Effective Oct. 1, 2018, skilled nursing facilities must capture three new drug regimen review items in section N (Medications) of the MDS for traditional fee-for-service Medicare Part A residents:

·         On every 5-day PPS MDS (A0310B = 01):

o   N2001 (Drug Regimen Review), which asks, “Did a complete drug regimen review identify potential clinically significant medication issues?,” and

o   N2003 (Medication Follow-up), which is completed if N2001 = 1 (yes) and asks, “Did the facility contact a physician (or physician-designee) by midnight of the next calendar day and complete prescribed/recommended actions in response to the identified potential clinically significant medication issues?”; and

·         On every Part A PPS Discharge assessment (A0310H = 1):

o   N2005 (Medication Intervention), which asks, “Did the facility contact and complete physician (or physician-designee) prescribed/recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission?”

These three items play two key roles in the Skilled Nursing Facility Quality Reporting Program (SNF QRP):

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:

The Centers for Medicare & Medicaid Services (CMS) requirement that facilities have a fully implemented QAPI program by November 28, 2019, means that it’s time to take QAPI plans from paper into practice. As the NAC, you have a lot to contribute to the process, especially when it comes to understanding how your facility’s quality ratings, such as Five-Star, come to be and can be improved to contribute to the success of your organization.

CASPER reports can be an important tool in developing Performance Improvement Projects to improve quality ratings, according to Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, President of Celtic Consulting. But they can only help if you use them in time, before the data hits the Five-Star ratings. As McCarthy says, “Five-Star reports are water under the bridge.” Alternatively, resident preview reports available through CASPER tell you which residents will be triggering, which gives you an opportunity to review the information for accuracy, to identify something larger going on, and even to correct erroneous information.

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.

The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program has been on the back burner at most facilities as the Centers for Medicare & Medicaid Services (CMS) worked out the program details over the past few years. However, on Oct. 1, 2018, the SNF VBP program will begin impacting all traditional Medicare Part A payments made to SNFs under the skilled nursing facility prospective payment system (SNF PPS).

The SNF VBP program is completely unrelated to the Skilled Nursing Facility Quality Reporting Program (SNF QRP). “The SNF VBP program is required by the Protecting Access to Medicare Act of 2014 (PAMA), whereas the SNF QRP is required under the Affordable Care Act,” pointed out CMS officials during the Nov. 16 SNF VBP Program FY 2018 SNF PPS Final Rule Call. Note: Access the call slides here. When available, access the transcript and recording here.

Nurse assessment coordinators (NACs) frequently don’t code MDS 3.0 Section C (Cognitive Patterns), including the critical item C1000 (Cognitive Skills for Daily Decision-Making), notes Kristin Bernard Breese, BSN, RN, CPC, RAC-MT, owner of Post-Acute Clinical Advisors LLC in North Granby, CT. “The social worker is often making the coding decision for C1000, and MDS coordinators as a rule aren’t going back and checking their work.”