QI/QM MDS 3.0 Quality Measures Why are QMs Important? FIVE STAR - PDF document

4/9/2012 QI/QM MDS 3.0 Quality Measures “Why are QM’s Important?” FIVE STAR RATING Brief Explanation of Methodology How the Ratings are Calculated: A nursing home's Overall Quality rating on Nursing Home Compare (www.medicare.gov) is based on its ratings for Health Inspections, Quality Measures (QMs), and Staffing . Ratings for each domain and the overall rating range from 1 star to 5 stars, with more stars indicating higher quality. Based on these three ratings, the overall 5­Star rating is assigned in 5 steps. Version 1.0 3 1

4/9/2012 rating is 5 stars; subtract one star if the Quality 6 6/25/2009 Overall Quality rating is 3 stars. Facility that has not graduated, the maximum Version 1.0 5 6/25/2009 Staffing and Quality Measure ratings. upgraded by more than one star based on the then the Overall Quality rating cannot be stars or lower than 1 star. 2 Measure is 1 star. The rating cannot go above 5 Version 1.0 above 5 stars or lower than 1 star. Rating. Inspection Rating. Subtract one star if the Staffing rating is 1 star. The rating cannot go or 5 stars and also greater than the Health 4 Version 1.0 Brief Explanation of Methodology How the Ratings are Calculated (Continued): • Step 1: Start with the Health Inspection • Step 2: Add one star if the Staffing rating is 4 Brief Explanation of Methodology How the Ratings are Calculated (Continued): • Step 3: Add one star if the Quality Measure • Step 4: If the Health Inspection rating is 1 star, Brief Explanation of Methodology How the Ratings are Calculated (Continued): Step 5: If a nursing home is a Special Focus

4/9/2012 rating for each of the following three additional points are added to the health inspection score. better 5­Star rating on Nursing Home Compare. 6/25/2009 8 Version 1.0 NURSING HOME COMPARE Nursing Home Compare provides a five­star components (Continued): deficiencies. If multiple revisits are required to 1)Health Inspection ratings (Continued): based on their score, and the number of stars is based on where the nursing home falls within the state ranking. bottom 20% get 1 star, and the middle 70% of nursing homes receive 2, 3 or 4 stars, with equal proportions (23.33%) in each category. 6/25/2009 9 3 ensure that major deficiencies are corrected, scope and severity of a nursing home's health more heavily. NURSING HOME COMPARE Nursing Home Compare provides a five­star rating for each of the following three components: 1)Health Inspection ratings: assigned to the results of nursing home surveys over the past three years, as well as complaint surveys from the past three years and survey revisits. More recent surveys are weighted 6/25/2009 7 Version 1.0 NURSING HOME COMPARE Nursing Home Compare provides a five­star rating for each of the following three components (Continued): 1)Health Inspection ratings (Continued): Version 1.0 • Ratings are calculated from points that are • Points are assigned based on the number, • Lower health inspection scores result in a • Nursing homes are ranked within their state • The top 10% of nursing homes get 5 stars, the

4/9/2012 rating for each of the following three Nursing Home Compare. 6/25/2009 11 Version 1.0 NURSING HOME COMPARE Nursing Home Compare provides a five­star components (Continued): 4 3) Staffing ratings: hours per resident day and total staffing hours (RN, LPN, nurse aid) per resident day. These two measures contribute equally to the Staffing rating. 6/25/2009 12 which are a subset of those reported on performance on 10 Quality Measures (QM’s), Version 1.0 2) Quality Measure ratings: NURSING HOME COMPARE Nursing Home Compare provides a five­star rating for each of the following three components (Continued): 1)Health Inspection ratings (Continued): every month to account for new survey results into the system. 6/25/2009 10 Version 1.0 NURSING HOME COMPARE Nursing Home Compare provides a five­star rating for each of the following three components (Continued): • Health Inspection ratings are re­calculated • Ratings are calculated from a nursing home’s • Ratings are calculated from two measures: RN

4/9/2012 5 Short Stay Section 1 Version 1.0 14 6/25/2009 calculation of the Staffing ratings. housekeeping staff, are not included in the 3) Staffing ratings (continued): components (Continued): rating for each of the following three Nursing Home Compare provides a five­star NURSING HOME COMPARE Version 1.0 13 6/25/2009 associated with each RUG­IV group. number of LPN, and nurse aide minutes assessments by RUG­IV group, based on the nursing home’s distribution of MDS that is then case mix adjusted based on the 3) Staffing ratings (continued): components (Continued): rating for each of the following three Nursing Home Compare provides a five­star NURSING HOME COMPARE Quality Measures • Staffing measures are derived from OSCAR data • Other staff, such as clerical, administrative, and

4/9/2012 pain, are on a scheduled pain medication 18 10/17/2011 frequency in the last 5 days. horrible/excruciating pain of any episode of moderate/severe pain or short­stay residents, with at least one This measure captures the percent of Moderate to Sever Pain Percent of Residents Who Self­Report MDS 3.0 Measure #0676 target assessment. who report lowered levels of pain on their regimen at their initial assessment, and short­stay residents who can self­report 6 This measure captures the percentage of QI/QM 17 10/17/2011 Pain Intensity or Frequency (Short Stay) Admission Who Self­Report a Decrease in Scheduled Pain Medication Regimen on The Percentage of Residents on a MDS 3.0 Measure #0675 end of the target period. or equal to 100 days as of the days in facility (CDIF) less than An episode with cumulative Short Stay QI/QM

4/9/2012 the Seasonal Influenza Vaccine influenza season. 10/17/2011 20 QI/QM MDS 3.0 Measure #0680A Percent of Residents who Received (Short Stay) appropriately, the influenza vaccination The measure reports the percent of short­ stay residents who received the influenza vaccination during the current or most recent influenza season. 10/17/2011 21 during the current or most recent stay residents who are given, 7 worsening Stage 2­4 pressure ulcers. MDS 3.0 Measure #0678 Percent of Residents With Pressure Ulcers that are New or Worsened (Short Stay) This measure captures the percentage of short­stay residents with new or 10/17/2011 The measure reports the percent of short­ 19 QI/QM MDS 3.0 Measure #0680 Percent of Residents Who Were Assessed and Appropriately Given the Season Influenza Vaccine (Short Stay) QI/QM

4/9/2012 Appropriately Given the vaccination during the current or most recent influenza season. 10/17/2011 23 QI/QM MDS 3.0 Measure #0682 Percent of Residents Assessed and Pneumococcal Vaccine (Short Stay) stay residents who did not receive, due This measure reports the percent of short­ stay residents whose pneumococcal polysaccharide vaccination (PPV) status is up to date during the 12­month reporting period. 10/17/2011 24 to medical contraindication, the influenza The measure reports the percent of short­ 8 the current or most recent influenza MDS 3.0 Measure #0680B Percent of Residents Who Were Offered and Declined Seasonal Influenza Vaccine (Short Stay) The measure reports the percent of short­ stay residents who are offered and declined the influenza vaccination during season. Influenza Vaccine (Short Stay) 10/17/2011 22 QI/QM MDS 3.0 Measure #0680C Percent of Residents Who Did Not Receive, Due to Medical Contraindication, the Seasonal QI/QM

4/9/2012 Vaccine (Short Stay) 10/17/2011 26 QI/QM MDS 3.0 Measure #0682C Percent of Residents Who Did Not Receive, Due to Medical Contraindication, the Pneumococcal This measure reports the percent of short­ polysaccharide vaccination (PPV) during stay residents who did not receive, due to medical contraindication, the pneumococcal polysaccharide vaccination (PPV) during the 12­month reporting period. 10/17/2011 27 the 12­month reporting period. declined the pneumococcal 9 vaccination (PPV) during the 12­month MDS 3.0 Measure #0682A Percent of Residents Who Received the Pneumococcal Vaccine (Short Stay) This measure reports the percent of short­ stay residents who received the pneumococcal polysaccharide reporting period. stay residents who were offered and 10/17/2011 25 QI/QM MDS 3.0 Measure #0682B Percent of Residents Who Were Offered and Declined the Pneumococcal Vaccine (Short Stay) This measure reports the percent of short­ QI/QM

4/9/2012 Percent of Residents Experiencing 30 10/17/2011 in the target period. or more falls with major injury reported stay residents who have experienced one This measure reports the percent of long­ (Long Stay) One or More Falls with Major Injury MDS 3.0 Measure #0674 10 the end of the target period. than or equal to 101 days as of days in facility (CDIF) greater An episode with cumulative Long Stay Quality Measures Long Stay Section 2 QI/QM