Meaningful Meetings in LTC

How much of your time is spent in meetings? Depending on your role, time in meetings may take more time than any other task or responsibility you have. Do you sometimes wonder if all these meetings are even necessary (“Could this have been an email?”) Days are busy and staffing shortages contribute to the feeling that meetings are overwhelming and can even be counterproductive when not well run. Ensuring that each meeting is an effective use of time and resources is essential. Strong meeting processes can facilitate clinical quality, MDS assessment accuracy, risk management, and correct reimbursement. Let’s examine three common meetings and take a closer look at key content, format and outcome goals for each to guide your team in driving focused, efficient and substantive meetings that bring value to your facility and promote effective and integrated work flow.

1. Daily Clinical Meeting. As the name suggests this meeting is generally held daily Monday through Friday and covers a variety of information to promote quality care. Suggested attendees include the Administrator, DON, MDSC, and representatives from other disciplines including, but not limited to Social Services, Therapy, and Dietary. The clinical meeting is an opportune time to identify which specific resident issues require further clinical review and or updates to the plan of care, as well as assigning and prioritizing IDT responsibilities for the remainder of the day. Discussion points for this meeting should include:
   • • • Census changes
       • Relevant resident issues identified by the IDT (e.g., new orders, accidents/incidents, condition changes, etc.)
       • Care plan revisions
       • Upcoming MDS schedule (including identification of Significant Change in Status Assessments and/or IPAs)
       • Follow-up or “action items” to be completed
2. Medicare or Utilization Review Meeting. This meeting is generally held weekly and attended by the Administrator, DON, MDSC, BOM, Therapy, Social Services, and others as required. The Medicare Meeting is an ideal opportunity for the IDT to review the care plan and support continued progress toward meeting discharge goals. When nursing or rehab identifies barriers to progress, collaboration during the meeting is essential to make patient-centered adjustments to the treatment plan. The team should always be driving the care plan toward the patient’s discharge goal and showing analysis and team consensus for continued skilled needs, length of stay, and the discharge plan. Discussion points for this meeting should include:
   • • • Medicare compliance (e.g., certs/recerts, provision of required notices, etc.)
       • Skilled services and interventions provided to each resident
       • Barriers to reaching care and discharge goals
       • Diagnosis coding and MDS assessment timing and completion
       • Review of supporting documentation
       • Discharge planning
3. Triple Check or Clean Claims Review. This meeting is generally held monthly and attended by the Administrator, DON, MDSC, BOM, Therapy, and others as required. The purpose of this meeting is to ensure all billing requirements are completed before claims submission. In addition to what is regularly reviewed in the Medicare/UR Meeting, Triple Check should also include:
   • • • Validation of physician visits and orders
       • Verification of qualifying stay
       • Review of draft UB04 for accuracy
       • Verification of daily skilled documentation
       • Validation that MDS assessments have been submitted and accepted to iQIES
       • Validation of physician-signed therapy POC

Regardless of the type of meeting, consider these general guidelines to make your time together productive.

• • • Set some ground rules: Ground rules for each meeting should be established to ensure that the meeting remains focused and efficient. The IDT should:
      • Be on time
      • Notify the receptionist to take messages or refer calls to another person during scheduled meeting times
      • Turn off cell phones
      • Come to the meeting prepared
      • Refrain from side-bar conversations
      • Set time limits and assign a time keeper
    • Appoint a leader for the meeting: The leader can change depending on which meeting is being conducted. For example, morning stand-up meetings are usually conducted by the facility administrator, while triple check may be led by the MDS nurse collaborating with therapy or the business office manager. Whatever the meeting and regardless of who is leading, the leader should keep the team focused on defined objectives, ensure there is active participation among all members based on assigned responsibilities, and keep the meeting moving.
    • Keep to a schedule. All members of the IDT should come to the meeting prepared with their department’s input and recommendations. Members of the IDT should be ready to speak when it is their turn. The speaker should stay on topic and be cognizant of their time and others. Provide the time that the meeting will conclude and follow an agenda to ensure time limits are respected.
    • Promote structure: Every meeting should have established objectives and structure. Team members should share items that are occurring within their departments and any difficulties they need help with related to the meeting topic. Unrelated topics should be held for a different time to ensure the meeting stays on task.
    • Ensure follow-up: Designate someone to take notes during the meeting as appropriate. Meeting minutes should serve as a way in which to follow up on important items and allow team members who were unable to attend the meeting to have information available that may affect their job or department. Assignments for specific follow up action items should be clarified with timeframes whenever possible

Having thorough and focused meetings can and will assist you in effectively managing care needs and regulatory and reimbursement requirements. Re-evaluate your meeting procedures often and, if something isn’t working for your facility and team, make adjustments. There is no set standard for how to run your team meetings, so consider what is working, what’s not, and where to improve for your team to best communicate and share information.

Interested in improving your meetings? Contact Proactive for a quality review of your meeting processes with recommendations, updated procedures, tools and resources. Make plans to join us September 26, 2023 for the webinar Meaningful Meetings as part of the Mission Possible: SNF Department Head series.

Written By: Eleisha Wilkes, RN, GERO-BC, RAC-CTA, RAC-CT, DNS-CT
Clinical Consultant

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