LTC Trend Tracker. Peggy Connorton, MS, LNFA Director, Quality and LTC Trend Tracker

Transcription

1 LTC Trend Tracker Peggy Connorton, MS, LNFA Director, Quality and LTC Trend Tracker

2 Benefits of LTC Trend Tracker AHCA member resource Benchmarking against your peers Increases efficiency saves you time Data in one central place pulled using Medicare number

3 AHCA Quality Metrics Rehospitalization Discharge to Community Length of Stay

4 Risk-Adjusted Rate

5 Data Source MDS 3.0 Over a 12-month period Based on admission assessment (5 day or OBRA) Discharge assessment

6 Rehospitalization Measures National measures based on claims Excludes ER visits & observation stays Excludes Medicare Advantage & private insurance Most measures Fail to risk adjust for differences in patients Claims allow for limited clinical information to risk adjust

7 Risk-Adjusted Rate Actual to Expected Ratio >1 you rehospitalized more people than expected

8 Rehospitalization Data MDS 3.0-based measure Adjusted rate Expected rate Actual rate Use in telling your story to hospitals Benchmark your Rehospitalization to your peers

9 Rehospitalization How to interpret your results How do I compare to others? look at risk adjusted results Are you getting better? look at your actual results Are you admitting sicker patients? look at your expected Are you admitting more or less than expected? look at your actual to expected ratio

10 How to interpret your results Risk adjusted is getting better but your actual & expected have not - Means you are doing better compared to others but you are not improving much - Your admissions have about the same acuity over time (e.g. they are not sicker in Jun 2014 compared to Jun 2013 based on expected rate) - Your ratio is 1.0 or less meaning you send fewer patients back to the hospital than expected (this is why your risk adjusted value is 3-4% points less than your actual (21% vs 18%)- however you still have room to do better since your ratio is close to 1.0 most of the time.

11 Rehospitalization Report

12 Actual Rehospitalization

13 Risk Adjusted Trend

14 Finding Percentiles Need to know the center percentile for rehospitalization Determine Ranking by selecting the more button Look at current practices to see what changes you need to make to get to the next percentile level

15 Percentile info

16 Discharge to Community Determine how you compare in your d/c to community rate Private home, apartment, board/care, assisted living, or group home as indicated on MDS discharge assessment Uses MDS Data from the d/c assessment

17 Discharge to Community Report

18 Discharge to Community The measure is risk adjusted using 59 variables in six domains: demographic, functional status, prognosis, clinical conditions, clinical treatments, and clinical diagnoses

19 How to use DC to Community See how you are doing on your dc rate to home and other nonclinical settings It can also tell you if you are sending more or fewer than expected individuals back to the community given the clinical characteristics of the population of individuals admitted to your center Use negotiations with hospitals, Manage Care organizations and others.

20 Five Star Rating Reports 3 Reports Overall, Staffing and QM Report QM-- Identify focus QMs for quality improvement Predict impact of QM improvements on Five-Star QM Rating Predict Staffing Five Star Rating

21 Five Star QM Report Look at your current QM Five Star Rating Determine QMs to focus from the Five Star QM Report Look at your current resident population Enter your scores and see the affect on your overall QM score Members use this report to see if they will maintain their five star rating

22 Sample Five Star overall

23 Changes with Staffing Look at Staffing Five Star Report Determine expected vs reported o o Did you enter the correct data during last survey? What does CMS Expect you to run? Look At CASPER Staffing Report for reported hours

24 Five Star Staffing Rating

25 Five Star Staffing Report

26 RN hours

27 Five Star Staffing Report

28 Casper Staffing Report

29 Five Star QM Rating

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33 SS Stay Antipsychotic

34 LS Antipsychotic

35 FUTURE CHANGES TO FIVE STAR IN 2015 & 2016 CMS plans to add additional quality measures to Five-Star Rehospitalizations Discharge back to community Staffing turnover and retention Other measures from IMPACT act Change how much measures contribute to scoring based on CMS audits of MDS and Staffing reports Linkages to individual state reporting and inspection results

36 CMS raised the bar, now SNFs return to work of quality improvement Outline of a strategy for improving your Five Star rating: Decrease survey score (frequency of tags weighted by scope and severity) o o o Monitor deficiencies (Trend Tracker) Implement strategies to reduce them Must be consistent, as survey score is 3-year average Increase RN and DCS staffing o o Monitor staffing (LTC Trend Tracker) Implement strategies to increase PPDs (see the Trend Tracker Five Star staffing predictor) Improve the 11 QMs o o o Monitor QMs (LTC Trend Tracker) Implement strategies to improve them (see the Trend Tracker Five Star QM predictor) Also must be consistent, as there is roughly a 6 month delay before appearing in Nursing Home Compare, and most measures are based on 12 months of data. So sustain improvement for at least 18 months. Also decrease rehospitalizations and increase discharge to community rates, as they will be added to Five Star QM component in 2016

37 The full list of elements to target in your Five Star strategy

38 What you can do Embrace Value Based Purchasing Programs they allow you more control over your payment Embrace data and the feedback it provides The details matter learn the details of each proposed measure and train your staff Keep an open mind as you perform root cause analysis Establish a common goal within your center

39 When you get back Look at Rehospitalization rates, implement INTERACT Review your Five Star Rating Use your clinical systems and root cause analysis to make changes MDS Process Use Free Tools such as Advancing Excellence or LTC Trend Tracker.

40 Contact Info Peggy Connorton or