In this week's episode, Cara is joined by Monica Woodward Luberto, RN to discuss the evolving landscape of skilled nursing facilities, focusing on wound care advancements and the upcoming CMS audit changes. Cara and Monica dive into how innovative equipment like specialized beds and wound vacs are transforming patient care, though challenges around access and cost persist, especially in rural areas. The conversation highlights the importance of electronic health records with auditing features to reduce errors, while also addressing the hurdles faced by smaller facilities still using paper charts. Tune in to discover practical strategies that can protect your facility’s reputation and ensure quality care for patients.
About the Guest
With more than 20 years of nursing experience, Monica Woodward Luberto, RN, has built a career at the intersection of clinical practice, compliance, and education. She has contributed to CMS-related documentation and reporting processes and now develops CEU courses that reach thousands of healthcare professionals across the country. Monica also runs Still On Call RN and founded RN Content Studio to expand her work in healthcare writing and education. She contributes regularly to national discussions on nursing practice and professional development.
Key Takeaways
- 00:04:06 - Advancements in wound care equipment, such as specialized beds and wound vacs, have significantly improved prevention and treatment, though access and cost remain challenges, especially in rural settings.
- 00:08:21 - Starting January 1, 2026, new CMS audit guidelines will target skilled nursing facilities (SNFs) with a 10% random audit of submitted MDS records, impacting reimbursement and facility reputation.
- 00:12:17 - The Minimum Data Set (MDS) form is a comprehensive, lengthy assessment tool used by SNFs to document patient status, including wounds, nutrition, and mobility, which must align precisely with clinical notes to pass audits.
- 00:17:06 - Electronic health record systems with built-in auditing features help reduce charting errors and improve compliance, but many smaller or rural facilities still rely on paper charting, increasing audit risk.
- 00:20:48 - To prepare for audits, SNFs should focus on consistent documentation, timely record submission, and strong interdisciplinary team communication, using microlearning and regular team huddles to reinforce best practices.
- 00:27:20 - Failing a CMS audit can lead to significant financial penalties, reduced Medicare reimbursements, lower facility star ratings, and damage to reputation, which affects patient referrals and family trust in the facility.
Episode Transcript
Monica Woodward-Luberto (00:08.854)
yeah, yeah, it breaks the ice. And that's what I did listen to several of your podcasts, because we have never communicated before. So I wanted to know who Kara was. Hi, Dad. And just I wanted to get a feel for your podcasts, which were fantastic. And I think what I took away from it most was that how easy you made people feel.
in answering questions and just the whole podcast setting.
Cara Lunsford, RN (00:42.863)
I'm so glad that you, okay, well Dawn, I don't know why it worked, but all of a sudden I stuck the headphones in and when I came back on, she came through the computer, suddenly came through the computer, but then I was able to switch her out and now she's coming through here and so we're all good, we're all good, thank you.
Monica Woodward-Luberto (00:44.951)
Yeah.
Dawn Lunsford (01:02.21)
You both sound great and look great. Okay. Bye. Have a great podcast.
Cara Lunsford, RN (01:05.293)
Perfect.
Monica Woodward-Luberto (01:06.402)
Bye, John.
Cara Lunsford, RN (01:08.239)
Thank you.
So which episodes did you, what did you listen to?
Monica Woodward-Luberto (01:17.166)
I'm gonna try, I knew you were gonna ask me that question. I can't remember that right off the top of my head. But the, yeah, I remember the last one was a male podcaster as opposed to some of the more female podcaster and he was a director. I can't remember his name. But I would, go ahead.
Cara Lunsford, RN (01:22.223)
That's okay. don't expect you to, but...
Cara Lunsford, RN (01:38.315)
Yeah, we, we've definitely had a lot of people on this podcast. And it's been a lot of fun. And we're now in our seventh season. And it's kind of crazy. I can't believe that we've been doing seven seasons. Like it really just flies by in a a weird way. But this is I'm really excited, Monica, to have you on.
Monica Woodward-Luberto (01:46.254)
Mm-hmm.
Mm-hmm. Wow, seven years.
Monica Woodward-Luberto (02:07.576)
Thank you.
Cara Lunsford, RN (02:08.494)
This is going to be very educational, a lot of fun. We always have a lot of fun.
Monica Woodward-Luberto (02:16.748)
Okay, yeah, and that's what I picked up most when I was listening to the podcast. I was like, wow, okay, Kara is making everybody feel very, very comfortable.
Cara Lunsford, RN (02:30.506)
good, good. Well, you know, I really do like to make people feel like you've known me a really long time and we're just chatting over a cup of coffee. So that's what we're pretty much gonna do.
Monica Woodward-Luberto (02:38.178)
Mm-hmm.
Monica Woodward-Luberto (02:41.868)
Right. exercising the podcast gremlins. What is that word?
Cara Lunsford, RN (02:52.206)
We're exercising the demons. We're exercising the podcast gremlins or demons. Yes. Yes, absolutely. Well, this is going to be great. I am really excited that you're here, Monica. I would love for you to share a little, first of all, share a little bit about yourself with our audience, who you are and how long you've been in this industry and
Monica Woodward-Luberto (02:55.982)
That's it. Gremlins.
Monica Woodward-Luberto (03:07.566)
Thank
Cara Lunsford, RN (03:21.742)
and how you kind of got into the area that you're in now. I know that you're a subject matter expert. You do a lot of content creation, which is awesome. But yeah, tell us a little bit about your history.
Monica Woodward-Luberto (03:30.826)
Mm-hmm. Thank you.
Monica Woodward-Luberto (03:36.633)
Well, as you know, I'm a registered nurse. I spent most of my career in critical care, case management, moon care. I came up through the ranks, started as a CNA, then onto LPN, and then onto RN, and everything pretty much in between. I spent 40 years at bedside, but the last five.
five years I went to the VA as case management. And that was an interesting experience to learn the government side of that. So I've really seen it all. I've seen the good, the bad, the ugly, and sometimes the really, really ugly. But my passion has always been critical care. So once I became an RN, that's where I strive to get into.
in the high acuity environments. And my work in medical ICU is what taught me the most. Those were the patients that were the sickest of the sick. And in that area, we had to deal with cardiac, surgical, medical issues all at one time. And either treating wounds or preventing wounds were the two of the most important things that we did.
dealing with either very frail, emaciated patients who had wounds or 500 pound patients who developed wounds because of the difficulty in turning, the difficulty in mobility. In ICU, know, a lot of times the patients were vented. So we were the purveyors of when the patient moved because the patient didn't know he had to move at that point, he or she.
So our biggest challenge was either to work on the wound and help it recover or prevent it altogether, which was our main goal. And now I take all of that information and I write CEUs and I write content and I try to teach.
Monica Woodward-Luberto (06:00.047)
the stuff that I know and put it into simple terms for medical assistants, nursing students, and just people who are interested in learning more.
Cara Lunsford, RN (06:10.926)
Yeah. And there's, I, so first of all, thank you for decades of service. You don't actually look old enough to have been doing that for 40 years. You look, you look amazing. Uh, I was, I thought 40 years. Thank you. Thank you. Uh, and so I, I.
Monica Woodward-Luberto (06:19.054)
Thank you.
Monica Woodward-Luberto (06:24.27)
Well thank you, I like that. Thank you. As do you. Well so do you.
Cara Lunsford, RN (06:41.1)
I really, one of the things I'd like to ask you about as someone who has been in the industry for as long as you have is I'm sure you've seen a lot of changes over time. And even in terms of what kinds of equipment and things have been available. So, I mean, the policies have obviously changed. So many things change over time. But one of the things that I think
Monica Woodward-Luberto (06:56.275)
yeah.
Cara Lunsford, RN (07:11.662)
stays the same is that we are always trying to prevent wounds from occurring. It's harder to treat them than it is to prevent them. And there's a lot that has, we've seen a lot of improvements in the area of equipment that's available and the beds that we have different than the beds. What are some of the things that stand out to you a little bit just over time in terms of what you've seen?
Monica Woodward-Luberto (07:20.685)
Mm-hmm.
Cara Lunsford, RN (07:41.326)
from back in the beginning of your career to now in terms of treating wounds, preventing wounds.
Monica Woodward-Luberto (07:54.137)
Well, think there's a lot of, obviously, there's a lot of things that have changed. But the equipment that has come down the pike, as I say, to help prevent has been one of the most important things. The beds, there are all sorts of new equipments.
The problem with new equipment, however, is that some of them can be very expensive. So if you're working in a main hospital, you know, that's got a thousand beds. I worked at one facility in North Carolina with 10,000 employees and a thousand beds. And we even had turn teams who could come into the ICU and help us turn those big patients so we weren't killing our backs.
Cara Lunsford, RN (08:27.598)
Mm-hmm.
Monica Woodward-Luberto (08:50.478)
You know, and that's one of the things that you can do is those policies that help, but that doesn't work in a rural setting. It doesn't work in a facility that's on the outer banks of North Carolina with only five ICU beds. know, nurses are just basically on their own with that. I think one of the biggest things I've seen that made a real difference was the creation of the WOMVAC.
I don't know if you're familiar with that, but yeah, that was basically a game changer for wounds. Before that, we were doing the basic wet to dry dressings, know, debriding, even surgical debriefments at times, and that's all you had to depend on. But once the wound vac came into place, that has even increased over the last 10 years from
Cara Lunsford, RN (09:21.201)
Absolutely.
Monica Woodward-Luberto (09:48.607)
when I originally started using wound VACs in that they're using the silver nitrate and some of the other different foams that better drain the wound and prevent further infection. I think it's silver nitrate is what is actually used to help.
Cara Lunsford, RN (10:08.578)
That's what I remember it being. Yes. Yes. I think that you're right. I've worked in home health as well as the acute setting. We obviously see home health and hospice. We see a lot of wounds. And I always tell people when you're looking through my phone, be careful how far you swipe because you might come across something.
Monica Woodward-Luberto (10:17.251)
Mm-hmm.
Monica Woodward-Luberto (10:20.814)
.
Monica Woodward-Luberto (10:33.366)
Right. The pictures are interesting.
Cara Lunsford, RN (10:36.086)
Yeah, you might come across something that you can't unsee.
Monica Woodward-Luberto (10:39.714)
Right. Yes, there are lots of things that you can't unsee. And I think one of the newest development is the fact that when Woonvax came out, they were strictly for hospital care. There was this big technical push. It was very daunting to use. You had to make sure everything was plugged in and the vacuum was working. And then the dressing changes were very complicated. And now we're sending patients home with Woonvax.
So they've reduced in size and minimized the equipment, the kits that patients can go home with and still achieve what that wound vet can do.
Cara Lunsford, RN (11:24.536)
Yeah, it's definitely, I agree with you that it is one of the most incredible advancements that we've seen in terms of wound care. you have, because of your work in, sorry, in content creation, subject matter expert, you work a lot in, you also work a lot in the areas of compliance.
Monica Woodward-Luberto (11:45.474)
Mm-hmm. Mm-hmm.
Cara Lunsford, RN (11:52.943)
and tracking, right? Tracking what types of changes and policy changes and CMS regulatory policies and what are you seeing right now in terms of some of the changes, the regulatory changes, especially within
Monica Woodward-Luberto (11:53.326)
absolutely.
Monica Woodward-Luberto (12:04.174)
Mm-hmm.
Cara Lunsford, RN (12:22.862)
skilled nursing facilities as it pertains to CMS.
Monica Woodward-Luberto (12:30.604)
Well, the newest thing coming down the pike, starting, I believe it's starting January 1st, 2026, is the new guidelines for SNFs for skilled nursing facilities. And those changes this time are just affecting the SNFs. They don't affect hospital settings and LTACs, any of those. just is, if...
you're a sniff, you're going to be affected. And that's basically
Cara Lunsford, RN (13:02.53)
Why do think that is, that it's not affecting... Do you have any theories on that?
Monica Woodward-Luberto (13:06.126)
Because you well because yeah because you With the hospitals and the LTCHs I think you have Joint Commission and the other regulatory bodies That are looking at those areas. I think eventually you may see it come down the pike to hospitals, but for right now, they're just rolling it out slowly
And that rollout is the 10 % increase. That's what they're looking at. They're going to take 10 % of these SNFs throughout the United States and start auditing them. And they'll pull 10 records. If you're selected, they're going to pull 10 of your records and compare it against what you actually submit it.
on the MDS forms to Medicare. So it's an external audit in that it's not like Joy Commission, they don't come in and look through the charts, but you're sending the charts to them via a portal and then they're comparing it to what you actually said was there. And that will affect dollars. The last statistic,
that I looked at, there's over 16,000 SNFs, and I think it's closer to 17,000 SNFs in the United States. Yeah, just in the US. And of course, the areas like Florida, Texas, California, the bigger states have more SNFs than someplace like Alaska or Washington DC. So those big states are going to have a bigger volume.
Cara Lunsford, RN (14:33.87)
Mm-hmm.
Monica Woodward-Luberto (14:54.222)
to choose from, so they're going to get hit the hardest. And those records are going to have to match word for word. If it doesn't, then it sends a red flag to Medicare, and Medicare is going to say, well, maybe we're going to pull back the dollars. Maybe you're not going to get the bonuses, because Medicare does give bonuses. It's their valuation program.
where if you're doing really, really well and meeting all the criteria, then they give you a bonus. And that can be reflected in not only the monies that they receive, but the prestige that you receive for patients and families when they're looking at facilities. It's a marketing thing that they can do. know, hey, we've met all of the standards for CMS.
Cara Lunsford, RN (15:43.438)
Interesting. Yes.
Monica Woodward-Luberto (15:50.497)
So we're a top notch, we're in the top 100, those kinds of things. If you're not in the top 100, somebody might want to look somewhere else for their family to go. And there's even penalties associated with that if it's not compliant, if they don't match.
Cara Lunsford, RN (16:08.258)
Yeah, so explain, so for the people who are listening who are thinking to themselves, gosh, I don't know what that process looks like at all. I'm not an administrator at a skilled nursing facility. I don't understand how.
Monica Woodward-Luberto (16:21.39)
Mm-hmm.
Cara Lunsford, RN (16:25.614)
they're reimbursed. I don't understand, you know, the MDS you mentioned and how that's submitted and then they're going to, they're basically going to cross reference when they do an audit and say, do these things match? so what does it look like when they do have to submit these reports, not the audit, but just MDS? What does that process look like for them?
Monica Woodward-Luberto (16:28.131)
Mm-hmm.
Monica Woodward-Luberto (16:32.013)
Mm-hmm.
Monica Woodward-Luberto (16:38.339)
Mm-hmm.
Monica Woodward-Luberto (16:54.958)
Well, the MDS is a standard assessment form. Any patient that goes into a skilled nursing facility is required, the SNF is required to fill out this form. And this is not just one or two pages. They can be 40 to 50 pages long. And they...
They provide information about the physical condition, the mental status, the nutritional status, the mobility status of the patient. And it has to be updated annually and quarterly to Medicare. And if a patient has an adverse effect, a fall, a hospitalization, then that form has to be updated again.
Just to give you an example, if a patient has a stage three pressure ulcer and it's listed on the COSIX, the nurse documents everything, the stage, the tissue type, the drainage, all of that, then usually either the wound care nurse or somebody in the facility case management form fills out
Fills it out, different sections say different things. Section K, for instance, reflects the nutrition, the supplements that were ordered. Section details how many, what's really present, the actual wound itself. Section O confirms that the wound care is being provided either through wet to dry dressings.
a wound vac, what is actually being done. And then it goes on to GG and KK and all the others about mobility. So it's a very, very lengthy assessment. And then when Medicare conducts an audit, they don't, like I said, they don't see the actual patient. They only see the chart and the MDS form. So they look at the pieces that fit together.
Monica Woodward-Luberto (19:11.71)
If the MDS says the wound is improving and the chart supports that in the notes and nutrition notes and therapy notes, everything is golden. But if the MDS says healed and the last nursing note shows that there's still drainage or slough, then that's a red flag to Medicare. And that's when they start looking deeper. And then that's why you might have a failed audit.
Cara Lunsford, RN (19:42.479)
be the advantage? why would maybe a skilled nursing facility or an administrator submit an MDS report that's maybe not consistent with what is actually happening with the patient? Is it that they're really trying to get reimbursed and they're not going to get reimbursed until
Monica Woodward-Luberto (19:42.54)
So they go hand in hand.
Cara Lunsford, RN (20:12.492)
that wound is healed? that kind of what is maybe prompting some of that?
Monica Woodward-Luberto (20:21.422)
No, it's the MDS is the assessment that is documented when the patient first arrives. If the patient has, say, a stage three, it will always stay a stage three. It never, never, declines. It's the first assessment assesses the deepest
Cara Lunsford, RN (20:34.392)
Right.
Monica Woodward-Luberto (20:50.348)
tissue damage that was done. Now, it may downgrade to a two, it can improve to a one, but it never should be documented as a stage two or a stage one. And that's where nurses sometimes, even experienced nurses mess up. They get caught up in, well, I'm looking at it today and that looks like a two, not a three. You know, because there's always that...
difference between what you see and what I see. That's why when I teach facilities or teach students, nurses, I always say one of the things you can do is look at photographs, which are important, I think, in documentation. Now, Medicare doesn't require photographs, but they can be used in team huddles once a week. You can look at the photo. You can say, this is it.
And then the following week at the next team huddle, you can look at it and see the improvement. It's still a stage three, but you can document it as a healing stage three. And that's the, and.
Cara Lunsford, RN (21:59.439)
Interesting, So that's what I, yeah, so that's such a good point. When I was working as in hospice and in home health, we would have to do OASIS start of cares. And I don't know exactly how that differentiates. I haven't personally ever worked in skilled nursing facility.
Monica Woodward-Luberto (22:12.943)
Mm-hmm.
Monica Woodward-Luberto (22:16.761)
Mm-hmm.
Cara Lunsford, RN (22:24.792)
But I have worked in, home health and hospice, and I have had to do the very, very lengthy Oasis start of care. And that's what I kind of figured. So one of the things that I've noticed is that the complexity of charting sets you up for error. yes.
Monica Woodward-Luberto (22:32.207)
yeah, yeah.
And that's basically the same thing as what a SNF has in the MDS form.
Mm-hmm.
Monica Woodward-Luberto (22:52.188)
it sets you up for failure.
Yeah, the complexity of charting sets you up for failure. One of the things that I've been impressed with is the move, and again, this is usually in the bigger facilities that have more dollars, moving to the electronic records like Epic, like Serna, some of the more complicated.
Cara Lunsford, RN (22:55.566)
100%.
Monica Woodward-Luberto (23:24.687)
programs out there that just make it easier for nurses. We're not talking about copy and pasting because you never want to do that, but the electronic programs that deal with it make it easier for nurses to be able to chart the information that they need.
Cara Lunsford, RN (23:45.487)
Because it has baked in auditing in those systems. So if you don't have someone within your facility that is really strong and can audit those charts for you, it helps, I think, when you're a nurse and you're charting to have that feedback from the electronic health record saying,
Monica Woodward-Luberto (23:58.147)
Mm-hmm.
Monica Woodward-Luberto (24:01.474)
Mm-hmm.
Monica Woodward-Luberto (24:10.97)
yes.
Cara Lunsford, RN (24:11.936)
you know, you didn't, you know, this isn't quite right, or it highlights an area that you may have missed. I can't tell you the number of times I've gone through the forum and I try to get to the end and it's like, nope, you're not.
Monica Woodward-Luberto (24:23.727)
Yeah, you are 100 % correct on that. And that has made a big difference for a lot of nurses and for the auditing process. Those, you the companies that can afford to do that are the ones that are benefiting from it. And again, going back to the smaller or the rural facilities.
I know facilities out west in Montana and Wyoming that are still hand-sharding just because that's what they have available. you know, it's, they will grow at some point, but that may take a long time for them. And they may be pushed out.
Cara Lunsford, RN (24:55.8)
Yes.
Cara Lunsford, RN (25:11.385)
So, yeah, yeah, absolutely. So let's say, you know, someone's listening to this podcast and they work in one of these more rural areas, as you mentioned, in a skilled nursing facility and they're thinking, oh my gosh, please do not let me be one of the 10 % that is getting audited. Nobody wants to get audited ever for any reason.
Monica Woodward-Luberto (25:34.514)
I don't want to be here.
Cara Lunsford, RN (25:39.982)
So, but you know, let's.
Monica Woodward-Luberto (25:41.987)
We all freeze when Joy Commission would come around.
Cara Lunsford, RN (25:44.993)
Right, right. It's the panic, right? The sky is falling. So what can some people do to get ahead, right? To get ahead of this? If you were an administrator in a rural skilled nursing facility and you're maybe still on paper charting and you're thinking, my gosh, I am going to have to submit these
paper charts, I'm gonna have to upload them to a portal. I'm not even on an electronic health record system and I'm, what would you say to these people who are kind of in a state of maybe panic a little bit, like, gosh, I don't want this to happen to me.
Monica Woodward-Luberto (26:32.975)
There's a mantra that I use. It's only three words. But having lived in South Florida for many years and dealing with hurricanes, I used to tell other nurses, plan, don't panic. Because when you're in a hospital setting and a hurricane is coming, you have to have the right plans in place in order to deal with this storm that is coming through.
for you, and that's the way I try to teach facilities, SNF facilities, to plan, don't panic. If you have a good plan in place and you're consistent with it, then if you are chosen for the audit, then you'll know what to do and there'll be less anxiety in what you have to do. The biggest thing, the first thing is consistency. The data report you have, you report to CMS has to be consistent.
It has to, every section of the MDS, if it doesn't match the nursing notes or the therapy documentation, then it can trigger an alarm. So that's the most important thing. Then the area of, the other area is incomplete records or timeliness. Not getting the, if you're audited, not getting it back.
to them in time, because then they're going to ask, well, why aren't they sending us the information? And the third, think, is team communication. If you have those things in place, if you're doing that weekly team meeting, then reviewing it before you submit it will be that much easier.
If you don't have access to the electronic.
Cara Lunsford, RN (28:35.384)
health records. yeah.
Monica Woodward-Luberto (28:35.641)
helpful tools, yeah, the health records, the tools, those kind of electronic tools. It won't matter if you've been consistent with your charting and your teaching and what your expectation is from your nurses. And nurses have to, you you have to give things to them in little bits.
if you expect them to sit down for a seminar, a two-hour seminar about wounds, it's going to go in one ear and out the other. But if, for instance, I usually recommend just have a weekly at your morning huddle on Friday mornings, hey, this patient in ABC, we're looking at the wounds, what have we charted in the past, what are we seeing now? And then,
If you do have a wound care nurse or one who is specialized who does better than the other, get them involved in it so that when it does come time for the audit, you'll have a clear picture of what you can send. And you'll be confident about it. That's the biggest thing is being confident about what you send. Because they're not, go ahead.
Cara Lunsford, RN (29:48.399)
happens if you haven't been? No, what happens if you're like, oh my gosh, I'm thinking about, I just stepped in and I'm the new director of nursing, right? For a skilled nursing facility. And I look back and I go, oh my, this, we're in trouble. This is a mess.
Monica Woodward-Luberto (30:02.863)
Mm-hmm.
Monica Woodward-Luberto (30:09.935)
We're in trouble.
Cara Lunsford, RN (30:18.19)
Do you have any recommendations for people in those situations? What happens there?
Monica Woodward-Luberto (30:25.579)
When you're looking at something from 30,000 feet in the air and you go, we've got a mess here, the first thing you have to do is organize and get your teams involved, all of your interdisciplinary teams, your nurses, your respiratory, nutrition. And what I have recommended a lot is for
mock audits, in other words, try and get them involved. You we run mock codes in hospital settings all the time. You run them to practice. You practice your BLS, you practice your ACLS, so that when the time comes that you have an actual code, everybody knows their role. Everybody's got it down pat. You practiced and practiced and practiced. And so that's a good way to take down the pressure.
among the staff members and say, we've got this. And also to encourage nurses to become part of those teams, those audit teams. Don't leave it to just one person to do. Ask for volunteers. Ask, yeah, it looks good on your resume. You know, ask or give them some sort of incentive to volunteer to participate in the audits.
and to learn more about what the charting is like so that they know when they go to, when they read the audit forms and they go, wow, MKJ, all of this, when they look at it and they can see what is actually involved with the check boxes and things like that, and that only takes 10 minutes in a huddle, here, here, this is the form that we have to fill out, you know. I want you to be aware of that. Then it's easier for them when they're charting.
Cara Lunsford, RN (32:18.179)
Yeah.
Monica Woodward-Luberto (32:23.417)
to actually, hey, I need to be sure that I am charting this. You can't just chart the wound that is red. You have to do those fine details. And giving nurses that in little snippets instead of seminars goes a long way, because then you're just reinforcing, reinforcing, reinforcing.
Cara Lunsford, RN (32:29.059)
Yes.
Cara Lunsford, RN (32:51.0)
We like to call that micro learnings, right? Like little micro learnings.
Monica Woodward-Luberto (32:53.832)
Yeah, micro learnings. Yes, yes, absolutely.
Cara Lunsford, RN (32:58.414)
Yes, I agree. I am so much better with a small five to 10 minutes of a micro learning than I am with two hours. My brain starts to wander. I start to think about all the things I need to get done. And honestly, you don't want to take people away from their patient care that long. it's not necessary, really.
Monica Woodward-Luberto (33:06.543)
Mm-hmm.
Monica Woodward-Luberto (33:15.8)
Mm-hmm.
Monica Woodward-Luberto (33:28.056)
Right. Right.
Cara Lunsford, RN (33:28.204)
better to have high quality and shorter bits for sure. Now, you talked a little bit in the beginning about what the consequences are. So we've talked a little bit about what can you do and how can you get in front of this and how can you even mitigate it if you are in a situation.
Monica Woodward-Luberto (33:34.863)
Correct.
Monica Woodward-Luberto (33:44.483)
Mm-hmm.
Cara Lunsford, RN (33:56.559)
where maybe your charts are not as clean as you would like them to be. But then, in the event that you get dinged, right? There's a red flag. Talk a little bit, go a little bit more in depth about what those consequences could look like. mean, obviously we want to make sure that
Monica Woodward-Luberto (34:03.383)
Mm-hmm.
Cara Lunsford, RN (34:24.984)
Patients are just getting the best care that they can get. But it wasn't documented, it wasn't done. And if it wasn't documented correctly, you're not getting paid.
Monica Woodward-Luberto (34:28.196)
Mm-hmm.
Monica Woodward-Luberto (34:34.893)
Right. Yep, that's basically it. Failing an audit can have really unfortunate financial and what we talked about before, reputational impact. The audits when Medicare is doing their quality reporting program, it's 100%. You have to meet 100 % submission to receive full reimbursement.
If the audit finds that things don't match the resident's record or if anything is missing, then they can reduce the annual payment by up to 2%. Now, that doesn't sound like a lot, but in Medicare revenue, that can be hundreds of thousands of dollars, depending on the size of the facility. There's also called a program called
value-based purchasing, which rewards or penalizes facilities based on their metrics. So if you fail the validation, it threatens the dollars that are coming in and you get a lower facilities star rating that is published. And that can affect referrals from hospitals and families. When it doesn't respond,
You can eventually recover financially by making improvements.
Cara Lunsford, RN (36:09.102)
Hold on one second, Monica. You said that can affect referrals. Can you say that one more time? Because you kind of paused a little bit in the Wi-Fi. Can you tell me a little bit more? You were saying that that can affect referrals.
Monica Woodward-Luberto (36:24.847)
Well, it affects the trust factor. refer patients and hospitals, patients have to and families have to choose where they go. The hospital doesn't decide that. So there's a choice factor that is allowed. We can say here are the 10 facilities in the 25 mile area.
Cara Lunsford, RN (36:37.506)
Mm-hmm.
Monica Woodward-Luberto (36:54.287)
that this patient can go to for rehabilitation or for SNF placement. And they will have a rating. You can go online, you can look up the rating, the four-star rating, five-star rating, just like you see on an object on Amazon. that would be on the government website, yeah, on CMS. And you also have input from
Cara Lunsford, RN (37:11.32)
Where do they see that? Where do they see the four or five star CMS? Okay, got it.
Monica Woodward-Luberto (37:23.779)
case management that deals with the transfer of the patients, the specialized areas where they want to go to and how they feel, the feedback that they get because you will have readmissions and you'll have patients that come in or family members that come in and say, that was, it's a horrible place.
You know, or you'll have families that come in and say, it's a Taj Mahal, it's the best care I've ever had. So do you want to refer the patient to the Taj Mahal or to the, you know, to the place that isn't perceived so well in the community?
Cara Lunsford, RN (38:12.514)
Yeah, I was recently looking for a skilled nursing facility for a family member this year. And the hospital said, well, we have this list. And they have the list. And they said, it's really up to you to choose. The case manager did tell me. said, well, are any of them kind of rated?
Monica Woodward-Luberto (38:12.537)
You know, it's like, go ahead.
Monica Woodward-Luberto (38:20.057)
Mm-hmm.
Monica Woodward-Luberto (38:27.169)
Right, they have the list.
Cara Lunsford, RN (38:40.34)
better than others. And so she did give me some of the ratings and said, you know, I've gotten some great feedback about, you know, these these ones. These gave me three or four that had some very some good ratings. Probably those ratings came from CMS. And then I went and I kind of looked on Google and I saw there what their Google rating was.
Monica Woodward-Luberto (38:52.651)
Mm-hmm, correct. Yes.
Monica Woodward-Luberto (38:57.977)
Mm-hmm.
Monica Woodward-Luberto (39:06.148)
Mm-hmm.
Monica Woodward-Luberto (39:09.774)
Mm-hmm.
Cara Lunsford, RN (39:09.97)
And as Google tends to be a little bit more, it's what customers are, how customers or clients or residents or families of residents are rating those facilities versus how is the payer rating the facility, which is a little bit different. But I think important to be able to see both of those things. So from a reputation management perspective, this is...
Monica Woodward-Luberto (39:21.081)
Mm-hmm.
Monica Woodward-Luberto (39:29.455)
Correct.
Cara Lunsford, RN (39:39.348)
I think this is a really big deal.
Monica Woodward-Luberto (39:42.6)
yeah, it boils down to that trust factor because you're trusting that facility to take care of your family member. And if you know that the facility is meeting the standards the government has set for 100 % compliance, they're meeting everything that the government says, hey, this is the... And what the government is saying is the minimum.
that we have to do. Keep that in mind. This is what Medicare, Medicaid says. This is what we expect the minimum to be. Anything after that is gravy. Anything after that is golden. So you want the ones that, and when you see that gold in that extra, that's where you get into the Google searches and what people are talking about and reflecting when they're doing surveys.
that patients are asked to fill out. what you really see from the government is what you can find on their website. And that will be black and white. It's not detailed. It just will be failed, passed, failed, passed. That's all you're going to see from it, 100 % compliance or not. And you won't necessarily know without digging a lot deeper.
into going down the rabbit hole, as I call it, and to find out what those failures are, because that's kind of NDA kind of information. Hospitals aren't going to just hand them out and tell you what they failed at. They may have it internally, but they're not going to tell a patient. Although I think they should.
Cara Lunsford, RN (41:22.957)
right.
Yes, of course, of course. I'm down for transparency as well. think it's important. I feel like if someone wants like more information, for example, they're thinking, okay, I either work at a skilled nursing facility, I have a family member at a skilled nursing facility, I'm an administrator at a skilled nursing facility.
Monica Woodward-Luberto (41:31.968)
Yes, yeah.
Monica Woodward-Luberto (41:51.266)
Mm-hmm.
Cara Lunsford, RN (41:55.087)
and you want to feel even more empowered. I mean, I think we, we scratched the surface a little bit here and we talked a little bit about what people should be expecting, and, and, and, and how they can be better prepared. I really liked your little, mantra, prepare, don't panic. plan. That's right.
Monica Woodward-Luberto (42:08.559)
Mm-hmm.
Monica Woodward-Luberto (42:20.789)
Right. Plan, don't panic. Yeah, plan, don't panic. Yeah, you got it. Yeah.
Cara Lunsford, RN (42:24.95)
I guess it's close, but plan, don't panel. Yes, you're right. What's that like really the poor performance? It's like it's proper preparation prevents poor performance. Do you remember that?
Monica Woodward-Luberto (42:41.071)
That's poor performance. Oh, say that. Yeah, say that. Yeah, they tried to teach us that. could never, you know, it's like all these acronyms in nursing. Yeah. That was a good one. Yeah.
Cara Lunsford, RN (42:47.638)
I can't hear you. Proper preparation.
that was a good one. Yeah. so, so I think that there's a, you had so many great gems of information, I think in, this podcast, but obviously people are listening. It's, scratching the surface. They're saying, okay, I need to dig in a little bit more to this. I need to go find more information about this. where, what kind of resources do you recommend?
Monica Woodward-Luberto (43:09.956)
Mm-hmm.
Monica Woodward-Luberto (43:14.265)
Mm-hmm.
Monica Woodward-Luberto (43:24.239)
I guess I need to ask you to clarify the question.
Cara Lunsford, RN (43:30.754)
Yeah, yeah, yeah. So in terms of the audit, right, and the new, these new regulations, and you're thinking, hey, I need to go get, I've now listened to this podcast. I know that this is on the horizon. I want to be prepared before January. What are some resources that you recommend?
Monica Woodward-Luberto (43:47.257)
Mm-hmm. Right.
Cara Lunsford, RN (43:59.939)
that people go and read, listen to webinars. don't know, is there anything?
Monica Woodward-Luberto (44:07.183)
Webinars, I'm not really familiar with any that I could just pull off the top of my head with that. To be quite honest, one of the things that you can use that people are turning to is AI to chat GPT because there's such a volume of information out there. And the nice thing about
the AI programs that are available. And a lot of them are free. You don't have to pay for them. But you can just go online and ask questions. And it will do a deep dive and say, can basically put in a, take that list of, say that case management list that you received.
You can take that list, put it into AI, and ask it to give you the government breakdown of failures, passing rates, surveys, what is considered the top, what are in the bottom lists according to surveys. And then, of course, PubMed and
the NHS websites are areas that you can go to so that you can find journal articles and that specifically will give you more information about, especially if you know the type of care that you need. We just had a family member who needed hospice care for dementia and that was that
It was a struggle to find facilities that would handle the specific needs of that patient, because not every SNF, not every facility is the same. You can go to a memory care facility, but they may not be able to handle a patient who is violent or who has severe dementia. And then what do you do? So there's a lot of research that goes into that.
Monica Woodward-Luberto (46:33.779)
And the case managers are usually your best source when the patient is in a hospital. And your physicians, of course, can recommend because they're the ones who are on the front line.
Cara Lunsford, RN (46:45.292)
Yeah, that's such good advice. I think AI is so, it's so new to a lot of people. I still meet people who haven't used it and have not used chat GPT or anything like that. And I think that it is really, really great when you are trying to understand something very complex.
Monica Woodward-Luberto (46:55.691)
Mm-hmm. Yes.
Cara Lunsford, RN (47:13.57)
when you're trying to understand that there is volumes and volumes of information out there, which can be very overwhelming. It's, think, much nicer to be able to go and say, hey, give me the Cliff Notes on this. Distill this down for me.
Monica Woodward-Luberto (47:21.742)
Mm-hmm.
Monica Woodward-Luberto (47:32.76)
Right. Break it down. Right. that's, I think if more people who are in that situation, you can't know everything, you can't do everything. And the nice part about AI is that the information is out there and it can summarize it for you quickly. I'm working, I have a client out of Canada.
Cara Lunsford, RN (47:36.148)
Mm-hmm. Absolutely.
Monica Woodward-Luberto (48:01.807)
that we are basically teaching AI. take the, they took, I wanna say, I'm trying to remember the exact amount of information. They took 12 years of research, 12 years of research. And.
The LLM program, the Large Language Model Program, the AI program, was able to concise that and break it down in two days. 12 days of research. And they were able then to create questions needed for the NCLEX. So it's amazing what AI can do.
Cara Lunsford, RN (48:40.056)
Wow.
Cara Lunsford, RN (48:53.742)
It really is. I know a lot of people get really scared of AI. And sometimes our tendency is to not use things when we're scared of them. But I think that if you're concerned, and I know as a director of nursing for a home health, I really appreciate
what is available now. I think I could have been a much better administrator if I had been able to utilize something that would like distill down the information for me. And then I can act on it much more because time is of the essence, right? Especially, yeah.
Monica Woodward-Luberto (49:42.822)
yeah. Especially as a manager or director, because you're wearing so many hats and you're trying to do so much and rather than spending 80 hours doing something that can be broken down into an hour or two hours because you have the right information in the right order. All of this information is out there and that's what is.
The beauty of it is it can all be pulled together and make your life so much simpler.
Cara Lunsford, RN (50:19.683)
Yes, it definitely makes your life so much easier. this, Monica, I so appreciate you spending this hour with me, going over something that can be a very complicated subject for people. I know for myself, I...
Monica Woodward-Luberto (50:40.239)
Thank you.
Cara Lunsford, RN (50:42.619)
I have a new role actually at Relias, which is VP of Healthcare Policy and Clinical Solutions.
Monica Woodward-Luberto (50:52.02)
well, congratulations.
Cara Lunsford, RN (50:54.339)
Thank you. So I've been spending the majority of my week really digging in and familiarizing myself with a lot of health care policy. And I really, really appreciate you coming on and explaining something that can be very complicated in a way that I think just about anybody could understand. So this was amazing.
Monica Woodward-Luberto (51:23.251)
well, thank you. that's what I, as I said, that's what I, in the beginning, that's what I'm trying to do is I've got all this experience in my head, you know, and I just want to share it and break it down so that it's simpler for people to understand in little bites, you know, and whether you're a nursing student, a nurse, an experienced nurse, or just a patient on the street.
who wants information.
Cara Lunsford, RN (51:54.0)
Well, I think that you are now all set up to do podcasting. so I personally, you know what? It's mostly audio anyway. I mean, you can do video, but it's mostly audio. I mean, if you create a little podcast snippets, maybe the micro learnings podcast style,
Monica Woodward-Luberto (51:58.0)
Now I gotta work on my lighting.
Monica Woodward-Luberto (52:05.806)
Yeah.
Yep.
Cara Lunsford, RN (52:22.677)
I will be one of your first subscribers and I'm going to try and stay. Yes. Absolutely. Well, thank you again for, for joining us. And again, if anyone has any questions or you're wanting more information, we will make sure that on nurse.com forward slash podcast that we have some details on that page about this episode. And we always put links there.
Monica Woodward-Luberto (52:25.327)
Oh, thank you. My first YouTube. Oh, well, thank you, Kara.
Monica Woodward-Luberto (52:50.991)
Terrific. Thank you.
Cara Lunsford, RN (52:52.269)
Yes. Monica, if people are looking for you personally, I know you do a lot around content creation and subject matter expertise. Where can people find you?
Monica Woodward-Luberto (53:05.481)
They can find me at stilloncallrn.com and my email is stilloncallrn at gmail.com and I have a second one, another one, rncontentstudio at gmail.com that I created to work on expanding that content beyond just CEUs.
So we're trying to expand that area. So either one of those Gmail's and you'll, I'd be happy to receive some information or go onto the website. You can see my portfolio and what I've written and LinkedIn, of course. So thank you for reaching out and letting me give that little blurb out there.
Cara Lunsford, RN (53:55.587)
Yeah, yeah, absolutely. Well, this has been amazing. For people who don't realize it is a Friday today, so I am going to wish you a very happy weekend.
Monica Woodward-Luberto (53:59.428)
Thank you.
Monica Woodward-Luberto (54:03.619)
Yes. Thank you. Thank you. And the same to you. I'm glad we were able to get rid of the gremlins. Yes. OK. I hope we can have another one down the road.
Cara Lunsford, RN (54:11.343)
Me too, me too, the podcast gremlins. Well, until next time, Monica, I will, yes, absolutely, for sure. See you later.
Monica Woodward-Luberto (54:22.776)
All right. Thank you.
