LTCH Lay of the Land: Reporting the LTCH CARE Data Set (2 of 3) August 21, 2012

Transcription

1 LTCH Lay of the Land: Reporting the LTCH CARE Data Set (2 of 3) August 21, 2012

2 Purpose: What s New? In Brief LTCH Quality Reporting Program New developments Updated CMS LTCH QRP Manual Final FY13 rule: What s Upcoming? Registration open for access to CMSNet & ASAP/CASPER for data transmission LTRAX: recent enhancements & upcoming changes Discussion 6 weeks and counting staying informed Q&A

3 LTCH QRP: What is it? LTCH Quality Reporting Program Requires LTCHs to submit patient data to CMS Data collection begins with Oct. 1 admissions Data collected on all patients, regardless of payer Penalty for not participating is a 2 percentage point reduction in annual Medicare payment update Affects payment beginning fiscal year 2014 (Oct. 1, 2013)

4 QRP Measures Beginning Oct. 1, LTCHs will be required to collect and submit data for 3 measures: 1. Patients with pressure ulcers that are new or have worsened 2. Catheter Associated Urinary Tract Infection (CAUTI) 3. Central Line Catheter-Associated Bloodstream Infection (CLABSI)

5 QRP Measures Beginning Oct. 1, LTCHs will be required to collect and submit data for 3 measures: 1. Patients with pressure ulcers that are new or have worsened LTCH CARE Data Set 2. Catheter Associated Urinary Tract Infection (CAUTI) 3. Central Line Catheter-Associated Bloodstream Infection (CLABSI) CDC s National Healthcare Safety Network

6 Pressure Ulcers LTCH CARE Data Set: Patient assessment instrument Collects documentation for pressure ulcers, selected pressure ulcer risk factors, patient demographics, and provider attestations Admission, Planned Discharge, Unplanned Discharge, and Expired assessments Submit electronically to CMS Used for all patients, regardless of payer

7 Pressure Ulcers: Data Collection Specific Pressure Ulcer Outcomes Measure data contained within the LTCH CARE Data Set: GG0160C. Functional Mobility: Lying to sitting on side of bed H0400. Bowel Continence I0900. Peripheral Vascular Disease (PVD) or PAD I2900. Diabetes Mellitus (DM) K0200A. Height (inches) K0200B. Weight (pounds) M0800. Worsened since prior assessment: A. Stage 2 Pressure Ulcers B. Stage 3 Pressure Ulcers C. Stage 4 Pressure Ulcers

8 What s New? Program Guidance Updated CMS LTCH QRP Manual (Version 1.1, August 2012) NHSN demo available Submission Guidance Registration open for access to CMSNet Registration open to obtain a QIES User ID and gain access to ASAP reporting system and CASPER reports LASER demo & documentation available

9 New CMS LTCH QRP Manual New manual contains significant changes to program rules and requirements: 1. LTCH CARE assessments are considered part of the patient s medical record. This includes any corrected versions of the LTCH CARE Data Set Assessment Record, which should be included to track modifications. LTCHs should retain a copy of the LTCH CARE Data Set(s), including signatures, in accordance with facility and state policies on managing medical records. Maintaining the LTCH CARE Data Set electronically does not require the entire clinical record be maintained electronically, nor does it require the use of electronic signatures.

10 New CMS LTCH QRP Manual 2. The first wound assessment(s) after admission should reported on the LTCH CARE Admission Assessment. LTCH CARE Data set is not intended to replace established clinical practices. Initial assessment(s) of pressure ulcer(s) identified and staged upon admission should be used to code the LTCH CARE Admission Assessment pressure ulcer items. If a pressure ulcer worsens within the 3-day LTCH assessment period, the initial stage of the pressure ulcer and staging would be documented on the LTCH CARE Admission Assessment.

11 New CMS LTCH QRP Manual 3. CMS divided the LTCH CARE data collection into Required and Voluntary items using the following categories: Required: CMS will reject record if the data is missing. Required for Measure Calculation: Item is used to calculate pressure ulcer outcomes or for internal consistency checks related to the pressure ulcer measure. Voluntary, Highly Recommended: Item considered voluntary but highly recommended. Voluntary, Default Required: Record will be rejected if a default, such as not assessed or none of the above, is not recorded. Voluntary

12 Required: Examples Required: CMS will reject record if the following data is missing. A0210. Assessment Reference Date A0220. Admission Date A0270. Discharge Date A0500C. Patient Last Name A0800. Gender A0900. Birth Date M0210. Unhealed Pressure Ulcer(s) Z0500B. LTCH CARE Data Set Completion Date

13 Required: Examples Required for Measure Calculation: Item is used to calculate pressure ulcer outcomes or for internal consistency checks related to the pressure ulcer measure. GG0160C. Functional Mobility: Lying to sitting on side of bed H0400. Bowel incontinence I0900. Active Diagnosis: Peripheral vascular disease (PVD) or peripheral arterial disease (PAD) I2900. Active Diagnosis: Diabetes mellitus (DM) K0200A. Height (in inches) K0200B. Weight (in pounds) M0300B1. Stage 2: Number of Stage 2 pressure ulcers M0300C1. Stage 3: Number of Stage 3 pressure ulcers M0300D1. Stage 4: Number of stage 4 pressure ulcers M0800 Worsening in Pressure Ulcer Status A. Stage 2 B. Stage 3 C. Stage 4

14 Voluntary: Examples Voluntary, Highly Recommended: Item considered voluntary but highly recommended. A0500A. Patient First Name A0600A. Social Security Number M0300A. Stage 1: Number of Stage 1 pressure ulcers M0300B2. Stage 2: Number of Stage 2 pressure ulcers present upon admission M0300C2. Stage 3: Number of Stage 3 pressure ulcers present upon admission M0300D2: Stage 4: Number of Stage 4 pressure ulcers present upon admission M0300E1: Unstageable: Number of pressure ulcers unstageable due to non-removable dressing or device M0300E2: Unstageable: Number of pressure ulcers unstageable due to non-removable dressing or device present upon admission

15 Voluntary: Examples Voluntary, Highly Recommended M0300F1: Unstageable: Number of pressure ulcers unstageable due to slough and/or eschar M0300F2: Unstageable: Number of pressure ulcers unstageable due to slough and/or eschar present upon admission M0300G1: Unstageable: Number of suspected deep tissue injuries M0300G2: Unstageable: Number of suspected deep tissue injuries present upon admission Z0400A-L. Attestation Signatures Z0500A. Attestation signature of person verifying assessment set completion

16 Voluntary: Examples Voluntary, Default Required: Record will be rejected if a default, such as not assessed or none of the above, is not recorded. A1000A-F. Race/Ethnicity A1050. Highest degree/level of school A1100A. Does the patient need or want an interpreter A1200. Marital Status A1400 (all). Payer Source(s) A1800. Admitted From A1810 (all). Past 2 Months A1820. Primary diagnosis in the previous setting B0100. Comatose GG0160A. Functional Mobility: Roll left and right GG0160B. Functional Mobility: Sit to lying I5600. Active diagnosis: Malnutrition or at risk for malnutrition M0300B3: Stage 2: Date of oldest Stage 2 pressure ulcer M0610 (A-C): Dimensions of unhealed Stage 3 or 4 pressure ulcer M0700. Most severe tissue type for any pressure ulcer

17 Voluntary: Examples Voluntary (V): A0500B. Patient Middle Initial A0500D. Patient Name Suffix A0600B. Patient Medicare/Railroad Insurance Number A0700. Patient Medicaid Number A1100B. Preferred Language A1300D. Lifetime Occupation(s)

18 LTCH CARE: Upcoming Five additional measures were proposed for data collection beginning calendar year 2014 (fiscal 2016 payment): Patients given seasonal influenza vaccine Influenza vaccination among healthcare personnel Patients given pneumococcal vaccine Ventilator Bundle: Head of the bed greater than or equal to 30 degrees Daily sedation interruption and assessment of readiness to wean Peptic ulcer disease Deep vein thrombosis prophylaxis Daily oral care with Chlorhexidine Restraint rate per 1,000 patient days

19 LTCH CARE: Upcoming Two additional measures were finalized for data collection beginning calendar year 2014 (fiscal 2016 payment): Patients given seasonal influenza vaccine revised LTCH CARE data set Influenza vaccination among healthcare personnel CDC s NHSN

20 LTCH CARE: Upcoming Three additional measures were withdrawn or postponed for data collection beginning calendar year 2014: Patients given pneumococcal vaccine Withdrawn because the CDC is reevaluating its guidelines for pneumococcal vaccination Ventilator Bundle Measure steward withdrew the measure from the reendorsement process. CMS plans to propose an updated version in future rulemaking. Restraint rate per 1,000 patient days CMS withdrew after consider public comments and will propose a patient restraint measure in future rulemaking.

21 LTRAX LTRAX is a complete outcomes system built specifically for long-term acute care hospitals. Contains complete system for completing all LTCH CARE assessments and preparing transmission files: Conforms to all CMS submission rules Checks assessments for integrity and consistency Scans assessments for any unmet requirements Contains easy-to-follow logic and organization to smooth workflow Comprehensive assessment and outcomes system for significant LTCH patient populations: Ventilator and weaning assessments and outcomes Wound assessments (PUSH & BWAT) and outcomes Operational & clinical outcomes

22 LTRAX: What s New? Preparing for the CMS submission process: Updated our Launch Screen (LTRAX user homepage) to be able to handle Admission & Discharge assessments in all their various states from start through transmission

23 LTRAX: What s Upcoming? Early September Updates to reflect changes in the new LTCH QRP Manual and final forms Color-coded workflow on the LTRAX Launch Screen to track assessments through the process and ensure facilities meet all their deadlines Updating our Pre-Admission Screening Tool to give liaisons the ability to answer two additional LTCH CARE questions: In the last 2 months, what other medical services has the patient received? Primary diagnosis in the previous setting (ICD code) Warning for reverse staging of wounds Late September File preparation for transmission to CMS

24 New Submission Guidance Registration open for CMSNet and QIES User IDs Registration opened Aug. 20 Facilities urged to complete registration by Sept. 14 to ensure your IDs are obtained and activated in time for Oct. 1 deadline Go to Webex recorded training on the application process Explains how to access the forms necessary to obtain both User IDs.

25 Discussion: Stay Informed Tune in to upcoming CMS calls & training Open Door Forums: Aug. 30 & Sept. 20 CMS website: QIES technical support: LTRAX resources Webinar series Mailing list

26 Discussion: Q&A 6 weeks and counting LTCH CARE data collection workflow and training Software training for submission system Technological issues CMSNet & QIES User ID registration to prepare for submission process

27 The Big Picture LTCH CARE data collection will establish the first industry-wide data set LTRAX benchmarking at 200+ LTCHs Ultimately illustrate the need for long-term acute care in the post-acute spectrum Data submission begins Oct. 1, Payment penalties begin Oct. 1, 2013.

28 Resources LTRAX CMS LTCH Quality Reporting Program: Reporting/index.html QIES Technical Support Office LTCH QRP Technical Issues Help Desk (fax)