5/26/2016. What's New? What's Changed? Urgent Updates QM Manual v10. Faculty Disclosure. Requirements for Successful Completion

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1 What's New? What's Changed? Urgent Updates QM Manual v10 Presented by: Judi Kulus, MSN, MAT, RN, NHA, RAC-MT, DNS-CT VP of Curriculum Development Faculty Disclosure I have no financial relationships to disclose I have no conflicts of interests to disclose I will not promote any commercial products or services 2 Copyright 2015 Requirements for Successful Completion 1.0 contact hour will be awarded for this continuing nursing education activity Criteria for successful completion includes attendance for at least 80% of the entire event. Partial credit may not be awarded. Approval of this continuing education activity does not imply endorsement by AANAC or ANCC (American Nurses Credential Center) of any commercial products or services. American Association of Post-Acute Care Nursing (AAPACN)* is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on accreditation. *AAPACN d/b/a American Association of Nurse Assessment Coordination 3 Copyright

2 Learning Objectives Describe the components needed to calculate each new Quality Measure List 4 specific Quality Measure vulnerabilities related to MDS accuracy Discuss clinical system practices needed for achieving competitive Quality Measures 4 Copyright 2015 Medicare Quality Reporting Program and Value-Based Purchasing Impact Act QRP 2016 Goals All Medicare FFS Linked to Quality 85% 2018 Goals All Medicare FFS Linked to Quality 90% 5 Copyright 2015 What to Know Six new QMs posted on Nursing Home Compare Revised MDS 3.0 QM User s Manual v10 posted Separate draft manual for the claims-based QMs Coming soon! Five-Star manual (July, 2016) Phase in of 5 of 6 QMS over 6 months beginning in July Excludes: Antianxiety/hypnotic Meds QM 6 Copyright

3 Six New Measures Added to Nursing Home Compare Includes Events that Occur AFTER Discharge Discharge to Community Emergency Department Use Decline in Mobility Short-Stay Re-Hospitalization Improvement in Function Since Admission Long-Stay Use of Hypnotics/Anxiolytics 7 Copyright 2015 Six New Measures Added to Nursing Home Compare Claims Based MDS Based Return to Community Improvement in Function Since Admission Emergency Dept Visits Decline in Mobility Re-hospitalizations Use of Hypnotics/Anxiolytics 8 Copyright 2015 PROVIDER PREVIEW REPORTS 3

4 Six New Quality Measures 10 Copyright 2015 Reported April, 2016 on Nursing Home Compare (Provider Rating Report) Accessing the QM Reports (MDS System) 11 Copyright 2015 Accessing the QM Reports (MDS System) Get Provider Preview Reports in Folder Titled: st LTC facid' 12 Copyright

5 Poll Question #1 Has your facility downloaded your Provider Preview Reports? a. Not yet, but I will do it right after the webinar b. Yes, I ve seen them, but we have not had a QAA meeting about them c. Yes, I ve seen them and we have begun QAPI Planning to make improvements d. I m still unclear about what these reports are and where to find them 13 Copyright 2015 Percent of Short-stay Residents Successfully Discharged to Community 1 Measure uses UB-04 claim and MDS assessment data to identify successful community discharges within 100 days of admission to the SNF, directly from the hospital, AND who stayed in community for 30 days without Being hospitalized Not readmitted to a nursing home Did not die in the 30 days after discharge 14 Copyright 2015 Percent of Short-stay Residents Successfully Discharged to Community 2 Numerator and Denominator Window The numerator and denominator include episodes that started over a 12-month period The data are updated every six months (in April and October of each year), with a lag time of nine months (i.e., the data posted in April, 2016 will include episodes that started 9-21 months prior) 15 Copyright

6 16 Copyright 2015 Percent of Short-stay Residents Successfully Discharged to Community 3 Numerator MDS discharge assessment, Item A2100 = 01, Community within 100 calendar days of the start of the episode AND UB-04 indicates resident not admitted to a nursing home within 30 days of the community discharge AND No unplanned inpatient hospital stay within 30 days of the community discharge. (Unplanned determined from the principal diagnosis and procedure codes on Medicare claims) AND Did not die within 30 days of the community discharge, as determined from the Medicare Enrollment database Percent of Short-stay Residents Successfully Discharged to Community 4 17 Copyright 2015 Percent of Short-stay Residents Successfully Discharged to Community 5 Occurrence Code 70: Hospital Stay 18 Copyright

7 Percent of Short-stay Residents Successfully Discharged to Community 6 Denominator Entered the nursing home within 1 day of discharge from an inpatient hospitalization Entered the nursing home within the target 12-month period Identified by using Medicare Part A claims Excludes inpatient rehabilitation facility and long-term care hospitalizations 19 Copyright Copyright 2015 Percent of Short-stay Residents Successfully Discharged to Community 7 Denominator Exclusions Not Fee-for-Service Parts A and B Medicare during risk period Excludes Hospice enrollees during the nursing home episode Resident was comatose (B0100 =[01]) or missing data on comatose on the first MDS assessment after the start of the episode Missing data on claims or MDS items used to construct the numerator or denominator Resident did not have an initial MDS assessment to use in constructing covariates for risk-adjustment Percent of Short-stay Residents Successfully Discharged to Community 8 Covariates See Tables 8 and 9 in the handouts for the list of claims-based and MDS-based covariates (pp. 9-11) 21 Copyright

8 Percent of Short-stay Residents with Outpatient Emergency Department Visit 1 Determines the percentage of all new admissions or readmissions to a nursing home from a hospital where the resident had an outpatient ED visit 22 Copyright 2015 Percent of Short-stay Residents with Outpatient Emergency Department Visit 2 Numerator: Number of residents Admitted to an emergency department within 30 days of entry/reentry to the nursing home Includes ED visits that occur after discharged from the nursing home Not admitted to a hospital for an inpatient stay or observation stay immediately after the visit to the emergency department ER visits are identified using Medicare Part B claims 23 Copyright 2015 Percent of Short-stay Residents with Outpatient Emergency Department Visit 3 Denominator: Number of residents who Entered or reentered the nursing home within 1 day of discharge from an inpatient hospitalization Entered or reentered the nursing home within the target 12- month period Excludes inpatient rehabilitation facility and long-term care hospitalizations 24 Copyright

9 Percent of Short-stay Residents with Outpatient Emergency Department Visit 4 Denominator Exclusions Not Fee-for-Service Parts A and B Medicare during risk period Excludes Hospice enrollees during the nursing home episode Resident was comatose (B0100 =[01]) or missing data on comatose on the first MDS assessment after the start of the episode Missing data on claims or MDS items used to construct the numerator or denominator Resident did not have an initial MDS assessment to use in constructing covariates for risk-adjustment 25 Copyright 2015 Percent of Short-stay Residents with Outpatient Emergency Department Visit 5 Covariates See Tables 5 and 6 of the handouts for the list of claims-based and MDS-based covariates (p. 6-7). 26 Copyright 2015 Percent of Short-stay Residents Re-hospitalized After a Nursing Home Admission 1 The percent of short-stay residents who entered or reentered the nursing home from a hospital and were re-admitted to a hospital for an unplanned inpatient stay or observation stay within 30 days of the start of the nursing home stay Planned inpatient readmissions are excluded Includes observation stays Includes hospitalizations that occur after nursing home discharge but within 30 days of the stay start date 27 Copyright

10 Percent of Short-stay Residents Re-hospitalized After a Nursing Home Admission 2 Planned Re-admissions Bone marrow, kidney, or other transplants. Maintenance chemotherapy and rehabilitation Normal pregnancy, Cesarean section; forceps delivery, vacuum, and breech delivery Readmissions to psychiatric hospitals or units 28 Copyright 2015 Percent of Short-stay Residents Re-hospitalized After a Nursing Home Admission 3 Denominator Entered or reentered the nursing home within 1 day of discharge from an inpatient hospitalization; AND Entered or reentered the nursing home within the target 12-month period Identified by using Medicare Part A claims Excludes inpatient rehabilitation facility and long-term care hospitalizations 29 Copyright 2015 Percent of Short-stay Residents Re-hospitalized After a Nursing Home Admission 4 Denominator Exclusions Not Fee-for-Service Parts A and B Medicare during risk period Excludes Hospice enrollees during the nursing home episode Resident was comatose (B0100 =[01]) or missing data on comatose on the first MDS assessment after the start of the episode Missing data on claims or MDS items used to construct the numerator or denominator Resident did not have an initial MDS assessment to use in constructing covariates for risk-adjustment 30 Copyright

11 Percent of Short-stay Residents Re-hospitalized After a Nursing Home Admission 5 Covariates See Tables 2 and 3 of the handouts for the list of claims-based and MDS-based covariates (pp. 2-4). 31 Copyright 2015 Percent of Short-stay Residents Who Improved Performance on Transfer, Locomotion, and Walking in the Corridor 1 Captures the percentage of short-stay residents who were discharged from the nursing home that gained more independence in transfer, locomotion, and walking during their episodes of care 32 Copyright 2015 Percent of Short-stay Residents Who Improved Performance on Transfer, Locomotion, and Walking in the Corridor 2 Numerator Short-stay residents who: Have a valid discharge assessment-return not anticipated (A0310F = [10]) and a valid preceding 5- day assessment (A0310B = [01]) or admission assessment (A0310A = [01]*); AND Have a change in performance score that is negative ([Discharge] - [5-day or admission assessment] < [0]), using the earlier assessment if resident has both 5-day and admission assessments *Uses the earliest assessment if both submitted 33 Copyright

12 Percent of Short-stay Residents Who Improved Performance on Transfer, Locomotion, and Walking in the Corridor 3 Performance calculation Sum of: G0110B1 (transfer: self- performance) Plus G0110E1 (locomotion on unit: self-performance) Plus G0110D1 (walk in corridor: self-performance) ADL Scores of 7 s (activity occurred only once or twice) and 8's (activity did not occur) recoded to 4's (total dependence) 34 Copyright 2015 Percent of Short-stay Residents Who Improved Performance on Transfer, Locomotion, and Walking in the Corridor 4 Numerator Example MDADL 5-Day/ Admission Discharge Return Not Anticipated Transfers Self-performance = 3 Self-performance = 2 Locomotion on Unit Self-performance = 2 Self-performance = 1 Walk in corridor Self-performance = 8 Self-performance = 3 Totals = = 6 MDALD Score Improves and Adds to the Numerator 35 Copyright 2015 Percent of Short-stay Residents Who Improved Performance on Transfer, Locomotion, and Walking in the Corridor 5 Denominator Short-stay residents who meet all of the following conditions, except those with exclusions: Have a valid discharge assessment (A0310F = [10], Discharge Return Not-Anticipated), AND Have a valid preceding 5-day assessment (A0310B = [01]) or admission assessment (A0310A = [01]) 36 Copyright

13 Percent of Short-stay Residents Who Improved Performance on Transfer, Locomotion, and Walking in the Corridor 6 Exclusions Prior assessment is the 5-day or Admission assessment and coded Comatose (B0100 = [1]) Life expectancy of less than 6 months (J1400 = [1]) Hospice (O0100K2 = [1]) Prior assessment and target assessment Missing data in G0110B1, G0110D1, or G0110E1 Residents with no impairment (sum of G0110B1, G0110D1 and G0110E1 = [0]) on the 5-day target assessment Residents with an unplanned discharge on any assessment 37 Copyright 2015 during the care episode (A0310G = [2]) Percent of Short-stay Residents Who Improved Performance on Transfer, Locomotion, and Walking in the Corridor 7 Covariates (From the 5-day or admission assessment) Age (<=54, 55-84, or >84) (A0900) Gender (A0800) Severe cognitive impairment (C0500, C0700, and C1000) Long-form ADL Scale (G0110A1 + G0110B1 + G0110E1 + G0110G1 + G0110H1 + G0110I1 + G0110J1) (categorized by tercile in the quarter) Heart failure (I0600) CVA, TIA, or stroke (I4500) Hip fracture (I3900) Other fracture (I4000) 38 Copyright 2015 LONG STAY QUALITY MEASURES 13

14 Residents Whose Ability to Move Independently Has Worsened 1 Captures long stay residents who experienced a decline in independence in locomotion. 40 Copyright 2015 Residents Whose Ability to Move Independently Has Worsened 2 Numerator Long-stay residents with a selected target assessment and at least one qualifying prior assessment who have a decline in locomotion when comparing their target assessment with the prior assessment. Decline identified by: Recoding all values (G0110E1 = [7, 8]) to (G0110E1 = [4]) Increase of one or more points on the locomotion on unit: self-performance item between the target assessment and prior assessment (G0110E1 on target assessment G0110E1 on prior assessment 1) 41 Copyright 2015 Residents Whose Ability to Move Independently Has Worsened 3 Denominator Long-stay residents who have a qualifying MDS 3.0 target assessment and at least one qualifying prior assessment, except those with exclusions (see next slide) 42 Copyright

15 Residents Whose Ability to Move Independently Has Worsened 4 Exclusions (Handout p.13) Residents satisfying any of the following conditions: Comatose or missing data on comatose (B0100 = [1, -]) at the prior assessment. Prognosis of less than 6 months at the prior assessment as indicated by: Prognosis of less than six months of life (J1400 = [1]), OR Hospice use (O0100K2 = [1]), OR Neither indicator for being end-of-life at the prior assessment (J1400 [1] and O0100K2 [1]) and a missing value on either indicator (J1400 = [-] or O0100K2 = [-]) 43 Copyright Copyright 2015 Residents Whose Ability to Move Independently Has Worsened 5 Exclusions (Handout p.13) (Con t) Residents satisfying any of the following conditions: Resident totally dependent during locomotion on prior assessment (G0110E1 = [4, 7, or 8]) Missing data on locomotion on target or prior assessment (G0110E1 = [-]). Prior assessment is a discharge with or without return anticipated (A0310F = [10, 11]) No prior assessment is available to assess prior function Target assessment is an admission assessment (A0310A = [01]), a PPS 5-day (A0310B = [01]), or the first assessment after an admission (A0310E = [01]), or A0310B = [06] Residents Whose Ability to Move Independently Has Worsened 6 Covariates (Handout p.13) From the prior assessment: Eating (self-performance): Needs help (G0110H1) Eating (self-performance): Dependence (G0110H1) Toileting (self-performance): Needs help (G0110I1) Toileting (self-performance): Dependence (G0110I1) Transfer (self-performance): Needs help (G0110B1) Transfer (self-performance): Dependence (G0110B1) 45 Copyright

16 Residents Whose Ability to Move Independently Has Worsened 7 Covariates (Handout p.13)(con t) Walking in corridor (self-performance): Independence (G0110D1) Walking in corridor (self-performance): Needs some help (G0110D1) Walking in corridor (self-performance): Needs more help (G0110D1) Severe cognitive impairment (C0500, C0700, and C1000) Linear age (A0900) Gender (A0800) Positive vision change score calculated from prior assessment to latest assessment with non-missing value after prior assessment (B1000) No oxygen use on prior assessment (O0100C2 = [0]) and oxygen use on latest assessment with non-missing value after prior assessment (O0100C2 = [1]) 46 Copyright 2015 Residents Who Receive Antianxiety/Hypnotic Medication 1 Captures long stay residents receiving an antianxiety and/or hypnotic medication. It excludes residents who are receiving hospice care or have a life expectancy of less than 6 months 47 Copyright Copyright 2015 Residents Who Receive Antianxiety/Hypnotic Medication 2 Numerator Long-stay residents with a selected target assessment where any of the following conditions are true: For assessments with target dates on or before 03/31/2012: Antianxiety medications received (N0400B = [1]), or Hypnotic medications received (N0400D = [1]). For assessments with target dates on or after 04/01/2012: Antianxiety medications received (N0410B = [1, 2, 3, 4, 5, 6, 7]), or Hypnotic medications received (N0410D = [1, 2, 3, 4, 5, 6, 7]). 16

17 Residents Who Receive Antianxiety/Hypnotic Medication 3 Denominator Long-stay residents with a selected target assessment, except those with exclusions (see next slide 49 Copyright 2015 Residents Who Receive Antianxiety/Hypnotic Medication 4 Exclusions The resident did not qualify for the numerator and any of the following is true: For assessments with target dates on or before 03/31/2012: (N0400B = [-] or N0400D = [-]) For assessments with target dates on or after 04/01/2012: (N0410B = [-] or N0410D = [-]) Any of the following related conditions are present on the target assessment (unless otherwise indicated): Life expectancy of less than 6 months (J1400 = [1]) Hospice care while a resident (O0100K2 = [1]) 50 Copyright 2015 Improving and Maintaining QM scores 17

18 Poor QM Score Contributors Staff don t understand the QM scores Lack of PIPs for poor performing QMs Not all shifts are included in CQI Lack of coordination across the care continuum 52 Copyright 2015 Poll Question #2 How would you rate your facility s Quality Measure management system? a) Fair b) Average c) Good d) Excellent 53 Copyright 2015 Tips to Improved Scores Manage QMs PROACTIVELY rather than Retrospectively Download and review QM scores Monthly Review scores as a team Sample audit resident charts Evaluate and enhance Transitions of Care Program Understand the Reimbursement Implications 54 Copyright

19 Tips to Improved MDS Accuracy Ensure accuracy of MDS assessments Shore up documentation Utilize the entire care team Code with integrity 55 Copyright 2015 QUESTIONS Resources MDS 3.0 Quality Measures User s Manual v10 Instruments/NursingHomeQualityInits/Downloads/MDS-30-QM-Users- Manual-V10.pdf CMS Five-Star Quality Rating System website 57 Copyright

20 Resources Claims-based QM Technical Specifications Manual Certification/CertificationandComplianc/Downloads/New- Measures-Technical-Specifications-DRAFT pdf Claims-based QM Technical Specifications Appendices Certification/CertificationandComplianc/Downloads/APPENDIX-New- Claims-based-measuresTechnical-Specifications pdf SNF PPS Proposed Rule 58 Copyright 2015 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program Instruments/Value-Based-Programs/Other-VBPs/SNF-VBP-Proposed-Rule- ODF-Presentation.pptx 59 Copyright