QUALITY INCENTIVE POINTS OHIO Mandy Smith Regulatory Director Ohio Health Care Association
WHAT ARE THE QUALITY INCENTIVE POINTS? Medicaid payment policy that rewards nursing homes for achieving quality incentive measures. At the center of this effort is the resident who lives in a nursing home for any length of time - whether they are elders or people with disabling conditions. The goal is for all nursing homes to achieve the quality incentive measures. Must meet 5/20 and one of those clinical to meet the incentive payment.
FIVE GENERAL AREAS The quality incentive measures are intended to stimulate practices that support residents in five general areas: Nursing Home Performance Choice Staffing Clinical Practice Environment
PERFORMANCE MEASURES Satisfaction Survey Overall Scores The facility's overall score on the resident satisfaction survey initiated in 2013 must be at least 87.5. Participation in the Advancing Excellence in America's Nursing Homes campaign The facility must have enrolled and selected goals by December 31, 2013 to be awarded points for state fiscal year 2015. One of the goals must be clinical and the facility must submit data monthly on a "process" goal for 6 consecutive months by December 31, 2013.
PERFORMANCE MEASURES CONT. Resident Review Compliance Self Reported Q22 To receive the quality incentive point for this measure, the facility must achieve a 95% compliance rate with requesting resident reviews in a timely manner for individuals admitted under a hospital exemption. The 95% compliance with the RR requirement is specific to admissions under the 30 day hospital exemption who stay beyond the 30 days. Now it is considered an environmental measure, but was originally a performance measure and is still listed this way on the Department of Aging s website.
PERFORMANCE MEASURES CONT. Standard and Complaint Survey Performance Facility must not have either of these for last survey or any complaint survey in 2013. A health deficiency with a scope and severity greater than F. A deficiency that constitutes a substandard quality of care.* There also is a requirement that the facility not be listed on Table B of the SFF list for 18 or more consecutive months at any time during 2013. *"Substandard quality of care" means one or more deficiencies related to participation requirements under 42 CFR 483.13, resident behavior and facility practices; 42 CFR 483.15, quality of life, or 42 CFR 483.25, quality of care, that constitute either immediate jeopardy to resident health or safety (level J, K, or L); a pattern of or widespread actual harm that is not immediate jeopardy (level H or I); or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm (level F). (42 CFR 488.301)
CHOICE MEASURES Choice in Dining Self Reported Q4 The facility must offer at least 50 percent of its residents a minimum of one of the following dining choices for at least two meals each day: Restaurant-style dining in which food is brought from the food preparation area to residents per the residents' orders; Buffet-style dining in which residents obtain their own food or have the facility's staff bring food to them, per the residents' directions, from the buffet; Family-style dining in which food is customarily served on a platter and shared by residents; Open dining in which residents have at least a two-hour period to choose when to have a meal; Twenty-four-hour dining in which residents may order meals from the facility any time of the day.
CHOICE MEASURES CONT. Choice in Bathing Self Reported Q5 At least 50 percent of the facility's residents must be able to take a bath or shower when they choose. Choice in Rising and Retiring To receive the quality incentive point for this measure, the facility must have at least the minimum scores noted below for the following topics on its resident satisfaction survey (initiated in odd years): Residents' ability to choose when to go to bed in the evening; minimum score: 89 Residents' ability to choose when to get out of bed in the morning; minimum score: 76
CHOICE MEASURES CONT. Advance Care Planning Self Reported Q7 To receive the quality incentive point for this measure, at least 75 percent of the facility's residents have the opportunity, following admission to the facility and before completing or quarterly updating their individual plans of care, to discuss their goals for the care they are to receive at the facility, including their preferences for advance care planning, with a member of the residents' healthcare teams that the facility, residents and residents' sponsors consider appropriate. The facility must record the residents' care goals, including advance care preferences in their medical records and use them in the development of the residents' individual plans of care.
CLINICAL MEASURES Pain To receive the quality incentive point for this measure, not more than 13.35% of the facility's longstay residents may report severe to moderate pain during the minimum data set assessment process.* Pressure Ulcers To receive the quality incentive point for this measure, not more than 5.16% of the facility's longstay, high-risk residents may have been assessed as having one or more stage two, three or four pressure ulcers during the minimum data set assessment process.*
CLINICAL MEASURES CONT. Restraints To receive the quality incentive point for this measure, not more than 1.52% of the facility's longstay residents may be physically restrained as reported during the minimum data set assessment process.* Urinary Tract Infections To receive the quality incentive point for this measure, less than 7.0% of the facility's long-stay residents may have had a urinary tract infection as reported during the minimum data set assessment process.*
CLINICAL MEASURES CONT. Hospital Admission Tracking Self Reported Q12/12C To receive the quality incentive point for this measure, the facility must use a tool for tracking residents' admissions to hospitals and must annually report hospital admission by month. Immunizations To receive the quality incentive point for this measure, at least 95% of the facility's long-stay residents must be given pneumococcal vaccine and at least 93% of long-stay residents are given seasonal influenza vaccine.* *The facility's MDS score will be verified. No reporting action by the facility is needed.
ENVIRONMENT MEASURES Private Rooms Self Reported Q13 To receive the quality incentive point for this measure, an average of at least 50 percent of the facility's Medicaid-certified beds must be in private rooms or semiprivate rooms to which all of the following apply: Each room provides a distinct territory for each resident occupying the room; Each distinct territory has a window and is separated by a substantial wall from the other distinct territories in the room; Each resident is able to enter and exit the distinct territory of the resident's room without entering or exiting another resident's distinct territory; and Complete visual privacy for each distinct territory may be obtained by drawing a curtain or other screen.
ENVIRONMENT MEASURES CONT. Eliminate Overhead Paging Self Reported Q15 To receive the quality incentive point for this measure, the facility must maintain a written policy that prohibits the use of overhead paging systems or limits the use of overhead paging systems to emergencies, as defined in the policy. The facility must communicate the policy to its staff, residents and families of residents.
STAFFING MEASURES Consistent Assignment Self Reported Q17 To receive the quality incentive point for this measure, the facility must do both of the following: Maintain a written policy that requires consistent assignment of nurse aides and specify the goal of having a resident receive nurse aide care from not more than twelve different nurse aides during a 30-day period; and Communicate the policy to its staff, residents and families of residents. Staff Retention To receive the quality incentive point for this measure, the facility's staff retention rate must be at least 75 percent. The facility must meet the accountability measure in the calendar year preceding the fiscal year for which the point is to be awarded. Based on Cost Report Data
STAFFING MEASURES CONT. Staff Turnover Self Reported Q19 To receive the quality incentive point for this measure, the facility's staff turnover rate for nurse aides must not be higher than 65 percent. Aide Participation in Care Conferences Self Reported Q20 To receive the quality incentive point for this measure, for at least 50 percent of the resident care conferences in the facility, a nurse aide who is a primary caregiver for the resident attends and participates in the conference.
QUALITY INCENTIVE DATA SUBMISSION TOOL Quality Incentive Data Submission Tool http://www.odjfs.state.oh.us/nfsurvey/ Facilities must submit no later than May 31, 2014 to be considered for the state fiscal year 2015 ratesetting. Submission Instructions http://medicaid.ohio.gov/portals/0/providers/providertypes/ LongTermCare/Survey-InstProv.pdf
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THANK YOU FOR ALL YOU DO! msmith@ohca.org 614-288-0613 (preferred) 614-436-4154