICFs could use more funding. She also said ICFs have a high turnover rate and regulations that complicate certain care processes. She hopes legislation passed this year will address those issues, but said despite room for improvement, the level of care her son and other residents receive in Billings is comprehensive.
Steven Buck, president and CEO of Care Providers Oklahoma said it’s important to provide resources for ICFs because they help those with intellectual disabilities live a fulfilling life.

Buck said state Rep. Marilyn Stark, R-Bethany, is working on House Bill 3101. This bill would create a Longterm Care Facility Advisory Council with a dedicated seat for an operator or administrator of an ICF.

“Outside of that bill, most of the conversations are going to be in the budget-making space,” Buck said.

Courtney Bishnoi

By Courtney Bishnoi

Vice President, Quality & Programs
American Health Care Associaiton

Did you know that OSHA recently expanded its record keeping requirements? Nearly all providers are already required to maintain OSHA 300 Logs, Form 301, and Form 300A and submit 300A summary data before March 2nd each year. The NEW requirement for employers with 100 or more employees adds additional information to be submitted: OSHA 300 logs and Form 301 (incident reports).

AHCA/NCAL is hosting an upcoming webinar with Brad Hunt, Chief Risk Office at Leverity Insurance Group on February 13 at 3 PM ET.

Brad, an expert on OSHA standards, will explain the OSHA record keeping requirements and prepare members to meet the deadlines and maintain compliance with the standard. He also share best practices and how to avoid common mistakes when submitting this required information.
Don't miss this important webinar!
------------------------------
Courtney Bishnoi
Vice President, Quality & Programs
American Health Care Association
Washington DC

By Jim Stafford
CPO Content Creator

I was struck by the sudden appearance of the Care Providers Oklahoma mission statement on the wall as I entered the CPO offices for the first time after the holidays.

There, in large black letters along the wall on the left side of the foyer as you walk to our classroom space, are these words:

"Our mission is to assist members in providing the highest quality care to the seniors, individuals with disabilities and vulnerable Oklahomans who live in our facilities.  We advocate for the enhancement of that care so that Oklahoma long-term care residents may live in the comfort and dignity they deserve."

I've participated in some mission statement development work over the years.  It can be excruciating when multiple team members weigh in with their thoughts and preferences.

Then, when you have it crafted the way you want it, it's added to your website, perhaps, and promptly forgotten about by most employees, and rarely seen by the public.

I asked Steven Buck, CPO President/CEO, why our mission statement was given so prominent a space.  Here's what he told me:

"For the past three plus years, the pandemic has been the predominant story in service to our members. As we continue to emerge from the worst days of the pandemic I wanted to emphasize the importance of all aspects of the association's business to center on serving our members and, through their excellence, benefitting Oklahoma's seniors and most vulnerable."

That's a compelling reason for making the mission statement so, well, obvious, in its new space for me and my colleagues here at CPO.

And the words on the wall make a bold statement of who we are and why we are doing it to  the many frequent visitors we have to our offices for continuing education classes and meetings.
Care Providers Oklahoma has partnered with Proactive LTC Consulting and other state affiliates to provide a 12-month webinar series on Deconstructing Immediate Jeopardy and High Risk Tags.  This webinar series will be conducted from 1:30 p.m. to 2:30 p.m. on the 2nd Tuesday of each month.  CEs are available through NAB for LNHA and Nurses CEs are available through the Kentucky Nursing Board.  Register here 

Shelly Maffia

By Shelly Maffia, RN, MSN, MBA, LNHA

Director of Regulatory Services, Proactive LTC Consulting
Understanding Immediate Jeopardy Citations is crucial for ensuring the quality and safety of nursing facility environments. In Fiscal Year 2023, several citations took the spotlight, shedding light on areas demanding careful attention in the year ahead. Let’s review the top five Immediate Jeopardy Citations and explore strategies for maintaining ongoing compliance.

Immediate Jeopardy Citations signify situations where a nursing facility’s non-compliance poses substantial risk to residents’ health and safety. Understanding causative factors behind these citations plays a pivotal role in driving continuous improvement in nursing facility care.

Top Immediate Jeopardy (IJ) Citations for FY2023
Top Five IJ Citations
# IJ Citations
% Providers Cited
% Surveys Cited
1. F689 – Free of Accident Hazards/Supervision/Devices
 
864
4.7%
38.8%
F689 citations arise when facilities fail to provide adequate supervision, resulting in accident hazards for residents. This underscores the importance of robust safety measures and vigilant supervision to prevent incidents that could harm residents. The most common situations resulting in F689 IJ citations include elopements, accidents involving mechanical lifts, transportation accidents, and incidents involving smoking or choking.
2. F600 – Free from Abuse and Neglect
 
525
2.8%
23.6%
F600 was the second most frequently cited Immediate Jeopardy area in FY2023, which emphasizes the critical need for nursing facilities to create an environment free from abuse and neglect. Ensuring staff awareness, proper training, and implementing stringent anti-abuse policies are vital steps in avoiding this citation.
3. F684 – Quality of Care
 
268
1.5%
12.0%
Quality of care is at the heart of nursing facility services. Immediate Jeopardy in this category highlights deficiencies that directly impact residents’ health and well-being. Maintaining high-quality care involves continuous evaluation, staff training, and adherence to best practices.
4. F835 – Administration
 
183
1.0%
8.2%
Administrative lapses can lead to Immediate Jeopardy situations. Facilities must ensure efficient administration, including proper documentation, adherence to regulations, and effective communication channels within the organization.
5. F880 – Infection Control
 
154
0.8%
6.9%
Infection control is a critical area for nursing facilities. Immediate Jeopardy arises when facilities fail to implement robust infection control measures, putting residents at risk. Strict adherence to infection prevention protocols is paramount.
 
How Nursing Facilities Can Mitigate Immediate Jeopardy Risks
Identifying, remediating, and preventing Immediate Jeopardy situations is an essential area of compliance for nursing facilities. Early detection, swift correction, and proactive measures are essential components of effective risk management. Comprehensive staff training, regular audits, and collaboration with regulatory bodies are integral to mitigating Immediate Jeopardy risks. Proactive measures ensure ongoing compliance and contribute to a safer environment for residents.
Stay tuned in to IJ risks by registering for Proactive’s new 2024 webinar series, Deconstructing Immediate Jeopardy & High-Risk Tags. This series is designed to empower nursing facility professionals with the knowledge and strategies needed to navigate the top risk areas associated with Immediate Jeopardy citations. Real-life examples will provide insights into recent incidents. Drawing from real-life examples of IJ citations, we’ll delve into actionable solutions to prevent these critical citations in facilities.
Editor’s note:  Kenny Daily is a licensed nursing home administrator and founder of Ohio-based Elder Care Systems Group. He has a long track record of leading people, building teams, and recommending best practices, quality control, and fiscal accountability for healthcare programs. Kenn has led multiple Life Safety Boot Camps for Oklahoma facilities, including our recent Tulsa class on Dec. 6.  He wrote this blog about his travel challenges flying into Tulsa to teach the class.

Kenn Daily

By Kenn Daily

For more than 5 years I have been teaching a two-day Life Safety Code compliance workshop for Maintenance Supervisors, Facility Managers and Administrators.  Well, last Monday I was traveling to Tulsa, Oklahoma, to teach a boot camp for Care Providers Oklahoma.

I headed to the airport for my 7:15 pm flight, arriving early and having plenty of time to get through TSA and to the gate.

Arriving at the gate I received a notice from the airline that my flight would be leaving about a half-hour late, but that was fine because I had more than an hour layover scheduled. Then an announcement was made that the flight would be leaving more than an hour and a half late due to no crew and then a few minutes after that the flight would be canceled, ironically for no staff.

At this point, I would miss my connection and never make it to Tulsa that evening.  So, I called the airline customer service who was pleasant and tried to be helpful but could only get me on an afternoon flight for the next day getting me in to Tulsa at 5 pm.

 This was a whole day later than planned and would shorten my boot camp to a single day.

  In the end, what I learned was many industries, not just senior living, are suffering from low or no staff to meet their customer’s needs.

EDITOR’S NOTE:  Kenn, we’re so glad you finally made it safely to Tulsa and met the challenge of providing two days of Life Safety education into a single-day class.

EDITOR'S NOTE: We're grateful to our partners at Proactive LTC Consulting for sharing the information below regarding CMS transition to IQIES for MDS submission and CASPER reporting access.
By Christine Twombly, RN
Clinical Consultant, Proactive LTC Consulting

Christine Twombly

Earlier this year CMS transitioned from QIES to IQIES for MDS submission and CASPER reporting access. This transition left some MDS coordinators confused about how to access reports that were previously made available through QIES.

Available report types for each user are determined by the IQIES role assigned to the individual users. Permissions are determined by the HARP access privileges. If users believe that they do not have the correct access set up, they should contact the Security Officer for their organization to verify their IQIES user role is correctly set up.
CMS recently posted the IQIES Reports User Manual (V2.5 10/5/2023), which can be accessed using the link below:
This manual provides detailed instructions on how to identify and view new reports that are automatically added to their reports folder and how to schedule and run the multitude of provider requested reports that can be generated on demand. The reports will likely be found in one of the following four permanent system folders:
MDS 3.0 Final Validation Report folder, where the system generated FVRs are stored.
MDS 3.0 Provider Preview Report folder, where files such as the provider preview reports and SNF VBP files are distributed.
Non-Compliance Notification folder, which contains APU compliance notification letters for all care settings.
Package Reports folder, which is a report page in IQIES, where a user can choose to run the MDS 3.0 Facility Characteristics, MDS 3.0 Facility-Level QM report and MDS 3.0 Resident-Level QM report all in ONE report run.
As a result of the significant changes to the MDS 3.0 effective 10/1/2023, which includes the removal of section G. Many of the MDS based quality measures have been revised to address the MDS changes. The current version of the MDS 3.0 Quality Measure User’s Manual (V16.0) can be accessed at this link: mds-3.0-qm-users-manual-v16.0.pdf (cms.gov)
Contact Proactive for more information on clinical reimbursement consulting partnerships and Interim MDS staffing services.
EDITOR'S NOTE: We're grateful to our partners at Proactive LTC Consulting for sharing the information below regarding significance of drug regimen review, its integration with CMS Standardized Patient Assessment Data Elements, and the penalties for noncompliance with reporting.

Brandy Hayes

By Brandy Hayes, RN
Clinical Consultant, Proactive LTC Consulting

In the complex landscape of geriatric healthcare, medication errors can significantly impact LTC resident health, safety and quality of life. Unfortunately, potential and actual adverse consequences related to medications are prevalent, often occurring during transitions in care. These adverse consequences can result in serious harm or even death, emergency department visits, and rehospitalizations.
One vital strategy to improve resident safety is the drug regimen review, a comprehensive process designed to identify and address potential and actual clinically significant medication issues. In this blog, we explore the significance of drug regimen review, its integration with CMS Standardized Patient Assessment Data Elements, and the penalties for noncompliance with reporting.
Planning for Care
Drug regimen review serves as a crucial component of the overall management and monitoring of a resident’s medication regimen. Its primary goal is the prevention and timely identification of potential and actual medication-related adverse consequences, ultimately reducing the resident’s risk for harm and enhancing quality of life. Key steps to ensure the success of this process include:
  1. Education: Staff should be well-versed in proper medication administration techniques and the adverse effects of medications. This knowledge equips them to be observant and proactive in recognizing adverse effects of medications promptly.
  2. System Implementation: Establish a systematic approach to ensure that each resident’s medication usage is evaluated upon admission and on an ongoing basis. This system should identify risks and problems and take appropriate actions. Use the critical element pathway 20082 Unnecessary Medications to guide QA efforts.
The Centers for Medicare & Medicaid Services (CMS) recognizes the importance of standardized patient assessment data to ensure the quality of care in healthcare settings, including Skilled Nursing Facilities (SNFs). This integration enhances the drug regimen review process by aligning it with CMS’s standards, ensuring a consistent and comprehensive approach to resident care.
CMS Standardized Patient Assessment Data Elements (SPADEs) are a set of essential data elements designed to assess the health and well-being of residents accurately. SPADEs include a range of information related to a resident’s special services, treatments, and interventions, medical conditions and co-morbidities, cognitive function, mental status including depression and dementia, and ability to communicate. The Drug Regimen Review element includes the following:
  1. Medication Reconciliation (N2001): “Clinically significant medication issue is a potential or actual issue that, in the clinician’s professional judgment, warrants physician (or physician-designee) communication and completion of prescribed/recommended actions by midnight of the next calendar day at the latest. ‘Clinically significant’ means effects, results, or consequences that materially affect or are likely to affect an individual’s mental, physical, or psychosocial well-being, either positively, by preventing a condition or reducing a risk, or negatively, by exacerbating, causing, or contributing to a symptom, illness, or decline in status. Any circumstance that does not require this immediate attention is not considered a potential or actual clinically significant medication issue for the purpose of the drug regimen review items.”
  2. Medication Follow-up (N02003): The process of contacting a physician to communicate an identified medication issue and completing all physician- prescribed/recommended actions by midnight of the next calendar day at the latest.
  1. Medication Intervention (N02005): Every time a potential or actual clinically significant medication issue is identified throughout the resident’s stay, it must be communicated to a physician, and the physician-prescribed/-recommended actions must be completed by the clinician in a time frame that maximizes the reduction in risk for medication errors and resident harm.
While compliance with CMS SPADEs and drug regimen review is essential, SNFs must be aware of the potential consequences of noncompliance. Notably, a 2% reduction in the SNF’s annual rate update is applied if noncompliant with reporting requirements. This financial penalty is further incentive for facilities to prioritize adherence to CMS regulations and reporting standards.
The drug regimen review is a vital safeguard in the care of residents, ensuring that their medication regimens are safe, effective, and aligned with their specific needs. By identifying and addressing potential issues proactively, healthcare providers can significantly enhance resident safety, ultimately improving the quality of life for those under their care. Integrating the drug regimen review with CMS Standardized Patient Assessment Data Elements ensures a comprehensive, standardized approach to medication management, reinforcing the commitment to delivering high-quality care in healthcare facilities, including SNFs.
However, SNFs must also recognize the importance of compliance with CMS regulations, as penalties for noncompliance, such as a 2% reduction in the annual rate update, can have substantial financial implications. Therefore, it is imperative that healthcare facilities implement a rigorous drug regimen review processes, continually educate their staff, and ensure strict adherence to CMS reporting requirements to maintain the highest standards of resident medication safety and regulatory compliance.

Champions of Health Awards Presentations were held in massive ballroom at the OKC Convention Center

By Jim Stafford
CPO Content Creator

I was privileged to be part of the Care Providers Oklahoma team that attended the 2023 Champions of Care Awards Presentations recently at the OKC Convention Center.

The Champions of Health awards program was launched in 2004 to recognized organizations and individuals working to improve health outcomes across Oklahoma.  Proceeds from the Awards Presentations ceremony benefits the Oklahoma Caring Foundation, a not-for-profit that provides preventative health services to underserved Oklahomans.

The Champions of Health Awards were presented by Blue Cross and Blue Shield of Oklahoma.

CPO is one of 11 member organizations that comprise the Champions of Health Coalition Partners, and Steven Buck, CPO President/CEO is part of the Coalition Leadership team.

"Champions of Health is a celebration of innovation in health delivery to vulnerable populations in our state,” Steve said. “I have been involved in Champions for over 15 years and am always amazed by the quality of emerging approaches to providing care. It is an honor to stand with colleague organizations like Oklahoma Hospital Association and the Oklahoma State Medical Association to showcase these accomplishments."

Awards were presented in five categories to organizations that are pursuing innovative health related programs that can be replicated in other communities.  Several CPO team members, including me, were among the judges who helped determine this year's winners.

Recipients recognized at the ceremony were:

Tulsa Public Schools as Champion of Children's Health for its student wellness progam.

Calm Waters as Champion of Senior Health for its grief support groups that are offered to seniors 55-plus who have experienced loss of a loved one.

Grand Mental Health as Champion of the Uninsured for providing health care services to under insured/uninsured Oklahomans.

Tulsa CARES as Champion of Community Health for being a provider of prevention and care programs for low income individuals living with HIV or Hepatitis C.

Neighborhood Services Organization as the Dr. Rodney L. Huey Memorial Champion of Oklahoma Health for its program to provide transitional and permanent housing for the unhoused to build stability, security and restore health.

NFL star Damar Hamlin participated in a fireside chat with Robin Marsh at the Champions of Health Awards Presentations

There were probably 1,000 folks or more at the Champions of Health Awards Presentation, and I'm sure that for some (me included) the big draw was the presence of NFL star Damar Hamlin, a defensive back with the Buffalo Bills.

If you're not familiar with Damar, he was the young man who collapsed on the field last January after a hard tackle.  His heart stopped and it took heroic efforts by the team's training staff and medical personnel to revive him before transporting him to the hospital, where he spent 9 days.

Hamlin eventually was cleared to resume his NFL career and played in his first game of the 2023 season this past weekend.

In his OKC appearance, Damar participated in a 'fireside chat' facilitated by TV news personality Robin Marsh.  He spoke about his past and the hard work it took to become an NFL player, and then his new mission of ensuring emergency technology like that which saved his own life is available to teams and organizations nationwide.

"‘It’s kind of like a calling, and we don’t get to choose our calling." he told the audience.

It was a touching presentation that showed a side of a professional athlete that we rarely get to see.  For more on Damar's brush with death and his chat with Robin Marsh, read the post I wrote at Jim Stafford's BlogOKC.

Damar's presentation capped an important evening to organizations like CPO and our counterparts who support better health outcomes for all Oklahomans.

I'm glad I attended.

My CPO colleagues and I took a selfie outside the OKC Convention Center with Champions of Health emcee Robin Marsh

BONUS! My CPO colleagues -- Tanecia Davis, Juliet Williams and Shanna Reece -- and I happened to come across Robin Marsh just outside the convention center as we were leaving after the presentations concluded, and someone asked Robin if she would do a group 'selfie' with us.

Of course, she gladly accommodated us, and the result is the souvenir photo to the left.

EDITOR'S NOTE: With the transition to the new MDS item set, there have been some minor issues with transition. We're grateful to our partners at Proactive LTC Consulting for sharing the information below regarding the issues different software vendors are facing during this transition.
By Eleisha Wilkes, RN
Clinical Consultant, Proactive LTC Consulting
With the implementation of the MDS 3.0 v1.18.11 this past Sunday, October 1st, it may not be surprising that there have been a few bumps in the road. Software vendors continue to work diligently to address issues, but here are some transitional potholes that you may want to watch out for:
PointClickCare (PCC): PCC is experiencing an issue where the following MDS Items are enabled when they should be disabled:
D0500
GG0130 Column 2
GG0170 Column 2
GG0170J5
GG0170K5
K0710
O0400D2
PCC is working to resolve the issue and advises users to NOT answer MDS items that should be disabled. They will provide an update when the issue is resolved with instructions to complete the affected assessments. There have also been reports that some providers are not seeing the updated diagnosis codes within the PCC software, and that coding IV fluids is not populating the Special Care High case mix group.
American Health Tech (AHT): When opening/scheduling an OSA, choose option 5 “other payment assessment” as the assessment type. Some providers are still having issues with the “Select other payment type” options not being updated. AHT scheduled a “Hot Fix” this past Saturday addressing the OSA and if problems persist you should call AHT technical support.
Matrix Care: Older versions are omitting the Staff support response options on some of the late loss ADLs. Also, even when GG is not dashed, a warning code is given alerting the user that section GG cannot be dashed and not allowing the user to save and close, even when GG is not dashed.
Other considerations include:
Diagnoses: Some diagnoses that once mapped to a PDPM Clinical Category may no longer (e.g., G20 – Parkinson’s disease). Make sure you have downloaded and are using the most recent PDPM ICD-10 Mapping
iQIES: An issue was discovered with the iQIES Z0100 HIPPS code calculation. The system-calculated value was incorrect for some assessments submitted between 9/19/23 – 9/23/23. The iQIES system recalculates the Medicare Part A HIPPS codes for qualifying assessments and compares that value to the value that was submitted in item Z0100 on the record. If the submitted value does not match the system-calculated value, error number -3935a (Incorrect RUG/PDPM Value: The submitted value of the HIPPS/PDPM code does not match the value calculated by the iQIES System.) is returned on the Final Validation Report. These affected assessments received error (-3935a) on the Final Validation Report. The iQIES technical team is working on correcting the issues and CMS will notify you of next steps if you are identified as having one or more assessments affected by the issue.
Editor's Note: Care Providers Oklahoma is presenting the final Life Safety Code Boot Camp of the year Dec. 5-6 on the OSU/Tulsa campus under the direction of Kenn Daily.  Connie Guinn, our Director of Education, provides this preview of the training.

Connie Guinn

By Connie Guinn
Director of Education, Care Providers Oklahoma

When CMS adopted the 2012 Life Safety Code and the Healthcare Facilities Code more than three years ago, it created new expectations for inspection, testing and maintenance of fire protection features in long term care facilities.

So, Care Providers Oklahoma is offering an intensive 2-day training on Dec. 5 & 6 especially for facility and maintenance managers, environmental services directors, administrators and long term care safety consultants.

The class will be held on the OSU/Tulsa campus and led by Kenn Daily, LNHA, president of Ohio-based Elder Care Systems Group. Kenn presents the training under the title, "Don't Get Burned: Your Next Life Safety Code Survey.”

The training focuses on the requirements of NFPA 101 Life Safety Code and NFPA 99 Healthcare Facilities Code and the tightening of requirements through stricter implementation that their adoption by CMS brought.

"This is Life Safety Code training for skilled nursing facilities, with a comprehensive review of the current Life Safety Code requirements, as well as a discussion of step-by-step ways to Life Safety Code compliance, the most common deficiencies, and ways a facility can identify and correct items in advance," Kenn said.

The Life Safety Code established minimum criteria for many protective features and systems, including fire protection, generators, doors, building services and maintenance activities.

Under Kenn's leadership, our unique Boot Camp helps you understand practical applications of the Life Safety Code and learn from a life safety expert on what to prepare for during survey. The comprehensive program examines all sections of the LSC applicable to skilled nursing and providers formers, policies and best practice guides for use by healthcare organizations.

"Life Safety Code Compliance and preparation are critical for skilled nursing, and I'll highlight some lessons learned from other facilities across the country and some of the missteps facilities have experience and ways that you all can be better compliant," he said.

Here's a sample of some of the topics covered: LSC origins and organization; construction types, operating features, door locks, hazardous areas, fire protection systems, smoke compartments, fire barriers, building services and many others.

We hope to see you there.

Registration closes at 11 pm, Sunday, Dec. 3. Register here. 

EDITOR'S NOTE: We're grateful to our partners at Proactive LTC Consulting for sharing the information below regarding CMS transition to IQIES for MDS submission and CASPER reporting access.
By Christine Twombly, RN
Clinical Consultant, Proactive LTC Consulting

Christine Twombly

Earlier this year CMS transitioned from QIES to IQIES for MDS submission and CASPER reporting access. This transition left some MDS coordinators confused about how to access reports that were previously made available through QIES.

Available report types for each user are determined by the IQIES role assigned to the individual users. Permissions are determined by the HARP access privileges. If users believe that they do not have the correct access set up, they should contact the Security Officer for their organization to verify their IQIES user role is correctly set up.
CMS recently posted the IQIES Reports User Manual (V2.5 10/5/2023), which can be accessed using the link below:
This manual provides detailed instructions on how to identify and view new reports that are automatically added to their reports folder and how to schedule and run the multitude of provider requested reports that can be generated on demand. The reports will likely be found in one of the following four permanent system folders:
MDS 3.0 Final Validation Report folder, where the system generated FVRs are stored.
MDS 3.0 Provider Preview Report folder, where files such as the provider preview reports and SNF VBP files are distributed.
Non-Compliance Notification folder, which contains APU compliance notification letters for all care settings.
Package Reports folder, which is a report page in IQIES, where a user can choose to run the MDS 3.0 Facility Characteristics, MDS 3.0 Facility-Level QM report and MDS 3.0 Resident-Level QM report all in ONE report run.
As a result of the significant changes to the MDS 3.0 effective 10/1/2023, which includes the removal of section G. Many of the MDS based quality measures have been revised to address the MDS changes. The current version of the MDS 3.0 Quality Measure User’s Manual (V16.0) can be accessed at this link: mds-3.0-qm-users-manual-v16.0.pdf (cms.gov)
Contact Proactive for more information on clinical reimbursement consulting partnerships and Interim MDS staffing services.
EDITOR'S NOTE: We're grateful to our partners at Proactive LTC Consulting for sharing the information below regarding significance of drug regimen review, its integration with CMS Standardized Patient Assessment Data Elements, and the penalties for noncompliance with reporting.

Brandy Hayes

By Brandy Hayes, RN
Clinical Consultant, Proactive LTC Consulting

In the complex landscape of geriatric healthcare, medication errors can significantly impact LTC resident health, safety and quality of life. Unfortunately, potential and actual adverse consequences related to medications are prevalent, often occurring during transitions in care. These adverse consequences can result in serious harm or even death, emergency department visits, and rehospitalizations.
One vital strategy to improve resident safety is the drug regimen review, a comprehensive process designed to identify and address potential and actual clinically significant medication issues. In this blog, we explore the significance of drug regimen review, its integration with CMS Standardized Patient Assessment Data Elements, and the penalties for noncompliance with reporting.
Planning for Care
Drug regimen review serves as a crucial component of the overall management and monitoring of a resident’s medication regimen. Its primary goal is the prevention and timely identification of potential and actual medication-related adverse consequences, ultimately reducing the resident’s risk for harm and enhancing quality of life. Key steps to ensure the success of this process include:
  1. Education: Staff should be well-versed in proper medication administration techniques and the adverse effects of medications. This knowledge equips them to be observant and proactive in recognizing adverse effects of medications promptly.
  2. System Implementation: Establish a systematic approach to ensure that each resident’s medication usage is evaluated upon admission and on an ongoing basis. This system should identify risks and problems and take appropriate actions. Use the critical element pathway 20082 Unnecessary Medications to guide QA efforts.
The Centers for Medicare & Medicaid Services (CMS) recognizes the importance of standardized patient assessment data to ensure the quality of care in healthcare settings, including Skilled Nursing Facilities (SNFs). This integration enhances the drug regimen review process by aligning it with CMS’s standards, ensuring a consistent and comprehensive approach to resident care.
CMS Standardized Patient Assessment Data Elements (SPADEs) are a set of essential data elements designed to assess the health and well-being of residents accurately. SPADEs include a range of information related to a resident’s special services, treatments, and interventions, medical conditions and co-morbidities, cognitive function, mental status including depression and dementia, and ability to communicate. The Drug Regimen Review element includes the following:
  1. Medication Reconciliation (N2001): “Clinically significant medication issue is a potential or actual issue that, in the clinician’s professional judgment, warrants physician (or physician-designee) communication and completion of prescribed/recommended actions by midnight of the next calendar day at the latest. ‘Clinically significant’ means effects, results, or consequences that materially affect or are likely to affect an individual’s mental, physical, or psychosocial well-being, either positively, by preventing a condition or reducing a risk, or negatively, by exacerbating, causing, or contributing to a symptom, illness, or decline in status. Any circumstance that does not require this immediate attention is not considered a potential or actual clinically significant medication issue for the purpose of the drug regimen review items.”
  2. Medication Follow-up (N02003): The process of contacting a physician to communicate an identified medication issue and completing all physician- prescribed/recommended actions by midnight of the next calendar day at the latest.
  1. Medication Intervention (N02005): Every time a potential or actual clinically significant medication issue is identified throughout the resident’s stay, it must be communicated to a physician, and the physician-prescribed/-recommended actions must be completed by the clinician in a time frame that maximizes the reduction in risk for medication errors and resident harm.
While compliance with CMS SPADEs and drug regimen review is essential, SNFs must be aware of the potential consequences of noncompliance. Notably, a 2% reduction in the SNF’s annual rate update is applied if noncompliant with reporting requirements. This financial penalty is further incentive for facilities to prioritize adherence to CMS regulations and reporting standards.
The drug regimen review is a vital safeguard in the care of residents, ensuring that their medication regimens are safe, effective, and aligned with their specific needs. By identifying and addressing potential issues proactively, healthcare providers can significantly enhance resident safety, ultimately improving the quality of life for those under their care. Integrating the drug regimen review with CMS Standardized Patient Assessment Data Elements ensures a comprehensive, standardized approach to medication management, reinforcing the commitment to delivering high-quality care in healthcare facilities, including SNFs.
However, SNFs must also recognize the importance of compliance with CMS regulations, as penalties for noncompliance, such as a 2% reduction in the annual rate update, can have substantial financial implications. Therefore, it is imperative that healthcare facilities implement a rigorous drug regimen review processes, continually educate their staff, and ensure strict adherence to CMS reporting requirements to maintain the highest standards of resident medication safety and regulatory compliance.

Champions of Health Awards Presentations were held in massive ballroom at the OKC Convention Center

By Jim Stafford
CPO Content Creator

I was privileged to be part of the Care Providers Oklahoma team that attended the 2023 Champions of Care Awards Presentations recently at the OKC Convention Center.

The Champions of Health awards program was launched in 2004 to recognized organizations and individuals working to improve health outcomes across Oklahoma.  Proceeds from the Awards Presentations ceremony benefits the Oklahoma Caring Foundation, a not-for-profit that provides preventative health services to underserved Oklahomans.

The Champions of Health Awards were presented by Blue Cross and Blue Shield of Oklahoma.

CPO is one of 11 member organizations that comprise the Champions of Health Coalition Partners, and Steven Buck, CPO President/CEO is part of the Coalition Leadership team.

"Champions of Health is a celebration of innovation in health delivery to vulnerable populations in our state,” Steve said. “I have been involved in Champions for over 15 years and am always amazed by the quality of emerging approaches to providing care. It is an honor to stand with colleague organizations like Oklahoma Hospital Association and the Oklahoma State Medical Association to showcase these accomplishments."

Awards were presented in five categories to organizations that are pursuing innovative health related programs that can be replicated in other communities.  Several CPO team members, including me, were among the judges who helped determine this year's winners.

Recipients recognized at the ceremony were:

Tulsa Public Schools as Champion of Children's Health for its student wellness progam.

Calm Waters as Champion of Senior Health for its grief support groups that are offered to seniors 55-plus who have experienced loss of a loved one.

Grand Mental Health as Champion of the Uninsured for providing health care services to under insured/uninsured Oklahomans.

Tulsa CARES as Champion of Community Health for being a provider of prevention and care programs for low income individuals living with HIV or Hepatitis C.

Neighborhood Services Organization as the Dr. Rodney L. Huey Memorial Champion of Oklahoma Health for its program to provide transitional and permanent housing for the unhoused to build stability, security and restore health.

NFL star Damar Hamlin participated in a fireside chat with Robin Marsh at the Champions of Health Awards Presentations

There were probably 1,000 folks or more at the Champions of Health Awards Presentation, and I'm sure that for some (me included) the big draw was the presence of NFL star Damar Hamlin, a defensive back with the Buffalo Bills.

If you're not familiar with Damar, he was the young man who collapsed on the field last January after a hard tackle.  His heart stopped and it took heroic efforts by the team's training staff and medical personnel to revive him before transporting him to the hospital, where he spent 9 days.

Hamlin eventually was cleared to resume his NFL career and played in his first game of the 2023 season this past weekend.

In his OKC appearance, Damar participated in a 'fireside chat' facilitated by TV news personality Robin Marsh.  He spoke about his past and the hard work it took to become an NFL player, and then his new mission of ensuring emergency technology like that which saved his own life is available to teams and organizations nationwide.

"‘It’s kind of like a calling, and we don’t get to choose our calling." he told the audience.

It was a touching presentation that showed a side of a professional athlete that we rarely get to see.  For more on Damar's brush with death and his chat with Robin Marsh, read the post I wrote at Jim Stafford's BlogOKC.

Damar's presentation capped an important evening to organizations like CPO and our counterparts who support better health outcomes for all Oklahomans.

I'm glad I attended.

My CPO colleagues and I took a selfie outside the OKC Convention Center with Champions of Health emcee Robin Marsh

BONUS! My CPO colleagues -- Tanecia Davis, Juliet Williams and Shanna Reece -- and I happened to come across Robin Marsh just outside the convention center as we were leaving after the presentations concluded, and someone asked Robin if she would do a group 'selfie' with us.

Of course, she gladly accommodated us, and the result is the souvenir photo to the left.

EDITOR'S NOTE: With the transition to the new MDS item set, there have been some minor issues with transition. We're grateful to our partners at Proactive LTC Consulting for sharing the information below regarding the issues different software vendors are facing during this transition.
By Eleisha Wilkes, RN
Clinical Consultant, Proactive LTC Consulting
With the implementation of the MDS 3.0 v1.18.11 this past Sunday, October 1st, it may not be surprising that there have been a few bumps in the road. Software vendors continue to work diligently to address issues, but here are some transitional potholes that you may want to watch out for:
PointClickCare (PCC): PCC is experiencing an issue where the following MDS Items are enabled when they should be disabled:
D0500
GG0130 Column 2
GG0170 Column 2
GG0170J5
GG0170K5
K0710
O0400D2
PCC is working to resolve the issue and advises users to NOT answer MDS items that should be disabled. They will provide an update when the issue is resolved with instructions to complete the affected assessments. There have also been reports that some providers are not seeing the updated diagnosis codes within the PCC software, and that coding IV fluids is not populating the Special Care High case mix group.
American Health Tech (AHT): When opening/scheduling an OSA, choose option 5 “other payment assessment” as the assessment type. Some providers are still having issues with the “Select other payment type” options not being updated. AHT scheduled a “Hot Fix” this past Saturday addressing the OSA and if problems persist you should call AHT technical support.
Matrix Care: Older versions are omitting the Staff support response options on some of the late loss ADLs. Also, even when GG is not dashed, a warning code is given alerting the user that section GG cannot be dashed and not allowing the user to save and close, even when GG is not dashed.
Other considerations include:
Diagnoses: Some diagnoses that once mapped to a PDPM Clinical Category may no longer (e.g., G20 – Parkinson’s disease). Make sure you have downloaded and are using the most recent PDPM ICD-10 Mapping
iQIES: An issue was discovered with the iQIES Z0100 HIPPS code calculation. The system-calculated value was incorrect for some assessments submitted between 9/19/23 – 9/23/23. The iQIES system recalculates the Medicare Part A HIPPS codes for qualifying assessments and compares that value to the value that was submitted in item Z0100 on the record. If the submitted value does not match the system-calculated value, error number -3935a (Incorrect RUG/PDPM Value: The submitted value of the HIPPS/PDPM code does not match the value calculated by the iQIES System.) is returned on the Final Validation Report. These affected assessments received error (-3935a) on the Final Validation Report. The iQIES technical team is working on correcting the issues and CMS will notify you of next steps if you are identified as having one or more assessments affected by the issue.

By Linda Farrar, RN

Do you ever feel like you are on an island and no one else knows or cares what you are going through in  your long term care profession?

CPO provides educational opportunities, both virtually and in person all
year long through webinars and through in-person attendance at specific trainings, convention, Fall Fair and the Leadership Conference.

They are wonderful learning and networking opportunities, but the providers reported they wanted something closer to home so more staff could attend, smaller venues so sharing could be more comfortable, and still able to offer CEUs for a reasonable price.

Ta-Da!

Thus came the CPO Road Shows.

The agenda is planned completely based on the needs and wants of the providers. In our last trip, we  spent the morning session talking about survey trends, and digging deeper into the tag numbers to talk about specific findings and apparent expectations of surveyors. During this session, attendees can share their own experiences. And believe me, there is plenty of “venting” going on also, which we all need sometimes. We also try to provide some tools and resources for facility use as appropriate.

Also discussed in this last trip included: Advance Directives: the expectations, evidence-based best practices, and tools, including INTERACT 4.0 and other tools; the need and importance of appropriate
Scheduled Drug Reconciliation; and expectations for a thorough and complete ANE investigation.

I would be remiss if there was no discussion about the sponsorship of PharmCare. WHAT A TEAM OF EXPERTS! They provided the venues in all three locations along with meals and snacks in all three locations. But as important, they shared experiences from their practices and their expertise.

The subject matter of the next Road Trip, which is scheduled for October 24, 25 and 26 with locations yet to be determined, is whatever you want it to be. Discussion of survey trends and findings will likely be included. Beyond that, what information would you like to have or discuss? It is an honor and a pleasure for me to be working in Oklahoma.

We are here to help … just tell us how.

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