CMS posted a revision to memo QSO-20-31-All

CMS posted a revision to memo QSO-20-31-All that updated the criteria a facility may meet that could trigger a focused infection control survey. This is important in light of the 5-Star user’s Guide posted today which is addressed below. Among the changes, CMS added, “criteria requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the quality of care.” These new criteria are considered, “other factors that may place residents’ health and safety at risk.

  • Multiple weeks with new COVID-19 cases;
  • Low staffing;
  • Selection as a Special Focus Facility per Section 1819(f)(8)(B) of the Social Security Act;
  • Concerns related to conducting outbreak testing per CMS requirements; or
  • Allegations or complaints which pose a risk for harm or Immediate Jeopardy to the health or safety of residents which are related to certain areas, such as abuse or quality of care (e.g., pressure ulcers, weight loss, depression, decline in functioning).

For the CMS QSO-20-31-all click here:


Internet Book of Critical Care (IBCC)

  • COVID-19 is a non-segmented, positive sense RNA virus.
  • COVID-19 is part of the family of coronaviruses.  This contains:
    • (i) Four coronaviruses which are widely distributed and usually cause the common cold (but can cause viral pneumonia in patients with comorbidities).
    • (ii) SARS and MERS – these caused epidemics with high mortality which are somewhat similar to COVID-19.  COVID-19 is most closely related to SARS.
  • COVID-19 binds via the angiotensin-converting enzyme 2 (ACE2) receptor located on type II alveolar cells,  intestinal epithelia, and the vascular endothelium (Hamming 2004).
    • This is the same receptor as used by SARS (hence the technical name for the COVID-19, “SARS-CoV-2”).
    • When considering possible therapies, SARS (a.k.a. “SARS-CoV-1”) is the most closely related virus to COVID-19.
  • COVID-19 is mutating, which may complicate matters even further.  Virulence and transmission will shift over times, in ways which we cannot predict.  Ongoing phylogenetic mapping of new strains can be found here.

For complete book Access:

CMS Updates PDPM Grouper

CMS has posted an update to the PDPM Grouper DLL, as v1.0009, to add support for new ICD-10 codes that may be used for assessments with target dates on or after 1/1/2021.

The posting notice lists those as: Z11.52, Z20.822, Z86.16, M35.81, M35.89 and J12.82.

It notes that codes M35.81 and M35.89 replace code M35.8, which should no longer be used on assessments with target date on or after 1/1/2021.

They’ve also released new lookup files for allowable ICD-10 codes for item I0020B, as of 1/1/2021.

New Group will be included in the upcoming ADL Update.

Congress Approves IoT Cybersecurity Bill

Passed by the U.S. Congress on November 17, 2020 and heading to the White House for the President’s signature, the Internet of Things Cybersecurity Improvement Act “requires the National Institute of Standards and Technology (NIST) and the Office of Management and Budget (OMB) to take specified steps to increase cybersecurity for Internet of Things (IoT) devices.”

Given the many recent security issues with “smart” devices and their rapid proliferation in the marketplace, we’re glad to see the U.S. Congress taking a step in the right direction to establish IoT security standards and best practices for the federal government.

Nonopioid Treatments for Chronic Pain

Principles of Chronic Pain Treatment

Patients with pain should receive treatment that provides the greatest benefit. Opioids are not the first-line therapy for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. Evidence suggests that nonopioid treatments, including nonopioid medications and nonpharmacological therapies can provide relief to those suffering from chronic pain, and are safer.

Effective approaches to chronic pain – Download: