Introducing the Discharge to Community Quality Measure

Transcription

1 Introducing the Discharge to Community Quality Measure Rachel Delavan, Director of Research Dawn Murr-Davidson, RN BSN, Director of Quality Initiatives October 20,

2 Objectives Define the discharge to community quality measure an the importance of incorporating the measure into performance scorecards and dashboards Indicate how the discharge to community measure will tie into the implementation of managed long-term care support and services. Discuss the relationship between the discharge to community quality measure and other performance metrics such as length of stay. Explain the value of including the discharge to community measure in conversations with referral sources and payers 2

3 Discharge to Community The discharge to community quality measure focuses on the transition of residents back into the community Currently this quality measure is not a Nursing Home Compare Measure, but this measure is included as part of the Impact Act. 3

4 The IMPACT Act Charge IMPACT Act of 2014 focuses on Improving Medicare Post-Acute Care Transformation and requires the implementation of specified clinical assessment domains using standardized data elements within the assessment instruments currently required for submission by LTCH, IRF, SNF, and HHA providers. The IMPACT ACT aligns with the CMS Quality Strategy s goals which are: Making care safer by reducing harm caused in the delivery of care Ensuring that each person and family is engaged as partners in their care Promoting effective communication and coordination of care Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease Work with communities to promote wide use of best practices to enable healthy living Making quality care more affordable for individuals, families, employers and governments by developing and spreading new healthcare delivery model 4

5 Quality Measure Domains to be Standardized Skin integrity and changes in skin integrity Functional status, cognitive function, and changes in function and cognitive function; Medication reconciliation Incidence of major falls Transfer of health information and care preferences when an individual transitions Resource use measures, including total estimated Medicare spending per beneficiary All-condition risk-adjusted potentially preventable hospital readmissions rates Discharge to community 5

6 The IMPACT Act and Discharge to Community Timeline 6

7 Alignment with National Initiatives & Recommendations 7

8 Managed Long-Term Services and Support in Pennsylvania Community HealthChoices (CHC) is the name of the MLTSS program to be rolled out in Pennsylvania in three phases over three years beginning in January

9 CHC Goals 9

10 Preliminary Procurement and Implementation Schedule Milestone Description Date Deadline for submission of comments on this document October 16, 2015 Release of RFP for CHC-MCOs November 16, 2015 Pre-proposal conference December 2, 2015 Deadline for submission of proposals January-February 2016 CHC-MCOs notified of selection (all regions) March 2016 Agreement negotiations for Phase 1 CHC-MCOs March-June 2016 Readiness reviews for phase 1 CHC-MCOs March-December 2016 Phase 1 CHC participants receive enrollment notices October 2016 Implementation of Phase 1 (Southwest Region) January 2017 Implementation of Phase 2 (Southeast Region) January 2018 Implementation of Phase 3 (Northwest, Lehigh-Capital and Northeast 10 Regions) January 2019

11 Using Data to Drive Results 11

12 Data and Reports in Trend Tracker Clinical/Resident Information- CASPER Resident Characteristics, NH QM Report AHCA Metrics Rehospitalization, Discharge to Community and Length of Stay Regulatory Compliance Standard Health Survey, Complaint, Combined, and Life Safety Code Financial and Marketplace results Cost Report, Five Star, CASPER Staffing Report and Medicare Utilization Report

13 Discharge To Community- AHCA Measure Defined Notes about the Measure- Numerator and Denominator, exclusions and risk adjustment

14 AHCA Measure Exclusions and Risk Adjustment Under age 55 Missing MDS items A1800 or A2100 ( entered from or Discharge Status ) Anyone with a stay in a nursing center during the 100 days prior to this admission Anyone with no risk adjustment data available from any MDS assessment within 18 days of this SNF admission The measure is risk adjusted using 59 variables in six domains: demographic, functional status, prognosis, clinical conditions, clinical treatments, and clinical diagnoses. Only data available from the MDS are used in this model.

15 Interpreting Risk Adjusted Measure Actual Rate- divide the total number of Discharges to Community from your center by the total number of Post-Acute Admissions to your center. Expected Rate- A model uses all the clinical and demographic characteristics to calculate the average likelihood of each person being discharged back to the community. A center average is then calculated. IF Actual = Expected, Center is performing as Expected given resident mix IF Actual < Expected, Center had fewer discharges than expected, so risk adjusted rate will be lower than the national average IF Actual > Expected, Center had more discharges than expected, so risk adjusted rate will be higher than the national average Why Risk Adjust? Use the risk adjusted rates to compare yourself to other centers in order to gauge your performance against your peers. This rate adjusts for differences in patient population. CMS will report a risk adjusted rate and referral sources and your partners in managed care and other payment models will require it.

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17 PA US PA US PA US PA US

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19 Interpreting Multiple Measures PA US PA US PA US

20 Interpreting Multiple Example 1 Measures Center 1 PA Center 1 PA Center 1 PA Example 2 Center 2 PA Center 2 PA Center 2 PA

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22 Additional LOS Report Information

23 Additional LOS Report Information

24 Long Term Care Trend Tracker Resources Login Page: Resource Page: ges/resources.aspx Contact for Help: Rachel Delavan, PHCA Director of Research,

25 PHCA Quality Initiative Plan 25

26 Quarterly Data % Meeting 2014 Targets 30-Day Risk-Adjusted Readmission LS Antipsychotic Medication SS Worsening Pressure Ulcer LS Pain* Three Measures Two Measure s One Measure 2013-Q Q3 (P) % Meet 2014 Target % Improve 10% Q Q3 % Meet 2014 Target % Improve 10% Q Q3 % Meet 2014 Target % Improve 10% Q Q3 US N/A N/A N/A N/A N/A N/A N/A N/A N/A PA PA Rank N/A N/A N/A N/A N/A N/A N/A 22 N/A N/A 27 N/A N/A 17 PA To 25% N/A N/A N/A N/A N/A N/A N/A N/A N/A PA For Profit PA Not For Profit PA Government PHCA Members PHCA 2015 Target N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A PHCA 2014 Target N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

27 New Quality Measure for 2015 Discharge to Community 2013-Q Q Q Q Q2 (P) % Meet 2015 Target % Improve 10%+ US N/A N/A PA PA Rank N/A N/A N/A N/A N/A N/A N/A PA To 25% N/A N/A PA For Profit PA Not For Profit PA Government PHCA Members PHCA 2015 Target N/A N/A PHCA 2014 Target N/A N/A N/A N/A N/A N/A N/A

28 PHCA Quality Implementation Strategies Member Engagement Strive for a quality contact at each and every member company or independent center Data sent to all board members, quality committee members and quality contacts quarterly At risk members sent an sent for focus area(s) with educational opportunities and tools on a recurring basis Educational Opportunities and Resources Webinars (quality topics at least monthly; archived webinars available) PHCA Reporter articles devoted to quality topics and recognition Featured Quality Topics at CALM Summit and Convention AHCA/NCAL Quality Award Bronze Workshop (Coming December 8, 2015) Quality Seminar Coming in May 2016 Recognition Quarterly recognition of centers meeting all three goals are recognized in PHCA Reporter and Board Meeting posters End of 2014 Quality Initiative Plan Recognition

29 Please contact: Dawn Murr-Davidson, Director of Quality Initiatives Rachel Delavan, PHCA Director of Research,