LTCH Lay of the Land: Reporting the LTCH CARE Data Set July 30, 2012
Purpose LTCH Quality Reporting Program, specifically the LTCH CARE Data Set CMS guidance, training & transmission Dates & Deadlines LTRAX: LTCH CARE data collection & recent enhancements Discussion Staying Informed Transition & Implementation Hot Spots
LTCH QRP: What is it? LTCH Quality Reporting Program Is a feature of the 2010 Patient Protection & Affordable Care Act Mandates quality reporting for LTCHs, IRFs & Hospice Brings post-acute care in line with mandates already in place for acute care
LTCH QRP: Purpose Improve quality Improve safety Minimize healthcare-associated infections (HAIs) & adverse events Improve coordination of care Create more person- and family-centered care
Data Collection: Overview LTCH QRP requires LTCHs to submit patient data to CMS for the first time Data collection begins with Oct. 1 admissions Data collected on all patients, regardless of payer Penalty for not participating is a 2 percentage point reduction in annual Medicare payment update Affects payment beginning fiscal year 2014 (October 2013)
Data Collection: Details Beginning Oct. 1, LTCHs will be required to collect and submit data for 3 measures: 1. Patients with pressure ulcers that are new or have worsened 2. Catheter Associated Urinary Tract Infection (CAUTI) 3. Central Line Catheter-Associated Bloodstream Infection (CLABSI)
Pressure Ulcers: Rationale Pressure Ulcers: percent of patients with one or more stage 2-4 pressure ulcers that are new or have worsened LTCH patients tend to be medically complex with functional limitations, sometimes severe. Pressure ulcers can lead to serious, life-threatening infections. Pressure ulcers are an increasingly common secondary diagnosis across all settings.
Pressure Ulcers: Data Collection CMS developed the LTCH CARE Data Set: Patient assessment instrument Collects documentation for pressure ulcers, selected pressure ulcer risk factors, patient demographics, and provider attestations Admission, Planned Discharge, Unplanned Discharge, and Expired assessments Submit electronically to CMS Used for all patients, regardless of payer
Pressure Ulcers: Data Collection Specific Pressure Ulcer Outcomes Measure data contained within the LTCH CARE Data Set: CMS will accept assessments but throw a warning if any of the following fields have been omitted: GG0160C. Functional Mobility: Lying to sitting on side of bed H0400. Bowel Continence I0900. Peripheral Vascular Disease (PVD) or PAD I2900. Diabetes Mellitus (DM) K0200A. Height (inches) K0200B. Weight (pounds) M0800. Worsened since prior assessment: A. Stage 2 Pressure Ulcers B. Stage 3 Pressure Ulcers C. Stage 4 Pressure Ulcers
HAIs: Rationale CAUTI (catheter-associated urinary tract infection) Medical severity & common comorbidities of LTCH patients make catheters common Most common healthcare-associated infection Largely preventable CLABSI (central line-associated bloodstream infection) Patients come to LTCHs from ICUs or step-down units with central lines in place, or have them inserted at the LTCH Largely preventable
HAIs: Data Collection CMS piggybacked on the CDC s National Healthcare Safety Network CDC will report quarterly information to CMS LTCHs participate via NHSN web-based reporting system
LTCH CARE: What s New? Attestations Removal of the requirement that an RN attest to completion of LTCH CARE assessments Removal of Assessment Coordinator language Transmission Specifications New v. 1.00.3 available LASER (CMS free tool) Test version expected late August Training material posted week of Aug. 27 Production version expected early September
CMS Guidance: Upcoming Long-awaited LTCH CARE FAQ: Promised very soon LTCH CARE Manual Draft available Revised & updated manual expected by mid-august CMS recorded training materials July 30: CMS.net & QEIS user registration Aug 27: assessment submission process, assessment & validation reports LTCH Open Door Forums Aug. 16, Sept. 20, & Oct. 18 2:30 p.m. to 4:00 p.m. EDT
LTCH CARE: Upcoming Five additional measures proposed for data collection beginning calendar year 2014: Patients given seasonal influenza vaccine Influenza vaccination among healthcare personnel Patients given pneumococcal vaccine Ventilator Bundle: Head of the bed greater than or equal to 30 degrees Daily sedation interruption and assessment of readiness to wean Peptic ulcer disease Deep vein thrombosis prophylaxis Daily oral care with Chlorhexidine Restraint rate per 1,000 patient days Effects fiscal year 2016 payment (Oct. 2015) Mandated public reporting of quality data: TBD
LTRAX LTRAX is a complete outcomes system built specifically for long-term acute care hospitals. Contains complete system for completing all LTCH CARE assessments and preparing transmission files: Conforms to all CMS submission rules Checks assessments for integrity and consistency Scans assessments for any unmet requirements Contains easy-to-follow logic and organization to smooth workflow Comprehensive assessment and outcomes system for significant LTCH patient populations: Ventilator and weaning assessments and outcomes Wound assessments (PUSH & BWAT) and outcomes Operational & clinical outcomes
LTRAX Modules Core Module: Patient assessments, including the LTCH CARE Data Set completion and transmission file system Additional components make it a single-source software solution for LTCH needs: Pre-admission screening (on & offline) & referrals outcomes Patient Satisfaction survey system and reporting Joint Commission ORYX Performance Measurement System
LTRAX: What s New? Push-the-button solution to CMS Skin Conditions questions (Section M): Complete wound assessment(s) at admission and discharge, including origin, stage, location Use an integrated wound assessment tool Bates-Jensen Wound Assessment Tool or PUSH Tool 3.0 Push COPY button and Voila! LTRAX churns assessment data through CMS Skin Conditions logic to answer LTCH CARE assessment questions Coming Soon: link to more information for how LTRAX computed skin conditions question for each patient assessment
LTRAX: What s New? Integrated interruptions logic: LTRAX warns when a user may be starting a duplicate patient assessment. LTRAX warns when a user may be starting a new Admission assessment when unnecessary (such as when a discharged patient returns within 3 days). LTRAX ties sets of LTCH CARE assessments together when a patient s admission and discharge pattern suggests an interrupted stay Additional questions allow a user to confirm or deny an interrupted stay
LTRAX: What s New? Integrated LTCH CARE assessment printing: Prints all assessment types on the CMS LTCH CARE Data Set forms PDF can be saved or printed
Discussion: Stay Informed Expect changes to clinical guidance Questions answered in the FAQ Revisions within manual Requirements for transmission Tune in to upcoming CMS calls & training Check their websites LTRAX resources Webinar series Mailing list
Discussion: Implementation DQMs: The Lynchpin Data Entry Burden Reduce duplicate data entry with HL7 imports Examine other reporting systems for duplication What s in it for me? Capitalize on the data opportunity Roles & Responsibilities Trace the entire physical workflow Trial everything before Oct. 1 Data entry: clinical expert or clerk? Stretch resources or add FTEs? Tie clinical expert s data entry role to outcomes
Discussion: Hot Spots How will we get that information? Integrate LTCH CARE into pre-admission screening process: A1800. Admitted From A1810. In the last 2 months A1820. Primary Diagnosis in the previous setting Patients expiring after discharge How will we track workflow? Assessment Reference Dates, Completion Dates & Submission Dates Learn and love your software
The Big Picture LTCH CARE data collection will establish the first industry-wide data set LTRAX benchmarking at 200+ LTCHs Ultimately illustrate the need for long-term acute care in the post-acute spectrum Data submission begins Oct. 1, 2012. Payment penalties begin Oct. 1, 2013.
Resources LTRAX www.ltrax.com 202-872-1033 assistance@ltrax.com CMS LTCH Quality Reporting Program: www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/ltch-quality- Reporting/index.html LTCHQualityQuestions@cms.hhs.gov QIES Technical Support Office www.qtso.com LTCH QRP Technical Issues Help Desk 877-201-4721 888-477-7871 (fax) help@qtso.com