PATHTalks: What Every Leader Needs to Know About R.O.I. 

In a rapidly shifting healthcare landscape, operational and clinical leaders are under more pressure than ever to optimize resources, improve outcomes, and demonstrate value. The intersection of regulatory oversight, data transparency, and value-based payment models has reshaped what it means to deliver quality care and how success is measured.

At the heart of this transformation is one core concept: Reimbursement Optimization Improvement (ROI). For organizations, strategic management of their Minimum Data Set (MDS) processes and data reporting practices is crucial to strengthen both financial sustainability and patient care outcomes.

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Consulting Solutions: MDS Baseline Assessment 

Pathway Health’s two-day onsite MDS Baseline Assessment delivers a comprehensive, real-time evaluation of your facility’s MDS processes. Led by clinical reimbursement specialists, it identifies vulnerabilities, enhances staff competencies, and ensures sustainable documentation practices.

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PATHTalks Podcast

Through this podcast, Pathway Health experts and other industry leaders will have an opportunity to share valuable insights that are focused on enhancing knowledge, sharing resources, and inspiring healthcare leaders along their career journey. 

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Article: Why Targeted Resident Chart Audits Are Essential for Skilled Nursing Facilities

In the highly regulated world of long-term care, nursing facilities are under constant scrutiny from federal and state agencies. The Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), and the Government Accountability Office (GAO) all emphasize the need for robust documentation and proactive quality assurance. Targeted chart audits are a proven strategy to meet these expectations, prevent deficiencies, and protect residents.

The Reality: Deficiencies and Penalties in U.S. Nursing Homes

• Nearly 400,000 deficiencies were cited in U.S. nursing homes over the last three years.

• 22,000+ harm-level and 8,648 immediate jeopardy citations.

• $566 million in fines, with Illinois alone exceeding $74 million.

• CMS may impose payment denials or terminate Medicare/Medicaid agreements for persistent noncompliance.

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Article: Driving Excellence in Skilled Nursing: Strengthening MDS Accuracy for Compliance, Quality, and Resident Outcomes

Insights from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC - Director of Reimbursement and Education

Why MDS Accuracy Matters More Than Ever

Today’s skilled nursing environment is under unprecedented scrutiny. A recent OIG report found that 43% of resident falls with major injury and hospitalization were not reported in Minimum Data Set (MDS) assessments.

These lapses not only compromise the accuracy of CMS’s Care Compare data but also expose organizations to compliance risk, reduced quality ratings, and potential reimbursement loss.

For skilled nursing facility leaders, the message is clear: MDS accuracy is not optional—it’s foundational. Accurate assessments drive compliance with CMS requirements, support resident-centered care planning, and impact nearly every program tied to financial sustainability, including Five-Star Ratings, SNF QRP, VBP, and PDPM.

Provided by Healthcare Research and Quality 

Toolkit for Improving Skin Care and MDRO Prevention in Long-Term Care

This toolkit outlines four evidence-based strategies to reduce infection risks and maintain skin integrity among long-term care residents, including keeping skin clean and safe, reducing MDRO transmission, using antibiotics wisely, and cleaning and disinfecting high-touch surfaces. 

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The following resource is provided by Provider: Long-Term & Post-Acute Care

Improving Section GG Accuracy Through QAPI 

U.S. Antibiotic Awareness Week (USAAW) Toolkit

November 18-24, 2025, was U.S. Antibiotic Awareness Week (USAAW), and we are reminded that the fight against antimicrobial resistance affects us all.

When it comes to healthcare settings, especially in long-term care and senior living, this focus is particularly vital. Antibiotics are among the most commonly prescribed drugs in nursing homes, yet studies show that 40–75% of those prescriptions may be inappropriate. Also, the overuse and misuse of antibiotics drive the rise of pathogens that evolve to resist treatment. Effective antibiotic stewardship is essential to quality care, resident safety, and an integral component of your IPC program.