Sneak Peak: MDS 3.0 Changes & New QRP s. Effective October 1, 2018 Natashia Mason, RN Director of Professional Development Care Providers Oklahoma

Transcription

1 Sneak Peak: MDS 3.0 Changes & New QRP s Effective October 1, 2018 Natashia Mason, RN Director of Professional Development Care Providers Oklahoma

2 Disclaimer These materials, including any medical literature and legal citations, are current to the best of the presenter s knowledge and are being provided as informational only. Accordingly, the user is admonished to check original citations of authority and to use these materials as a starting point for individual research and decision-making. Further, these materials are not intended as legal advice and the user should seek their own legal counsel related to any matters requiring interpretation and application of the law and/or regulations. Care Providers Oklahoma makes no warranty, express or implied, relating to the accuracy or content of these materials.

3 Sneak Peak More anticipated changes, effective October 1, 2018 November 2017, CMS released the draft Minimum Data Set (MDS) item sets This will be Version of the MDS January 2018, CMS released a new draft version of MDS 3.0 Data Specifications

4 Changes There will be minor verbiage, punctuation, and grammar changes There will be anticipated major changes to Sections: GG, I, J, M, N, O

5 SECTION GG Sneak Peak: MDS 3.0 Changes

6 GG0100 New Items: Prior Functioning Everyday Activities

7 GG0100 Coding New

8 GG0100 New items: GG0100A. GG0100B, GG0100C, GG0100D

9 GG0110 New items: Prior Device Used

10 GG0130 Self Care & GG0170-Mobility New coding option for Admission Performance, Discharge Goal, and Discharge Performance for GG0130-Self Care and GG0170-Mobility Items

11 09-Not Applicable Verbiage added to coding option 09-Not Applicable for Admission Performance, Discharge Goal and Discharge Performance Note: Coding instructions did not change for this option

12 GG0130-Self Care New items: GG0130E, GG0130F, GG0130G, GG0130H for Admission Performance, Discharge Goal, and Discharge Performance

13 GG0170-Mobility New item: GG0170A for Admission Performance, Discharge Goal, and Discharge Performance

14 GG0170-Mobility New item: GG0170G for Admission Performance, Discharge Goal, and Discharge Performance

15 GG0170-Mobility Deleted item: GG0170H1 for Admission Performance, Discharge Goal, and Discharge Performance

16 GG0170-Mobility New item: GG0170l for Admission Performance, Discharge Goal, and Discharge Performance

17 GG0170-Mobility New item: GG0170L, GG0170M, GG0170N, GG0170O, and GG0170P for Admission Performance, Discharge Goal, and Discharge Performance

18 SECTION I Sneak Peak: MDS 3.0 Changes

19 I0020 & I0020A New Items:

20 SECTION J Sneak Peak: MDS 3.0 Changes

21 J2000 New item: J2000 Prior Surgery

22 SECTION M Sneak Peak: MDS 3.0 Changes

23 Added Verbiage to Section M Injury added after Pressure Ulcer

24 M0300B3 Deleted item: M0300B3-Date of Oldest Stage 2 Pressure Ulcer

25 M0610 Deleted item: M0610-Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar

26 M0700 Deleted item: M0700-Most Severe Tissue Type for Any Pressure Ulcer

27 M0800 Deleted item: M0800-Worsening in Pressure Ulcer Status

28 M0900 Deleted item: M0900-Healed Pressure Ulcers

29 SECTION N Sneak Peak: MDS 3.0 Changes

30 N2001 New item: N2001-Drug Regimen Review

31 N2003 New item: N2003-Medication Follow Up

32 N2005 New item: N2005-Medication Intervention

33 SECTION O Sneak Peak: MDS 3.0 Changes

34 O0100F & O0100G Verbiage changed: O0100F and O0100G

35 Who completes section GG Your MDS coordinator??? Your rehab department??? Your nurses??? Best practice: Have your nurses and rehab department complete section GG and then as an IDT determine the scores based off that information Some do this during weekly Medicare Meeting

36 SNF QRP FY2020 Quality Reporting Program

37 New QRP s 5 New QRP s added, data collection to begin October 1, 2018 for FY2020 Drug Regimen Review Conducted with Follow-Up for Identified Issues Change in Self-Care Score for Medical Rehabilitation Patients Change in Mobility Score for Medical Rehabilitation Patients Discharge Self-Care Score for Medical Rehabilitation Patients Discharge Mobility Score for Medical Rehabilitation Patients Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury (Previously Pressure Ulcer Worsening)

38 SNF QRP Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury SNF QRP uses only the Part A PPS Discharge MDS to calculate the measure The measure will be calculated quarterly using a rolling 12 months of data All Medicare Part A SNF stays, except those that meet the exclusion criteria, during the 12 months are included in the denominator and are eligible for inclusion in the numerator For residents with multiple stays during the 12 month time window, each stay is eligible for inclusion in the measure Uses Present on Admission item for each pressure ulcer stage (Stage 2 through and including unstageable pressure ulcers) to calculate the measure

39 Risk Adjustments Functional Mobility Admission Performance: GG0170C (Functional Mobility; Lying to Sitting on Side of Bed); Bowel Continence: H0400 (Bowel Continence); Peripheral Vascular Disease/Peripheral Arterial Disease or Diabetes Mellitus: I0900 (PVD or PAD); I2900 (DM); Low BMI, based on Height and Weight: K0200A (Height); and K0200B (Weight)

40 Drug Regimen Review Measure Description This patient assessment-based process quality measure evaluates whether PAC providers were responsive to potential or actual clinically significant medication issue(s) when such issues were identified. Specifically, this process quality measure reports the percent of patient/resident stays in which a drug regimen review was conducted at the time of admission and timely follow-up with a physician occurred each time potential clinically significant medication issues were identified throughout the stay.

41 Measure Description For this quality measure: 1. medication reconciliation is a process that identifies the most accurate and current list of medications, particularly during transitions of care, it also includes the evaluation of the name, dosage, frequency, and route; 2. Drug regimen review is defined as the review of all medications or drugs the patient/resident is taking to identify any potentially clinically significant medication issues; and 3. Potential clinically significant medication issues are identified as those issues that, in the clinician s professional judgement, warrant interventions, such as alerting the physician and/or others, and the timely completion of any recommended actions (by midnight of the next calendar day) so to avoid and mitigate any untoward or adverse outcomes 4. Medication reconciliation and drug regimen review are interrelated activities; this quality measure utilizes both the process of medication reconciliation and a drug regimen review, in the event an actual or potential medication issue occurred. This measure is applied uniformly across the PAC settings.

42 Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633) This quality measure estimates the risk-adjusted mean change in self-care score between admission and discharge for SNF Part A residents discharged from a SNF This applies to coding for section GG0130 Purpose/Rationale This finalized quality measure meets the requirements of the IMPACT Act addressing the domain of functional status, cognitive function, and changes in function and cognitive function. This finalized measure focuses on self-care activities

43 Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633) Denominator Exclusions Residents with incomplete stays Residents who are independent with all self-care activities at the time of admission Residents with the following medical conditions: coma; persistent vegetative state; complete tetraplegia; locked-in syndrome; sever anoxic brain damage; cerebral edema, or compression of brain Residents younger than 21 years Residents discharged to hospice Residents who are not MCA beneficiaries Residents who do not receive physical or occupational therapy services

44 Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633) Risk Adjustments Age Diagnoses Prior functioning Surgery within 100 days Pressure Ulcer presence Co-morbidities Cognitive ability Communication ability Feeding Tube/TPN Continence

45 Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634) This quality measure estimates the average risk-adjusted mean change in mobility score between admission and discharge for Medicare Part A residents discharged from SNF Applies to items in section GG0170 Purpose/Rationale This is the second functional outcome quality measure being finalized to meet the requirements of the IMPACT Act, addressing the domain of functional status, cognitive function, and changes in function and cognitive function. This finalized quality measure focuses on mobility activities

46 Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634) Denominator Exclusions Residents with incomplete stays Residents who are independent with all mobility activities at the time of admission Resident with the following medical conditions: coma, persistent vegetative state; complete tetraplegia; locked-in syndrome; severe anoxic brain damage, cerebral edema, or compression of brain Residents younger than 21 years Residents discharged to hospice Residents who are not Medicare Part A beneficiaries Residents who do not receive physical or occupational therapy services

47 Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634) Risk Adjustment Age Diagnoses Prior mobility functioning Prior device use Surgery within 100 days Pressure Ulcer Presence Co-morbidities Cognitive ability Communication ability Feed Tube/TPN Continence History of falls

48 Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635) This quality measure estimates the percentage of SNF residents who meet or exceed an expected discharge self-care score Purpose/rationale for the Quality Measure As noted above, SNF s provide rehabilitation services to many residents with a goal of improving resident functioning. This is the third quality measure being finalized to meet the requirements of the IMPACT Act, addressing the domain of functional status, cognitive function, and changes in function and cognitive function. This finalized quality measure focuses on self-care activities. Focuses on section GG0130

49 Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635) Denominator Exclusions Residents with incomplete stays Resident with the following medical conditions: coma, persistent vegetative state; complete tetraplegia; locked-in syndrome; severe anoxic brain damage, cerebral edema, or compression of brain Residents younger than 21 years Residents discharged to hospice Residents who are not Medicare Part A beneficiaries Residents who do not receive physical or occupational therapy services

50 Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635) Risk Adjustment Age Diagnoses Prior functioning Surgery within 100 days Pressure Ulcer Presence Co-morbidities Cognitive ability Communication ability Feed Tube/TPN Continence

51 Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636) This quality measure estimates the percentage of SNF residents who meet or exceed an expected discharge mobility score Purpose/rationale for the Quality Measure As noted above, SNF s provide rehabilitation services to many residents with a goal of improving resident functioning. This is the fourth quality measure being finalized to meet the requirements of the IMPACT Act, addressing the domain of functional status, cognitive function, and changes in function and cognitive function. This finalized quality measure focuses on mobility activities. Focuses on section GG0170

52 Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636) Denominator Exclusions Residents with incomplete stays Resident with the following medical conditions: coma, persistent vegetative state; complete tetraplegia; locked-in syndrome; severe anoxic brain damage, cerebral edema, or compression of brain Residents younger than 21 years Residents discharged to hospice Residents who are not Medicare Part A beneficiaries Residents who do not receive physical or occupational therapy services

53 Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636) Risk Adjustment Age Diagnoses Prior mobility functioning Prior device use Surgery within 100 days Pressure Ulcer Presence Co-morbidities Cognitive ability Communication ability Feed Tube/TPN Continence History of Falls

54 Compliance with SNF QRP At least 80% of Assessments must be in Compliance to prevent 2% APU loss Modify assessments, if possible, to ensure accuracy and completion of SNF QRP items Reports can be accessed through QIES ASAP System Submission deadline is May 15, 2019 for data from October 1, 2018 to December 31, 2018

55 RCS-1 vs RUG IV Further MDS changes if RCS-1 takes effect October 1??? From all we know right know, MDS items will probably not be added or changed but we anticipate changes in what PPS MDS assessments will be required

56 Resources CMS.gov Draft MDS 3.0 Comprehensive Item Set FederalRegister.gov/agencies/centers-for-medicare-medicaidservices Final specifications for SNF QRP Quality Measures and Standardized Resident Assessment Data Elements Assessment- Instruments/NursingHomeQualityInits/Downloads/Final- Specifications-for-SNF-QRP-Quality-Measures-and- Standardized-Resident-Assessment-Data-Elements-Effective- October pdf

57 Questions