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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:
Last month, the Centers for Medicare & Medicaid Services (CMS) published its annual updates to the RAI User’s Manual. And this time around, there were quite a few—62 to be exact. While many of them were welcome changes, several others have led to questions and confusion within the long-term care community.
While we can’t address every single change here, we spoke with AANAConnect community leaders to discuss some of the most confusing changes—and how you can address them within your facility.
New national palliative care clinical practice guidelines seek to ensure the millions of people living with serious illness, such as heart failure, lung disease and cancer, have access to vital care that can help meet their needs. The guidelines promote improved access to palliative care, which is focused on giving patients and their caregivers relief from the symptoms and stress of serious illness, is based on need, not prognosis, and can be provided along with disease-focused treatment.
The Clinical Practice Guidelines for Quality Palliative Care, 4th edition calls for a seismic shift in the delivery of this specialized care by urging all health care professionals and organizations to integrate it into the services they provide to people living with serious illness. The guidelines also include tools, resources and practice examples to help with implementation.
The Centers for Medicare & Medicaid Services (CMS) thanks all skilled nursing facilities (SNFs) that participated in Phase Two of the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program’s Review and Corrections process. As a result, CMS is providing updated rankings for all SNFs included in the Fiscal Year (FY) 2019 program year. A list of each SNF’s incentive payment multiplier and updated ranking can be found on the SNF VBP website.
The incentive payment multiplier applicable to each SNF is unchanged from the multiplier that CMS previously included in the SNF’s FY 2019 Annual Performance Score Report. That multiplier will be used to adjust the Federal per diem rate otherwise applicable to the SNF for services furnished from October 1, 2018 through September 30, 2019. A more detailed file containing facility level performance will be made publicly available later this year on Nursing Home Compare.
To assist SNFs, CMS is excited to announce new Skilled Nursing Facility (SNF) Annual Payment Update (APU) warning edits are being incorporated into the MDS technical submission specifications. These warning edits appear as both pop-up messages in jRAVEN, the free CMS software that allows SNFs to submit MDS data to CMS in the proper format, and also on the MDS 3.0 Final Validation Report (FVR). The edits will appear when required standardized patient assessment data elements and data elements required for quality measure calculation for the purposes of the SNF QRP are dashed. These warning edit will display on FVR as error identification numbers:-3897, -3907 or -3908. Warning edits do not prevent MDS 3.0 assessment from being accepted by the Assessment Submission and Processing (ASAP) system.
Active diagnoses and ICD-10-CM diagnosis codes will be a significant payment driver in the Patient-Driven Payment Model (PDPM) that goes into effect on Oct. 1, 2019, under the skilled nursing facility prospective payment system (SNF PPS) for traditional Medicare Part A residents. Diagnoses will impact all five of the case-mix-adjusted payment categories: physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), nontherapy ancillary (NTA), and nursing, notes Judy Wilhide Brandt, RN, BA, QCP, CPC, RAC-MT, DNS-CT, principal of Wilhide Consulting in in Virginia Beach, VA.
The way the nurse assessment coordinator (NAC) is tracking pressure ulcers may have changed, but that doesn’t mean the nursing team’s care process should.
As part of its annual October updates to the RAI User’s Manual, the Centers for Medicare & Medicaid Services (CMS) made some changes to how pressure ulcers are referred to and how they are coded.
First and foremost, the RAI manual has broadened the scope of its terminology, to include pressure injuries rather than just pressure ulcers.
On Oct. 24, 2018, in accordance with Section 1899B(g)(1) of the Social Security Act, which requires CMS to provide for the public reporting of SNF provider performance on the quality measures, CMS announced the inaugural release of the Skilled Nursing Facility Quality Reporting Program (SNF QRP) quality data on Nursing Home (NH) Compare.
Specifically, the following five SNF QRP measures are now being displayed on the NH Compare site:
CMS has decided not to publish a 6th quality measure, Potentially Preventable 30-Day Post-Discharge Readmissions, at this time. Additional time would allow for more testing to determine if there are modifications that may be needed both to the measure and to the method for displaying the measure. This additional testing will ensure that the future publicly reported measure is thoroughly evaluated so that Compare users can depend upon an accurate picture of provider quality. While we conduct this additional testing, CMS will not post reportable data for this measure, including each SNF’s performance, as well as the national rate.
We are reaching out to remind you of the upcoming submission deadline for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). MDS assessment data for April 1 – June 30 (Q2) of calendar year (CY) 2018 are due with this submission deadline.
All data must be submitted no later than 11:59 p.m. Pacific Standard Time on November 15, 2018.
While F881 (antibiotic stewardship program) citations remain low overall compared to other citations nationwide, as of Oct. 15, 2018, QCOR data, F881 is now the 10th most-cited new F-tag with a severity level of F or above. -Staff
Register now to attend a one-hour webinar that explains how long-term care facilities can run an effective antibiotic stewardship program by joining a free, 12-month national project. Beginning in December, the AHRQ Safety Program for Improving Antibiotic Use will provide participating long-term care facilities with antibiotic use guidelines, expert coaching, online education, improvement tools and patient education materials to help prevent harms associated with antibiotics, such as Clostridium difficile. Participants also have the opportunity to earn continuing education credits.
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