Often, when myriad changes hit all at once, even anticipated ones, it is difficult to implement them, especially when they seem to be coming from every direction. Every fall we expect updates from the Centers for Medicare & Medicaid Services (CMS) to the RAI User’s Manual, Five-Star Quality Rating System, Skilled Nursing Facility (SNF) Quality Reporting Program (QRP), and Quality Measures (QMs). When these updates bring big changes—some of which we expect and some, of course, we do not—we have to adapt our facility processes quickly. This is a significant challenge, considering that it requires us as leaders to thoroughly understand many changes from multiple manuals and reporting programs.
This fall CMS released significant updates to the SNF QRP Measure Calculations and Reporting User’s Manual and the Nursing Home Compare Claims-Based Quality Measure Technical Specifications. AANAC has updated the 2018 AANAC Quality Measures Survival Guide to include these changes. Here’s an overview of what’s new:
Changes to the SNF QRP Quality Measures
Six new SNF QRP measures became effective on October 1, 2018. This should not have surprised anyone, because these measures were finalized in the SNF Prospective Payment System (SNF PPS) Final Rules for 2017 and 2018, giving providers plenty of time to prepare. The six new measures are:
· Drug Regimen Review Conducted With Follow-Up for Identified Issues—PAC SNF QRP
· Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury
· SNF Functional Outcome Measure: Discharge Self-Care Score for SNF Residents
· SNF Functional Outcome Measure: Discharge Mobility Score for SNF Residents
· SNF Functional Outcome Measure: Change in Self-Care Score for SNF Residents
· SNF Functional Outcome Measure: Change in Mobility Score for SNF Residents
Additionally, one measure was retired this fall: SNF QRP New or Worsened Pressure Ulcers was replaced by the new Changes in Skin Integrity measure, effective October 1, 2018.
Changes to Nursing Home Compare
On October 24, 2018, five SNF QRP measures became publicly reported on Nursing Home Compare (NHC). This change was also expected, as it was previously introduced to providers in the 2017 and 2018 SNF PPS Final Rules.
- Percent of SNF Residents With Pressure Ulcers That Are New or Worsened
- Percentage of SNF Residents Who Experience One or More Falls With Major Injury
- Percentage of SNF Residents Whose Functional Abilities Were Assessed and Functional Goals Were Included in Their Treatment Plan (also referred to as Application of Percent of Long-Term Care Hospital Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function)
- Rate of Successful Return to Home and Community From a SNF (also known as Discharge to Community—PAC SNF QRP)
- Medicare Spending per Beneficiary (MSPB) for Residents in SNFs—PAC SNF QRP
In addition, the measure Potentially Preventable Hospital Readmissions was posted on NHC, although the data for this measure has been suppressed until CMS can complete more testing and finalize a method for reporting.
With the fall 2018 release of the updated Nursing Home Compare Claims-Based Quality Measure Technical Specifications, CMS also introduced a brand new and unanticipated claims-based measure, Number of Hospitalizations per 1,000 Long-Stay Resident Days. This measure became publicly reported in late October 2018 and is planned to be integrated into the Five-Star Quality Rating System in spring 2019. The measure reports the number of unplanned hospital readmissions or outpatient observation stays that occurred among long-stay Medicare FFS–enrolled residents during a one-year period.
NHC provides a link to the public for the SNF Value-Based Purchasing (VBP) program data. While baseline performance data has been available to the public for some time, in late October CMS released the ranking file, as anticipated following the Phase 2 review and correction. See your ranking here.
Changes to NHC Claims-Based Measures
In addition to the claims-based measure Number of Hospitalizations per 1,000 Long-Stay Resident Days, there are three other NHC measures, all of which had unexpected and significant updates to the covariates this fall:
· Percentage of Short-Stay Residents Who Were Re-hospitalized After a Nursing Home Admission
· Short-Stay Residents Who Have Had an Outpatient Emergency Department Visit
· Percentage of Short-Stay Residents Who Were Successfully Discharged to the Community
CMS noted in the September 2018 Nursing Home Compare Claims-Based Quality Measure Technical Specifications, in regard to MDS-based covariates:
We also excluded factors related to conditions that increase the risk for readmission to the hospital by short-stay nursing home resident only when proper care and management is not provided by the facility. These exclusions were based on the set of conditions considered to be potentially preventable for the Potentially Preventable 30-Day Post-Discharge Readmission Measure for the Skilled Nursing Facility Quality Reporting Program (QRP).
The scope of Quality Measures has grown significantly over the past few years, with the development of the Five-Star Rating System, expansion of the MDS 3.0 Quality Measures, and rollouts of the SNF QRP and VBP programs. It is often difficult to determine which measure belongs to which program, and it is nearly impossible to instantly recall all the specifics of all the different program measures when working toward your facility’s quality improvement goals.
Whether you are trying to reduce rehospitalizations, prevent in-house–acquired pressure ulcers, or lower the percentage of residents self-reporting pain, you must understand the minutiae of each QM and be able to lead and educate your interdisciplinary team as needed. The 2018 AANAC Quality Measures Survival Guide explains each measure and its program clearly in order to help you accomplish your quality improvement goals. Get your updated copy today!
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