Kathleen: Thank you very much for that introduction. I appreciate it and thank all of you who logged on for today's presentation. SNF quality measures are not really that new because CMS released these last year (April 2016), but this is something that we are taking a little more notice of in our skilled nursing facilities right now. I think our administrators are starting to see the impact of these new quality measures. We want to talk about what impact OTs can have to help our facilities be successful.
Overview of New Quality Measures
Let's look at the new quality measures.
- Short-stay successfully discharged to the community
- Short-stay with OP ED visit
- Short-stay re-hospitalized after admit
- Short-stay who made improvements in function
- Long-stay whose ability to move independently worsened
- Long-stay receiving antianxiety or hypnotic
There are a few that are in bold-faced type. I think these are the ones that we are going to have the most direct impact upon.
Claims-Based
The ones that are claim-based are the percentage of short-stay residents who were successfully discharged to the community, had an outpatient emergency department visit, or were re-hospitalized after a nursing home admission. These are all claims-based.
MDS-Based
There are three that are MDS-based: the percentage of short-stay residents who made improvements in function, whose ability to move independently worsened, and finally those who received an antianxiety or hypnotic medication.
Benefits
If you are not in tune with the quality measure language, you may not know what short-stay versus long-stay is. There are very specific definitions for that. I think that for our purposes and our discussion today, we can consider a short-stay person to be that person who comes from the hospital for a skilled Part A admission to the skilled nursing facility, and we can consider those long-stay individuals to be folks who reside in the nursing home and would be covered under Medicaid or Medicare Part B for purposes of therapy.
Before we get into some of the specifications, let's identify some of the benefits. A lot of the measures, previously on the books, were long-stay measures. They looked at what our long-term care population was doing and did not really look as much at our short-stay folk, folks who were coming in Part A and then going back home. For OT purposes, this is nice that we are going to start including information from those short-stay patients.
These measures address other domains that are not covered by other measures. As we go through this, you will not that they are very functionally based. Some of the other measures, that are out there for nursing homes, address things like influenza and pneumonia vaccines and things like that, but these measures are very functional. Again, I think this is right in line with what we, as occupational therapy practitioners, would be doing.
Finally, the Centers for Medicare & Medicaid Services (CMS), feels that the claims-based measures might be a little more accurate than some of the MDS-based measures. The reason for this is, in long-term care, the MDS is completed by a nurse. As such, you are really held to that person's judgement and that person's ability to score that MDS. Thus the scoring or the measure might be a little more skewed because it is based on human error. Claims-based measures are truly based on Medicare claims.
Five-Star Quality Ratings
We cannot do this discussion without talking about Five-Star Quality Ratings. There is a website that goes through each skilled nursing facilities' Five-Star Quality Rating. I can only speak from personal experience. I have used this site and I know some of our consumers use this as well. It talks about the type of quality, outcomes, and the type of survey that a certain facility has.
Of those measures that I just went through, five of those six new measures were phased in to the Five-Star Quality Ratings beginning July of 2016. CMS decided to leave out the measure on anti-anxiety and hypnotic medications, because they were not sure about how to develop specific thresholds for that measure. For now it is out, but will probably be added in at some point in the future.
In July, those five measures had 50% of the weight of the previous measures. Starting in January of 2017, the measures all have the same weight, or 100%. Back in July, facilities were eligible to get 50 of those 100 points, and now they are eligible to get 100 of those 100 points. I think this is why this is coming up as a question for a lot of our facilities. They are looking to therapy to assist them with some of their programming.
How is it figured? There is imputation from the quality measures, which we just talked about. Health inspections and staffing ratios also are factored in. You total up all of the points across all of the quality measures, and the scoring rules are on Figure 1.
