NYSHFA ADVANCED TRAINING INITIATIVE & July 30, 2015

Transcription

1 1 NYSHFA ADVANCED TRAINING INITIATIVE & COST REPORT PREP July 30, 2015

2 Introductions 2 Kathie Angelone, Director Shauna Seeley, Supervisor Division of EFP Rotenberg, LLP

3 Agenda 3 RHCF-4 Cost Report Filing Issues 2014 Changes 10:00 Exhibit O 10:05 Exhibit P 10:15 Exhibit Q 10:25 Quality Initiative & the RHCF-4 10:35 Advance Training Initiative 11:00 What, When, How and Why?

4 2014 RHCF-4 Revisions 4 Configure Screen Added a PFI field Permanent facility identifier Added a County field For data mining gpurposesp Must be completed before you can proceed with preparation of report PFI can be found at: PFI can be found at:

5 2014 RHCF-4 Revisions 5 Configure Screen

6 2014 RHCF-4 Revisions 6 Schedule 10B Schedule meant to aid DOH in its energy initiative Initially added in the 2013 RHCF-4 Date fields not properly formatted Instructions did not explain its purpose Revised slightly for 2014 Fixed the date formatting

7 2014 RHCF-4 Revisions 7 Schedule 10B

8 2014 RHCF-4 Revisions 8 Schedule 10B Most important data is line 113 : Estimated Useful Life of Facility RHCF-4 Instructions: Column 1184: Years Left: This is an estimation made by the Facility to the remaining operational life of the facility. This could be more than 40 years.

9 2014 RHCF-4 Schedule O 9 Quality Measures Section 1: Hours Paid for RN s, LPN s & Aides

10 2014 RHCF-4 Schedule O 10 Quality Measures Section 2: #of employees per quarter and # of employees terminated

11 2014 RHCF-4 Exhibit O 11 Contract Staff Hours Paid and Terminations DOH s methodology based on study results which indicate that staff retention contributes to higher quality care. Very difficult to get accurate info for Schedule O Terminations isn t really accurate when reporting contract staff

12 2014 RHCF-4 Exhibit O & 2015 Quality measure: If percentage of contracted staff is <10% you get the 5 points in your quality score. 10% or more and you get 0.

13 2014 RHCF-4 Schedule P 13 Staff Turnover One schedule each for RHCF, Head Injury, Vent & Behavioral

14 2014 RHCF-4 Schedule P 14 Very Important Schedule Quality Initiative Advanced Training Initiative

15 2014 RHCF-4 Schedule P 15 Staffing Rate Nurse Hours per day for RN s s, LPN s & Aides Turnover Rate Contract and Per Diem staff are excluded from this measure.

16 2014 RHCF-4 Schedule P 16 Things to Look For: Col 0770: # Empl on 1/1/2014 Should equal your ending employees on 12/31/2013 Col : # Empl on 3/31, 6/30 & 12/31 These columns are at the end of the calendar quarters Col 0775 & 0776: # FT and PT Empl As of 12/31/2014 Col 0777: # Empl on 12/31 who were empl on 1/1 **This column cannot be more than col 0770** Col 0778 & 0779: # Empl Hired and Fired during the year Don t estimate get actual data.

17 2014 RHCF-4 Schedule P 17 Issues which can distort the retention and turnover rates Long term casual employees sometimes called Per Diem FMLA should not count as terminations and/or hires Transfer departments how are these employees recorded in your records?

18 2014 RHCF-4 Exhibit Q 18 Not required but strongly recommended! Currently considered a reference document DOH will use it to help with your rate but rate calculation does not pull from this schedule. Most often used after s on rate errors.

19 2014 RHCF-4 Exhibit Q 19 Capital Streamlining Process September, 2015: Version #1 of capital component is issued to providers November, 2015: Version #2 issued with the 2016 draft rates January (or February), 2016: Version #3 issued with the 2016 Initial rates.

20 2014 RHCF-4 Exhibit Q 20 Capital Streamlining Process s can and should be sent to DOH after each version to fix any errors. DOH will look at Schedule Q during this process

21 2014 RHCF-4 Exhibit Q 21 Give them as much info as possible Do the work for them! Location of where cost is reported schedule and cost center If you need more room put it in the notepad and say SEE NOTEPAD on Schedule Q If your resident days are < 90% for the year DOH will impute those days to 90% for use in the capital component.

22 2014 RHCF-4 22 QUESTIONS? Feel free to contact: Shauna Seeley, RHCC w: (585) e:

23 23 Quality Initiative & the RHCF-4

24 Quality Initiative & the RHCF-4 24 Refresher: Program to reward facilities providing exceptional quality care and to encourage other facilities to improve. Began in 2013 and continuing through 2015 Currently $50M in project $50M is currently in the Medicaid rates and will be removed and paid to high scorers. No funds have been taken back or paid out 2013 impacts range from $(1.50) to $2.50 per day

25 Quality Initiative & the RHCF-4 25 Schedule O Currently used in 2014 Quality Initiative % of Contract/Agency Staff Used RN s, LPN s & Aides Only Very difficult to get accurate info for Schedule O Quality Initiative Scoring: < 10% = 5 points >= 10% = 0 points

26 Quality Initiative & the RHCF-4 26 Schedule O QI Scoring Calculation: Schedule O(1) TtlH Total Hours Paid (Sched O hrs Paid + Total Hrs Paid Sched 5A) Ex: Contract hours paid 3,500 = 2.4% Total hours paid 144,397 < 10% (RN s, LPN s & Aides) QI Score = 5 Points

27 Quality Initiative & the RHCF-4 27 Quality Measures Section 1: Hours Paid for RN s, LPN s & Aides

28 Quality Initiative & the RHCF-4 28 Based on industry feedback and the uncertainty of the reported information new staffing measures were considered for Two new staffing measures will be gathered for benchmark purposes but will not be used in scoring. (See Schedule P) Contract staff measure will continue to be used for 2015.

29 Quality Initiative & the RHCF-4 29 Schedule P Not yet used in the QI Scoring Will be gathered in 2015 (from 2014 RHCF 4) Will be gathered in 2015 (from 2014 RHCF-4) for benchmarking purposes

30 Quality Initiative & the RHCF-4 30 Schedule P # of employees at 5 different times during the year # FT & PT employees at year-end # employees on 12/31 who were employed on 1/1 # employees hired during the year # employees fired during the year

31 Quality Initiative & the RHCF-4 31 Schedule P Used to calculate both: Staff Retention Staff Turnover

32 Quality Initiative & the RHCF-4 32 Schedule P Staff Turnover Proposed QI Calculation: Data: Total # of RN s, LPN s & Aides at end of each quarter (Schedule P, columns 0771, 0772, 0773, 0774) Total # of RN s, LPN s & Aides terminated (Schedule P, column 0779) Contract and per diem staff are EXCLUDED from this measure. Do Not include your per diem (casual) employees on Schedule P.

33 Quality Initiative & the RHCF-4 33 Schedule P Staff Turnover Proposed QI Calculation: # Total Annual RN, LPN, Terminations Date Aide Staff End Quarter Turnover End Quarter Rate End Quarter End dquarter / 4 / 4 Per DOH NHQI Update 6 Avg Per Qtr %

34 Quality Initiative & the RHCF-4 34 Staff Turnover Rates Per DOH data 2013 Staff Turnover rates: Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 Statewide 3.0% 5.4% 8.4% 12.3% 44.6% 8.4% Per DOH NHQI Update

35 Quality Initiative & the RHCF-4 35 Staff Turnover Rates Other data puts the statewide turnover rate at approximately 25%. Turnover rates fairly consistent between sponsors Turnover rates significantly higher upstate than downstate possibly due to stabilizing influence of unions data widely believed to be inaccurate.

36 Quality Initiative & the RHCF-4 36 NY Annualized Staffing Measure Proposed QI Calculation: Data: Total # of RN s, LPN s & Aides hours worked (Schedule 5A, columns 0146, 0148, 0150) Hours Expected

37 Quality Initiative & the RHCF-4 37 NY Annualized Staffing Measure Proposed QI Calculation Hours Expected CMS calculation; used in 5 star rating Distribution of RUG categories (closest to survey) X CMS 1995 and 1997 Staff Time Study Rate is per resident day

38 Quality Initiative & the RHCF-4 38 NY Annualized Staffing Measure Proposed QI Calculation: (Hours worked from Schedule 5A / # of residents from MDS) / 365 Days ((RUG distribution from MDS X hours from CMS time study) / #of residents from MDS 3.0) / 365 days Per DOH NHQI Update

39 Quality Initiative & the RHCF-4 39 NY Annualized Staffing Measure National Average April,2014 = 4.03 per resident per day NYS statewide average April, 2014 = 3.9 per resident per day NYS statewide average 2013 = 3.47 per resident per day (using cost reports) Per DOH NHQI Update

40 Quality Initiative & the RHCF-4 40 REMEMBER Annualized Staffing measure will not be used to score 2015 QI Staff Turnover will not be used to score 2015 QI Use this benchmark year to get a handle on where your facility falls

41 Quality Initiative & the RHCF-4 41 Timely filing of the RHCF-4 will get the facility 5 points. Late reports get 0. RHCF-4 filing deadline is August 14, 2015 All tifi ti t b l t b A t All certifications must be complete by August 14, 2015

42 Quality Initiative & the RHCF Change in Scoring Quality Component 2014: 14 measures for possible 70 points Had planned to add Staff Turnover measure with total possible points of 75; maybe in Compliance Component 2014: 3 measures for possible 20 points 2015: 3 measures for possible 20 points had planned to drop 5 star rating from 10 points to 5 and total compliance points from 20 to 15; maybe in 2016 Efficiency Component 2014 & 2015: 1 measures for possible 10 points

43 43 Advanced Training Initiative

44 Advanced Training Initiative 44 What? NYS reimbursement for training programs aimed at early detection of resident decline. NYS will provide $46 M in reimbursement for approved programs.

45 Advanced Training Initiative 45 Objectives Reduce expensive avoidable hospitalizations for nursing home residents. Improve quality of life - consistent staff assignment in an effort to ensure families and residents can rely on highly hl trained caregivers to provide effective, high quality, individualized care.

46 Advanced Training Initiative 46 What would training look like? Help direct care staff identify changes in a resident s physical, mental or functional status that could lead to hospitalization. Development and implementation would be coordinated d with DOH.

47 Advanced Training Initiative 47 Eligibility? A facility will be required to fulfill eligibility criteria before applying for funds Criteria has not yet been developed Discussions in workgroup around staff retention rates as criteria meeting a statewide or regional target (Schedule P!!!) VAP recipients i are not eligible ibl

48 Advanced Training Initiative 48 Timing Effective June 1, 2015 Workgroup developing eligibility criteria and approved program guidelines Hoping to make awards by December, 2015

49 Advanced Training Initiative 49 Application Trying to avoid it being too cumbersome Provider Information Name, Date, OpCert, Contact Training Program Details Program, curriculum, # of training hours, who will participate Staff Retention ti & Assignment Methods to increase retention, how will retention be measured

50 Advanced Training Initiative 50 Questions? Eligibility criteria regional or statewide? Will DOH approval of acceptable training curriculum/programs happen before or after applications are submitted? How staff retention rate will be calculated Schedule P divide col 0777 (employees retained) by col 0774 (employees at 12/31) or by col 0770 (employees at 1/1)

51 Advanced Training Initiative 51 Questions? May be additional funds available in year 2. Will funds be available for replacing staff while they are at training? How will the effectiveness of the training be measured or are there plans for measurement? Payment method

52 Advanced Training Initiative 52 QUESTIONS? Feel free to contact: Kathie Angelone, RHCC w: (585) e: