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The Quality Measure Survival Guide: What It Is and Why You Need It

By Jessica Kunkler, MA, Staff Writer - December 04, 2017

The new frontier of Quality Measures in long-term care is more challenging than ever and with so much updated information, it can feel like you are lost without a compass. Not only are there three quality reporting programs—MDS 3.0 Quality Measures, Quality Reporting Program (QRP) Measures, and SNF Value-Based Purchasing Program (VBP) Measures—there are more than 51 Quality Measures (QMs). Not to mention all the manuals in which the measures are currently found: Quality Measures Technical User’s Guide, Five-Star User’s Manual, Quality Reporting Program Technical User’s Guide, Nursing Home Compare Technical User’s Guide, SNF QM User’s Manual V1 (QRP Manual), and Nursing Home Compare Quality Measure Technical Specifications. All these programs, all these manuals, all these measures—how will you ever find the way?

The experts at the American Association of Nurse Assessment Coordination created the Quality Measure Survival Guide to be your easy-to-use map to understanding the measures, explaining them to your team, and auditing your facility’s information in a way that makes sense.

Here’s a summary of each of the pieces of the comprehensive guide.


The At-a-Glance

The At-a-Glance is just that. All in one place, this portion of the tool lays out each of the measures across the three programs—MDS 3.0 Measures, QRP Measures, and SNF VBP Measures—clearly indicating which will impact your Five-Star rating, which are publicly reported, and which are reported in CASPER.

Definitions and Algorithms

After reviewing the At-a-Glance, you will feel more organized, but also hungry for more details. What is the difference between a stay and an episode? What exactly is a covariate or risk adjustment? How are records selected for Short Stay and Long Stay QMs? What is the long stay look-back scan for falls? What is the effective date for the 2% reduction to APU for noncompliance? When it comes to all these measures and programs, there are lots of questions!

The Definitions and Algorithms section of the tool clearly defines the words and terms you need to know. It also provides a detailed description of each program as well as diagrams and charts to help you connect the dots to what’s happening in your facility. This section even provides a worksheet you can use to evaluate the SNF VBP performance for your facility!


The Reference Guide

The Reference Guide section of the tool is designed to give detailed, at-length descriptions, with excerpts from the manuals. The guide lists each measure, program, and data source, along with the following information:

·         What does this measure tell me?

·         Who will trigger? (Numerator)

·         Who is in the denominator? Who is excluded?

·         Which items are used for the risk adjustments? (Covariates)

·         Which MDS items need to be audited for accuracy?

Audit Tools

The most challenging part of QM survival is understanding how to apply the chaos of rules and nuanced information to your facility. For example, you’ve noticed that two or three residents with dementia on the second floor have fallen recently. Do you know how this will be quantified in your QMs? The audit tools will help you verify accuracy and identify trends to improve resident outcomes and QMs.

The tools can be used by reviewing your facility’s CASPER reports to identify residents who have triggered, then entering the information into the audit tool (see a sample here). The tool will help you to identify how the resident triggered the QM, if and why a resident was excluded from the calculations, and which covariates were used for risk adjustments. The trends you identify can be submitted to your facility’s Quality Assurance program.



The Quality Measure Survival Guide was designed to be your map to the 51 QMs. Purchase the tool today to improve your facility’s measures!

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