Skilled Nursing News spoke on March 22 with Dr. Sunil Pandya and Annaliese Impink. Pandya is the chief medical director of Atlanta-based SavaSeniorCare Administrative and Consulting LLC. Impink is an in-house lawyer for SavaSeniorCare chain. Sava has outsourced to the CMO role to Geriatric Administrative Provider Services (GAPS), a Dallas-based physician-led organization that provides medical directorships to SNFs; Pandya serves as GAPS’s national medical director of telehealth. Below are some excerpts.
Can you go into what is entailed in the chief medical director role at Sava? What are some of your immediate priorities for the clinical programs?
Pandya: I actually appreciate you asking us what the title means, because many larger groups have what’s called a chief medical officer, and I’m not an officer of the company. The role is really a medical director; I’m a servant leader to both the currently existing medical directors both in the facility and regionally, and [in] more of a collegial situation where I’m a resource for them for a variety of things — everything from bedside clinical to quality to any sort of administrative functions that they provide as medical directors.
What we’re trying to do is provide some consistency and quality to the side of the stool of health care. I look at health care as a three-legged stool; I don’t think you can stand with two [legs]. In the skilled nursing world, nursing is obviously huge. They’re the caretakers at the bedside. The administrative — you can’t be without them. [There are] so many regulations, so many quality measures, so many things that they do. And then the third that is recognized by Sava is that you need the medical side.
That is part of what I wish to humbly present to them: the medical, nursing, and administrative all working together in a consistent and quality manner.
But as far as what I’m doing day-to-day, starting with this role, is that I’m starting to listen to the facilities. I’ve been talking with two and three facilities in person at the facility level and even regionally. We’re prioritizing the western North Carolina first, and then what we lovingly term the Lone Star area of Texas, so around Dallas.
Then we have national tools, different ideas in our toolbelt, if you will, and we listen to the facility: What are the intrinsic needs of the facility? Do they want to create something more with telehealth? Do they need more QAPI standards? Do they need some medical optimization? Is it about COVID rounds? Is there a dearth of medical specialty in the facility?
There’s a variety of different things. So my priorities become the priorities of the facility after I do my initial interview.
So after those interviews are done, what comes next?
Pandya: Then starts the ramping up process. Sava has outsourced their medical directorships, for lack of a better term, to GAPS Health, and I’m a proud member of GAPS — not only serving the role as chief medical director for these few pilot places where we’re starting, but also for Sava in general. The concept, starting in North Carolina and then getting over to Lone Star, is: “Let’s go ahead and find out what the needs are and start implementing.”
What are some of the priorities for Sava in terms of QAPI, and what are some of the areas of focus for more development?
Pandya: No. 1 is skin, skin, skin, skin, skin. We’ve had this situation before COVID, and now it’s made worse because of COVID, and Impink just mentioned about weight loss; well, some of nutrition even affects skin. So that’s a super important quality improvement that we’re focusing on. We’re also looking at nursing documentation, and we have a big project centered on rehospitalizations.
What does that project include?
Impink: Certainly a root cause analysis for why that’s occurring, and we have a lot of different focuses on that, because there are a lot of things that go into rehospitalizations. It’s physician education; it’s nurse education; it’s patient education. It’s enhancing and improving skill sets for our nurses, clinical judgment, communication with physicians. There’s a whole bunch of factors that contribute, and one of the reasons that we as a company engaged Dr. Sunil and GAPS was to help us really do that root-cause analysis and focus on developing an action plan based on what the data and the information tells us.
So [rehospitalizations] and skin are probably the priority projects for us now in QAPI, and nursing documentation is also a project. But we need to impact skin and rehospitalizations, and then we’ll probably move to medication management.
Got it. And going back to the clinical side of Sava’s plans, Sava has talked about focusing on dialysis as a way to focus on patients’ increasing acuity. What are some of the other clinical programs the company is looking at and thinking about as priority areas for clinical programming?
Pandya: It’s something I’m definitely going to be dealing with, have a role in setting the agenda for, and certainly can be a resource to what we call field support. So memory-care units — our loving term for them is life engagement units — there has to be a focus on right-fitting those in certain environments, where there’s a huge need for that. And it’s even greater with some of the dementias that we’re talking about coming out of COVID.
Wound certifications — we want to go through that as a as a clinical practice. There’s some infection control practices, IP [infection preventionist] certifications. Bringing infection control from the bookshelf to the bedside is something that I did when I first started with GAPS — and that’s how I got linked up with Sava, was performing some of those things.
You mentioned dialysis, so dialysis dens — we have them in Maryland abd Georgia, and we are seeing what that looks like as far as a service that we can provide in other locations.
When you talk about bringing infection control from the bookshelf to the bedside — which is a great phrase — what does that look like? What is the process of going from the principle of it to the practice of it, and how would you like to see that implemented?
Pandya: So, you coined a great phrase too – that’s exactly what it is, taking the principle of it, which we all know with our hearts and minds, and putting it to our hands and feet. You’re taking from principle to practice or bookshelf to bedside. So many of us know to wash our hands frequently, so many of us know to keep six feet distance and use hand sanitizer, but this pandemic proves that a lot of us were not doing it.
Impink: The other thing is the certification. We have infection preventionists in all of our buildings, not just because we’re required to but because it’s the right thing. Now we’ve got to make sure they have the tools they need — through a certification process the company’s committed to — to make sure they have everything they need to be successful.
We’re hiring 60 new infection preventionists across the country to supplement or take to the next level the skill set of infection prevention. So there’s a lot of effort on that right now.