MDS Coding. Antipsychotic Quality Measure

Transcription

1 MDS Coding Antipsychotic Quality Measure The information in this presentation may be subject to copyright and may not be reproduced without permission of the presenter.

2 Introduction Jessica Mirabal, RN Clinical reimbursement manager with Genesis Healthcare SNF LTC experience of eight years Two years as a clinical reimbursement manager Four years as a director of nursing One year as an assistant director of nursing One year as a floor nurse

3 Objectives Upon completion of the training you will know: The requirements per the RAI Manual of coding antipsychotic medications, How the coding of antipsychotics affect the quality measure rating, Helpful tips on reducing and evaluating antipsychotic use in your facility related to quality measure reporting.

4 Section N: Medications

5 Section N: Medications Intent: The intent of the items in this section is to record the number of days, during the last seven days (or since admission/entry or reentry if less than seven days) that any type of injection, insulin and/or select medications were received by the resident. In addition, an antipsychotic medication review has been included. Including this information will assist facilities to evaluate the use and management of these medications.

6 Section N: Medications Item Rationale Health-related Quality of Life Medications are an integral part of the care provided to residents of nursing homes. Residents taking medications in these medication categories and pharmacologic classes are at risk of side effects that can adversely affect health, safety and quality of life.

7 Section N: Medications Item Rationale (cont.) Health-related Quality of Life While assuring that only those medications required to treat the resident s assessed condition are being used, it is important to assess the need to reduce these medications wherever possible and ensure that the medication is the most effective for the resident s assessed condition. As part of all medication management, it is important for the interdisciplinary team to consider non-pharmacological approaches.

8 Section N: Medications Steps for Assessment Review the resident s medical record for documentation that any of these medications were received by the resident during the 7-day look-back period (or since admission/entry or reentry if less than seven days). Review documentation from other health care settings where the resident may have received any of these medications while a resident of the nursing home (e.g., valium given in the emergency room).

9 Section N: Medications received

10 Section N: Medications Coding Instructions N0410A H: Code medications according to the pharmacological classification, not how they are being used. N0410A, Antipsychotic: Record the number of days an antipsychotic medication was received by the resident at any time during the 7-day look-back period (or since admission/entry or reentry if less than seven days).

11 Section N: Medications Coding Tips and Special Populations Medications that have more than one therapeutic category and/or pharmacological classification should be coded in all categories/classifications assigned to the medication, regardless of how it is being used.

12 Section N: Medications Coding Tips and Special Populations (cont.) Include any of these medications given to the resident by any route (e.g., PO, IM, or IV) in any setting (e.g., at the nursing home, in a hospital emergency room) while a resident of the nursing home. Count long-acting medications that are given every few weeks or monthly only if they are given during the 7-day look-back period (or since admission/entry or reentry if less than seven days).

13 Section N: Medications Coding Tips and Special Populations (cont.) Combination medications should be coded in all categories/pharmacologic classes that constitute the combination.

14 Section N: Medications Coding Tips and Special Populations (cont.) Doses of psychoactive medications differ in acute and long-term treatment. Doses should always be the lowest possible to achieve the desired therapeutic effects and be deemed necessary to maintain or improve the resident s function, wellbeing, safety and quality of life.

15 True or false Medications are coded based off the indication (use) of the medication and not the classification? Answer: False. Code medications in Item N0410 according to the medication s therapeutic category and/or pharmacological classification, not how it is used.

16 Five-star Rating System: Quality Measures

17 What is the 5-star quality rating system? In December 2008, the 5-star quality rating system was added to Nursing Home Compare for all nursing homes participating in Medicare or Medicaid. Goal is to provide residents, families, and consumers a way to compare nursing homes more easily and to help identify areas about which they may want to ask questions.

18 What is the 5-star quality rating system? The 5-star rating system features an overall rating of one to five stars based on facility performance for three types of measures, each with its own five star rating Health Inspections Ratings are based on outcomes from State health inspections Staffing ratings are based on nursing home staffing levels Quality Measures (QMs) ratings are based on MDS and claims-based quality measures

19 5-star quality measures Based on performance in 16 of the 24 QMs that are posted on NH Compare Based on MDS 3.0 assessments Also based on hospital and ED claims Includes nine long-stay and seven short-stay measures

20 MDS long-stay measures Percentage of residents whose ability to move independently has worsened* Percentage of residents whose need for help with activities of daily living has increased Percentage of high-risk residents with pressure ulcers Percentage of residents who have/had a catheter inserted and left in their bladder* Percentage of residents who were physically restrained Percentage of residents with a urinary tract infection Percentage of residents who self-report moderate to severe pain* Percentage of residents experiencing one or more falls with major injury Percentage of residents who received an antipsychotic medication

21 MDS short-stay measures Percentage of residents whose physical function improves from admission to discharge* Percentage of residents with pressure ulcers that are new or worsened* Percentage of residents who self-report moderate to severe pain Percentage of residents who newly received an antipsychotic medication

22 Claims-based short-stay measures Percentage of residents who were re-hospitalized after a nursing home admission Percentage of short-stay residents who have had an outpatient emergency department (ED) visit Percentage of short-stay residents who were successfully discharged to the community *Only include residents in a traditional Medicare Part A covered stay *These are claims-based measures which utilize the first MDS of the stay adjustments for risk

23 Percentage of residents who newly received an antipsychotic medication (Short Stay Measure)

24 What is a short stay? A short stay is defined as: A resident whose latest episode is less than or equal to 100 days (cumulative days in facility, or CDIF)

25 Percentage of residents who newly received an antipsychotic medication Short-stay residents for whom one or more assessments in a look-back scan (not including the initial assessment) indicates that antipsychotic medication was received Note that residents are excluded from this measure if their initial assessment indicates antipsychotic medication use or if antipsychotic medication use is unknown on the initial assessment

26 Percentage of residents who newly received an antipsychotic medication Note: N0410A does not note the specific antipsychotic medication. It does not note if the brand/type of antipsychotic changes from MDS to MDS (i.e., Risperdal is changed to Abilify), just that an antipsychotic was administered in the look-back period

27 Percentage of residents who newly received an antipsychotic medication Exclusions: All MDSs in the look-back scan (excluding the initial MDS) N0410A is coded with a [-] Any of the following related conditions are present on any assessment in a look-back scan: Schizophrenia (I6000 = [1]) Tourette s syndrome (I5350 = [1]) Huntington s disease (I5250 = [1]) The resident s initial MDS indicates antipsychotic medication use or antipsychotic medication use is unknown (i.e., coded with a [-])

28 Percentage of residents who newly received an antipsychotic medication FOR QM VALUES NUMBER OF QM POINTS IS BETWEEN AND JULY 2016 JANUARY

29 Percentage of residents who received an antipsychotic medication (long stay measure)

30 What is a long stay? A long stay is defined as: A resident whose latest episode is greater than or equal to 101 days (cumulative days in facility, or CDIF)

31 Percentage of residents who received an antipsychotic medication Long-stay residents with a selected target assessment where the following condition is true: antipsychotic medications received.

32 Percentage of residents who received an antipsychotic medication Exclusions: All MDSs in the look-back scan (excluding the initial MDS) N0410A is coded with a [-] Any of the following related conditions are present on any assessment in a look-back scan: Schizophrenia (I6000 = [1]) Tourette s syndrome (I5350 = [1]) Huntington s disease (I5250 = [1])

33 Percentage of residents who received an antipsychotic medication FOR QM VALUES NUMBER OF QM POINTS IS BETWEEN AND JULY 2016 JANUARY

34 What question on the MDS triggers the antipsychotic quality measure? A) Hypnotic (N0410D) B) Anti-anxiety (N0410B) C) Antipsychotic (N0410A) D) Both A and C (N0410A and N0410D) Answer: C) Antipsychotic (N0410A)

35 What are the exclusions for the antipsychotic measure? A) Schizophrenia (I6000), Tourette s syndrome (I5350), Huntington s disease (I5250) B) Schizophrenia (I6000), Tourette s syndrome (I5350), Alzheimer s disease(i4200) C) Psychotic disorder (other than schizophrenia) (I5950), Tourette s syndrome (I5350), Huntington s disease (I5250) D) Schizophrenia (I6000), Post Traumatic Stress Disorder (I6100), Huntington s disease (I5250) Answer: A)Schizophrenia (I6000), Tourette s syndrome (I5350), Huntington s disease (I5250)

36 CASPER REPORTING

37 CASPER reporting

38 CASPER reporting

39 CASPER reporting

40 CASPER reporting

41 QM review

42 Tips for success Be proactive: Ensure that MDS are coded accurately prior to submission. Evaluate clinical processes that have an affect on MDS coding. Ensure that antipsychotic medications are reduced to the lowest possible dose or eliminated, if applicable. Work with MDs on discontinuing antipsychotics prior to admission if no clinical history of a psychiatric disorder. Be reactive: Evaluate CASPER QM reports monthly for accuracy and modify MDS, if applicable. Identify clinical processes that need improvement for better resident outcomes. Ensure that interval monitoring of antipsychotics is completed, as appropriate. Keep focus on the end goal: Quality Care A 5-star QM rating and excellent survey outcomes derive from providing quality care.

43 THANK YOU! Jessica Mirabal, RN Clinical Reimbursement Manager Genesis Healthcare Deborah Coble-White, RN Clinical Reimbursement Manager Genesis Healthcare Tina Sanchez, RN, SMQT Program Operations Bureau Division of Health Improvement - MDS/OASIS Coordinator tina.sanchez2@state.nm.us

44 Please join us in 2 weeks: March 23, :30 1:00 p.m. De-Escalation Strategies Christopher Burmeister, Bureau Chief, Program Operations Bureau New Mexico Department of Health Holly Bauer, LCSW, Clinical Director Sequoia Treatment Center 44

45 This material was prepared by HealthInsight, the Medicare Quality Innovation Network -Quality Improvement Organization for Nevada, New Mexico, Oregon and Utah, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-C