Quality in Long Term Services and Supports (QuILTSS) for Nursing Facilities

Transcription

1 TENNESSEE LTSS VBP INITIATIVES NASHP Annual Conference /24/2017 Quality in Long Term Services and Supports (QuILTSS) for Nursing Facilities Began in 2013 with stakeholder engagement. Bridge Payment phase Quarterly retrospective adjustments to per diem rates largely focused on activities (i.e., process measures) Nursing Facility bed taxes are used for payment during this phase. Full Model Quality is a component of the prospective per diem rate based on quality performance compared against benchmarks (i.e., outcome measures) 2 1

2 NF QuILTSS Framework Threshold Measures Current with NF Assessment Not provide false information Quality Measures Satisfaction 35 Points Resident (Process Measurement*) 15 points Family (Process Measurement*) 10 points Staff (Process Measurement*) 10 points Culture Change/Quality of Life 30 Points Respectful Treatment (Process Measurement*) 10 points Resident Choice (Process Measurement*) 10 Points Member/Resident and Family Input (Process Measurement*) 5 Points Meaningful Activities (Process Measurement*) 5 Points Staffing/Staff Competency 25 Points RN hours per day (Outcome/CMS Data) 5 points CNA hours per day (Outcome/CMS Data) 5 points Staff Retention (Outcome/Self-Reported) 5 points Consistent Staff Assignment (Outcome/NNHQIC) 5 points Staff Training 5 points Clinical Performance 10 Points Antipsychotic Medication (Outcome/CMS Data) 5 points Urinary Tract Infections (Outcome/CMS Data) 5 points Bonus Points 10 Points * Transi3oning Process to Outcome Measurement 3 NF QuILTSS Performance (Satisfaction) 100% Sa.sfac.on Quality Measure 90% Percent of Facili.es Awarded Points 80% 70% 60% 50% 40% Resident Satisfaction Survey Took Action based on Resident Survey Family Satisfaction Survey Took Action based on Family Survey Staff Satisfaction Survey Took Action based on Staff Survey 30% * 7 8* QuILTSS Submission * Increase in Quality Measure Standard 4 2

3 QuILTSS Successes with Culture Change Staff Training (Staff/Culture Change Domain): In QuILTSS #6 (September 2015) 28.37% of QuILTSS NFs reported maintaining a 100% level of training for all staff in the CMS Hand-in-Hand curriculum. In QuILTSS #8 (September 2016) 82% of QuILTSS NFs reported maintaining a 100% level of training for all staff in the CMS Hand-in-Hand curriculum. This is an improvement of approximately 110 facilities who were providing high-quality training that emphasizes person centered care. Resident Choice (Quality of Life Domain): A facility must offer choice in the following areas of everyday living; (1) Meal Time, (2) Meal Menu, (3) Bathing Time, (4) Sleep/Wake Time, (5) Room Décor In QuILTSS #6 (September 2015) only 34% of all participating facilities provided evidence of offering choice in all of the categories above. In QuILTSS #9 (February 2017) more than 82% of all participating facilities provided evidence of offering choice in all of the categories above for all residents. This equates to approximately 139 more facilities across the state who are providing residents with basic care preference choices. 5 Stakeholder Surveys / Updated Rules March 2017: Survey was conducted of resident/family councils and nursing facility administrators. The goal of the survey was to determine the direction of QuILTSS for the state rulemaking process. Overall Summary: Respondents overwhelmingly (91%) felt that QuILTSS should utilize standardized outcome measurements. Most (63%) felt that a third-party should administer/collect satisfaction data. Most (78%) felt the amount of payment tied to quality should be higher than the current 4%. More than Half (54%) indicated 10% or more of payment should be tied to quality. 6 3

4 Enhanced Respiratory Care TennCare implemented structured ERC rates in The number of ERC patients increased five-fold (558%) The expenditures for the services multiplied by a factor of ten (941%). Program saw a movement away from the primary goal of liberation with only 4% of expenditures in 2015 related to weaning. TennCare implemented new rules on July 1, 2016 in order to: Strengthen medical eligibility requirements Refine standards of care for Ventilator services Create standards of care for Secretion Management Modify ERC reimbursement to incentivize quality outcomes, including primarily ventilator liberation and improve the member s quality of care and quality of life 7 ERC Measures 8 4

5 ERC Successes (Quality) Personal Outcomes Weaning Chronic Pa.ents July 2016 March individual weaned who had been mechanically ven3lated for 4 years. 2 individuals weaned who had been mechanically ven3lated for 3 years. 2 individuals weaned who had been mechanically ven3lated for 2 years. 9 ERC Successes (Utilization) From FY 2010 until FY 2015 ERC spending increased ten-fold. FY 2016 marks the first year ERC spending has decreased. The changes in rates and service definitions when coupled with the changes to utilization patterns to secure a higher quality score has demonstrated a decrease of 25% in ERC spending. FY 16 FY A decrease (-4.73%) in the amount of chronic ventilator care 2. A substantial increase (55%) in ventilator weaning utilization 3. A significant decrease in tracheal suctioning (-90.27%) 10 5

6 I/DD Initiatives System of Support (Implemented, March 2016) Person Centered Planning, Crisis Stabilization, Sustained Community Living Monthly case rate aligned to support improvement and independence. ECF Choices (Implemented, July 2016) Promotes competitive integrated employment (CIE), community living as first and preferred outcome. Outcome-based reimbursement for up-front services leading to employment 1915(c) waivers (Live Date, July 2018) Cross-walk lessons learned from ECF CHOICES into 1915(c) waivers Establish separate rates for job development/customization or self-employment start-up, coaching, and stabilization and monitoring Create Community-Based wrap-around service with greater payment than Community-Based Day that does not wrap CIE 11 THANK YOU 6