VOLUME TO VALUE: CHALLENGES & OPPORTUNITIES. Update on the AOTA Quality Program October 12, 2018
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1 VOLUME TO VALUE: CHALLENGES & OPPORTUNITIES Update on the AOTA Quality Program October 12, 2018
2 The Quality Team Sharmila Sandhu, JD Director of Regulatory Affairs Jennifer Bogenrief, JD Assistant Director of Regulatory Affairs Jeremy Furniss, OTD OTR/L BCG Director of Quality
3 Agenda Incentives for Health Systems Today Countdown to new Value Based Programs Consider Future Incentives & the Response from OT
4 OT Services & Medicare Payment Today OT Services staff hours productivity Audit Activity Organization Reimbursement Dollars Incentives for Health Systems Hire more OT Practitioners Maximize productivity Focus on defensive documentation to minimize negative audit findings
5 Medicare is Making Changes An effort to change incentives for health systems We ll count down changes in 4 practice areas These are the highlights, make sure to Check out links for more info on aota.org Keep an eye out for new training modules
6 Medicare A Quality Programs Value Based Purchasing VBP Payment changes based on Quality Measure performance Quality Reporting Program QRP Public Reporting of Quality Measure performance
7 IMPACT Act Mandated changes in Post-Acute Care, including Domains using standardized (uniform) data elements Implement quality measures from five quality measure domains using data Development and reporting of measures pertaining to resource use, hospitalization, and discharge to the community CMS created standardized data elements that can be found at Section GG is one of these areas
8 Section GG Self-Care Elements Eating Oral hygiene Toilet hygiene Shower/bathe self Template & Education at Check out the link to the official CMS training! Upper body dressing Lower body dressing Putting on/taking off footwear 6: Independent 3: Partial/moderate assist 5: Setup or cleanup assist 2: Substantial/maximal assist 4: Supervision or touching assist 1: Dependent
9
10
11 #4 January 1, 2020
12 Home Health HH (Draft Rule) Section GG QRP VBP Therapy Time Yes Yes. Self-Care Measures are based on legacy data elements Demonstration (9 states) OT visits no longer contribute to payment as of Jan 1, 2020
13 #3 October 1, 2019
14 Inpatient Rehabilitation Facilities Section GG QRP VBP Therapy Time HH Yes Yes. Self-Care Measures are based on legacy data elements Demonstration (9 states) OT visits no longer contribute to payment as of Jan 1, 2020 IRF Yes. FIM is being replaced by GG. Used for Measures & Payment Yes. Self-Care & Mobility Measures based on GG Not yet Does not impact payment
15 #2 October 1, 2019
16 Skilled Nursing Facilities Section GG QRP VBP Therapy Time HH IRF SNF Yes Yes. Self-Care Measures are based on legacy data elements Demonstration (9 states) OT visits no longer contribute to payment as of Jan 1, 2020 Yes. FIM is being replaced by GG. Used for Measures & Payment Yes. Self-Care & Mobility Measures based on GG Not yet Does not impact payment Yes. Used for Measures & Payment Yes. Self-Care & Mobility Measures based on GG Yes. 1 st Payment Adjustment 10/1/18 OT minutes no longer contribute to payment as of Oct 1, 2019
17 BEFORE WE GET TO #1
18 Future of OT Services & Medicare Payment Consumers d/t QRP Measures OT Services staff hours VBP Measures Organization Reimbursement Dollars Incentives for Health Systems Maximize staff that have an impact on quality measures Minimize staff that have little or no impact on quality Focus on collaboration and documentation that identifies value Identify gaps and improve care using quality measures
19 Examples of QRP & VBP Measures Functional Outcome Measure: Change in Self- Care Score (based on Section GG) Percent of Residents Experiencing One or More Falls with Major Injury Percent of Patients or Residents with Pressure Ulcers that are New or Worsened
20 #1 January 1, 2019
21 Quality Payment Program (QPP) Medicare Part B Outpatient (not facility based yet) In 2019, Best performers can earn +7% to 2021 payments. Worst performers can earn -7%. Low Volume Threshold determines eligibility 60 OT NPIs mandated to participate 4,400 OT NPIs eligible to opt-in
22 QPP Categories In 2019, OT will likely only be scored on 2 of the 4 categories: Quality Report 6 measures (1 outcome or high priority). Scored based on performance. Improvement Activities Complete 90-days of quality improvement using selected activities Cost Compares the cost of services to peers Promoting Interoperability Measures based on the use of certified EHR technology
23 QPP (MIPS) Quality Measures Claims 1. N-0101 Falls: Screening, Risk assessment, and POC 2. N-0421 BMI Screen & Plan 3. N-0419 Doc Meds in Record 4. N-0420 Pain Assess & f/u 5. N-2624 Functional Outcome 6. N-0028 Tobacco Use 7. N-0418 Depression Screen & f/u 8. Q-181 Elder Maltx screen & f/u Registry/EHR 1. N-0422 FOTO Knees 2. N-0423 FOTO Hip 3. N-0424 FOTO Foot/Ankle 4. N-0425 FOTO Lumbar 5. N-0426 FOTO Shoulder 6. N-0427 FOTO Elbow, Wrist, Hand 7. N-0428 FOTO Gen Ortho 8. N-2152 Unhealthy Alcohol Use Dementia: Cognitive Assmt Dementia: Functional Status Assmt Dementia: Associated Behavior/Psych Dementia: Safety Concerns
24 Improvement Activities A few examples Depression screening Engagement of Patients, Family, and Caregivers in Developing a Plan of Care Implementation of fall screening and assessment programs Participation in Quality Improvement Initiatives Practice Improvements that Engage Community Resources to Support Patient Health Goals Promote Use of Patient-Reported Outcome Tools Tobacco use Unhealthy alcohol use Use of decision support and standardized treatment protocols
25 QPP.CMS.GOV
26 AOTA QUALITY PROGRAM
27 To maintain relevance OT practitioners must deliver high-quality services that impact each client and impact systems level quality measurement.
28 What is AOTA Doing? We support OTs who review, critique, and/or recommend quality measures for every program We develop clinical resources for practitioners We provide feedback directly to CMS We work with measure developers We are developing action oriented education
29 2018 External Quality Work There are over 20 committees/groups that include OTs just this year! PCPI Primary & Preventive Care TEP PCPI Measure Advisory Committee AAPM&R & PCPI Measure Development NQF Neurology Committee NQF Serious Mental Illness Action Team NQF Adult Medicaid Group NQF Medicaid Scorecard NQF Cancer Standing Committee NQF Clinician Workgroup NQF Admissions & Readmissions Workgroup NQF Post-Acute Care Workgroup NQF Clinician Workgroup NQF Membership Advisory Council CMS MSK Non-spine Cost Measure Dev CMS MSK Cost Measure Dev CMS Psych Cost Measure Dev CMS Neuro Cost Measure Dev CMS Measure Development Plan TEP CMS Unified PAC PPS TEP CMS IMPACT TEP (multiple) And more
30 Our Initial Focus is the OT Eval Areas to Address in an OT Eval 1. Occupational Profile Occupational Performance 1. ADLs 2. IADLs 3. Fall Prevention / Fear 4. Psychosocial Skills 5. Functional Cognition 6. Vision
31 Our Initial Focus is the OT Eval Quality Measure Examples Readmissions Change in Self-Care Fall with major injury Discharge to community Falls: Screening, Risk Assessment, and POC Functional Outcome Depression Screen & f/u Areas to Address in an OT Eval 1. Occupational Profile Occupational Performance 1. ADLs 2. IADLs 3. Fall Prevention / Fear 4. Psychosocial Skills 5. Functional Cognition 6. Vision
32 Our Initial Focus is the OT Eval Quality Measure Examples Readmissions Change in Self-Care Fall with major injury Discharge to community Falls: Screening, Risk Assessment, and POC Functional Outcome Depression Screen & f/u Areas to Address in an OT Eval 1. Occupational Profile Occupational Performance 1. ADLs 2. IADLs 3. Fall Prevention / Fear 4. Psychosocial Skills 5. Functional Cognition 6. Vision
33 Questions for Practitioners Can we answer: How do I, as an OT practitioner, contribute to client and system outcomes? Are we familiar with Medicare quality programs VBP, QRP, QPP? How OT contributes? Are we comfortable with Section GG as a measure for self-care & mobility? Are we experts? Can we implement a quality improvement project?
34 Slide Deck Visit to download the PowerPoint and PDF versions of the slide deck The PowerPoint version has bonus slides that include an activity using Nursing Home Compare quality measures Feel free to edit and use the slides in your programs
35 Questions, Ideas, & Discussion
36 Bonus Slides These slides were put together for use with students in the classroom Keep an eye out for additional resources & education from AOTA SNF Measures are included. Measures in other settings will vary. Here s a great presentation from PCPI on the PDSA process discussed in these slides
37 SNF VBP Measures Measure Data Status Skilled Nursing Facility 30-Day Potentially Preventable Readmission Measure (SNFPPR) Claims Implemented Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) Claims Implemented
38 SNF QRP Measures Measure Data Status Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) MDS Implemented Percent of Patients or Residents with Pressure Ulcers that are New or Worsened MDS Implemented Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function Discharge to Community- Post Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Potentially Preventable 30-Days Post-Discharge Readmission Measure for Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) MDS Claims Claims Implemented Implemented Implemented Medicare Spending Per Beneficiary Post-Acute Care (PAC) Skilled Nursing Facility Measure Claims Implemented
39 Measure SNF QRP Measures: FY 2020 Claims Medicare Spending Per Beneficiary (MSPB) Post Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). Discharge to Community Post Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Potentially Preventable 30-Day Post-Discharge Readmission Measure for Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). FY 2020 begins Oct 1, 2019 This slide includes measures calculated with claims data The next slide includes measures calculated with data from the Minimum Data Set (MDS)
40 SNF QRP Measures: FY 2020 MDS Measure Percent of Residents or Patients With Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678). Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury. Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) (NQF #0674). Application of Percent of Long-Term Care Hospital (LTCH) Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631). Application of IRF Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634). Application of IRF Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636). Application of the IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633). Application of IRF Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635). Drug Regimen Review Conducted With Follow-Up for Identified Issues- Post Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).
41 Activity Visit Nursing Home Compare Select a facility (in the area, from a fieldwork, etc.) Identify a quality measure for improvement Identify the ways OT can impact the measure, questions you would ask, & possible action steps
42 Visit: Or search for Nursing Home Compare
43
44 Search for your SNF here
45
46 Stars provide an overview meant for consumers
47 Click the name of your facility to get to the good stuff!
48 Each tabs is important. But, we are going to focus on Quality
49 For SNF, there are 2 sets of measures check out both! Short-stay & Long-stay Each tabs is important. But, we are going to focus on Quality
50 Up to Date Click on current data collection period These measures are often a few months old New measures may not be published yet The facility can pull current measures using Electronic Health Records and/or CASPER reports (Available from a CMS portal)
51 Short Stay Measures The performance of your facility is in this column.
52 Short Stay Measures The average performance of your state is in this column.
53 Short Stay Measures The national average performance is in this column.
54 Short Stay Measures While most all of these measures relate to OT, some are directly connected!
55 Short Stay Measures All of these measures are important. Measures that are worse than state or national will likely rise to the top of priorities!
56 Short Stay Measures Your facility can identify the people in the measure using MDS software or CASPER report.
57 Short Stay Measures What questions might you ask for this measure? Were the people with pressure ulcers that are new or worsened referred to OT? If so, what areas did the OT address in the evaluation & intervention? If not, why not? Can this be changed? Identify ways in which OT may help the interdisciplinary team improve on the measure. Is OT evaluating ADL and IADL performance for clients who are at risk for pressure ulcers? (e.g., toileting for people with decreased independence in mobility)
58 HOW CAN WE USE THIS INFORMATION TO IMPLEMENT A PDSA CYCLE?
59 PDSA Cycle Download a PDSA Worksheet from the Institue for Healthcare Improvement Plan State the objective or purpose Make a prediction of what will happen and why Develop a plan to test the change Who? What? When? Where? What data needs to be collected? Generate a Good Idea
60 PDSA Cycle Do Test the change on a small scale (e.g., one patient, one unit, one shift, one hour 1:1:1 test ) Document what happened problems and unexpected observations Begin data analysis Test on a SMALL scale!
61 PDSA Cycle Study Complete data analysis Compare data to predictions Summarize learnings and think about meaning Don t Forget to Study the results!
62 PDSA Cycle Act Adopt, adapt, abandon the change based on results of the test Prepare plan for next test Adjust and Do Again
63 Compare Sites This process works the same way for most settings. See the sites below: Home Health Compare Inpatient Rehabilitation Facility Compare Long Term Care Hospital Compare Hospital Compare Physician Compare (Including OT in private practice)
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