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Reducing Rehospitalizations with Nursing Advantage

Comprehensive resident assessments guide nurses in providing high-quality, well-documented care at Avamere


Identifying residents at risk through consistent, high quality nursing documentation to provide early interventions.


Nursing Advantage supports nurses with comprehensive assessments and proactive clinical guidance.


  • 55% decrease in long stay rehospitalizations
  • 30% less COVID mortality vs. surrounding region

Avamere Family Companies

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33 communities

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Skilled nursing, rehabilitation, independent living, assisted living, and memory care

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Locations in OR and WA

Founded in 1995
“Enhancing the life of every person we serve”


Avamere Family of Companies, a group of independent privately owned post-acute care organizations, has always been dedicated to improving seniors’ health and well-being. To meet this goal, Avamere saw an opportunity to enhance nursing documentation. Not only would this demonstrate the thoroughness and completeness of their resident care, but it would also reduce revenue lost to audit due to incomplete documentation. They also wanted clear visibility into which residents were most at risk for poor outcomes.

After careful consideration, Avamere chose PointClickCare’s Nursing Advantage as the solution to address these opportunities. Along with many immediate positive changes, Avamere is thrilled that each update of this innovative tool has brought continued benefits to their residents and staff.

How PointClickCare Helped Us

Avamere’s team chose Nursing Advantage because it emphasizes best practices, helping nurses create a more complete note that supports evidence-based resident care. Dynamic, diagnosis-based assessments and clinical guidance support Avamere’s nursing staff in thoroughly evaluating each resident’s condition and proactively responding to changes. As a result, Avamere experienced improved resident outcomes.

Avamere experienced an average 55% decrease in long stay rehospitalizations across all facilities since implementing Nursing Advantage. “Early intervention is always key. So being able to intervene with medically fragile patients early and reducing rehospitalizations company-wide was huge for us just in that respect,” says April Alexis, CPMA (Certified Professional Medical Auditor), RAC/Denial Manager at Avamere. “It’s such a simple way to increase your revenue and improve your outcomes that I can’t believe we didn’t have something like this sooner.”

The use of Nursing Advantage also resulted in:

  • Increased clinically relevant content in notes
  • Reduced revenue loss due to incomplete charts on audit
  • Significantly reduced denials regarding supporting documentation for SNF care
  • Gained recognition by referral sources as a preferred provider
  • Strengthened working relationships with physician groups thanks to comprehensive resident insights

The improved charts for Medicare Recovery Audit Contract (RAC) auditors were an unexpected benefit of using Nursing Advantage. As Avamere’s documentation improved, staff noticed that denials and appeals went down drastically. With Nursing Advantage, they now have enhanced documentation to support the coding of isolation and shortness of breath while lying flat to maximize reimbursement and prevent denials.

“Coding within the MDS of isolation and shortness of breath while lying flat were two of our biggest issues, auditors were just hammering us repeatedly regarding these. I haven’t seen one chart have these issues since the introduction of Nursing Advantage, and that alone is my success story” says Alexis. In the end, Avamere estimates that they are saving hundreds of dollars a day from being reclaimed by auditors.

How It Works

Smart assessments within Nursing Advantage ensure consistent, thorough evaluations of each resident based on their individual needs, current health status, and diagnoses. “You can see the improvement also in the quality of their documentation over time and how well the nurses would complete each body system. And it improved the application of nursing interventions,” says Paula Love, Director of Clinical Informatics. “What I like about Nursing Advantage is it guides the author to make a better note. So, if the nurse gets pulled away, they can come back and pick up right where they left off.”

Clear, consistent assessment information enables Avamere to analyze the insights collected with Nursing Advantage. With all the essential resident information in one place, they can quickly and objectively identify who their sickest and highest-risk residents are, taking the guess work out of prioritizing care. Love recounted this example: “As we were rolling this out in training, I was at the facility and showing them how the care insights rank patients by acuity. And as we were doing that the person at the top of the list was being sent out to the hospital. From that moment, they were believers.”

This ability to improve outcomes is measurable. For example, Avamere notes 30% less COVID mortality compared to the surrounding region, aided by Nursing Advantage. As Alexis put it, “The respiratory screener truly helped us save lives during COVID, and that alone is priceless.”
The local healthcare community has started taking note of Avamere’s improved care, too. “We have a lot of specialty contracts with providers that want to have contracts with us purely because of our outcomes. They see the care that we are providing, they’re hearing that patients are happy and well-cared for, and they want to do business with us,” notes Alexis.

Learn More

If you’re interested in achieving the same success as Avamere Family of Companies with comprehensive assessment guidance and improved nursing documentation for your team, contact our team to see if Nursing Advantage is the right solution for your organization.

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