Serving Colorado, Illinois and Iowa 2 1 5/22/2019 Housekeeping - - PDF document

▶
serving colorado illinois and iowa
SMART_READER_LITE
LIVE PREVIEW

Serving Colorado, Illinois and Iowa 2 1 5/22/2019 Housekeeping - - PDF document

May 31, 2023 223 likes •449 views

5/22/2019 Nursing Home Compare Five-Star Rating System: Resetting Your Course Lisa Bridwell, Program Specialist Telligen This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under

slide-1
SLIDE 1

5/22/2019 1

1

Nursing Home Compare Five-Star Rating System: Resetting Your Course

Lisa Bridwell, Program Specialist Telligen

This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. This material is for informational purposes only and does not constitute medical advice; it is not intended to be a substitute for professional medical advice, diagnosis or treatment. 11SOW-QIN-05/0919-3417

2

Serving Colorado, Illinois and Iowa

slide-2
SLIDE 2

5/22/2019 2

3

Housekeeping

  • Due to large number of attendee’s the lines will be

muted

  • The PPT will be sent out via email by 5/24/2019
  • Please enter any questions in the chat
  • Chat questions that do not receive a response will be

responded to via email, after we receive the attendee list

4

Objectives

  • Learn how to calculate the overall star rating
  • Recognize how each QM domain is calculated
  • Identify data sources used for calculating the Five-

Star Rating

  • Identify scoring exceptions for the Staffing domain

that result in a one star rating for RN and Total Staffing

slide-3
SLIDE 3

5/22/2019 3

5

Nursing Home Compare

6

Critical Resources

slide-4
SLIDE 4

5/22/2019 4

7

Critical Resource

8

Domains

  • Health Inspection: “Freeze” is over!

– Using pre-freeze weighting

  • Quality Measures

– New /Removed Measures – Weighting/Scoring changes – Thresholds may change every 6 month

  • Staffing Measures

– PBJ data – Cut point updates – Automatic downgrade in Staffing Domain to 1 star if NHs report > 4 days in a quarter without an RN onsite

April 2019 Changes in Technical User’s Guide

slide-5
SLIDE 5

5/22/2019 5

9

  • Measures based on outcomes from State

Health Inspections

  • Number, scope and severity of deficiencies
  • Standard and substantiated complaint survey

Health Inspection Rating

  • Measures based on nursing home staffing

levels

  • Data: PBJ RUGs Case Mix, MDS

Staffing Rating Quality Measures Rating

Five- Star Rating Components

  • Composite Rating

Overall Nursing Home Rating

  • Use a subset of publically reported QMs on

Nursing Home Compare

  • Data: MDS and Medicare Claims

10

Calculation: Overall Nursing Home Rating

  • Special Focus Facilities (SFF) no longer have ratings displayed, have yellow warning sign
  • If a nursing home has no health inspection rating (to new or not), then no overall rating

is assigned.

https://www.cms.gov/medicare/provider-enrollment-and- certification/certificationandcomplianc/fsqrs.html

slide-6
SLIDE 6

5/22/2019 6

11

Example Overall Nursing Home Rating Calculation Preview Report

Example #1 NH ABC Example #2 NH DDD

12

Health Inspection Scoring 3 Cycles

  • 3 most recent

substantiated standard surveys and complaint surveys within calendar year

  • Each deficiency is

weighted by scope and severity

  • More recent surveys

weighted more heavily

slide-7
SLIDE 7

5/22/2019 7

13

Health Inspection Score

https://www.cms.gov/medicare/provider-enrollment-and- certification/certificationandcomplianc/fsqrs.html 14

Weights for Repeat Revisits

slide-8
SLIDE 8

5/22/2019 8

15

Health Inspection Example Survey Cycle #1

16

Health Inspection Example

Calculating points In 2018 – 4Dx4=16 , 1Ex8=8, repeat revisit 36 points (½ score) In 2017 – 2Dx4=8, 2Ex8=16 24 points (1/3 score) In 2016 – 6Dx4=24, 4Ex8=32, 2Fx16=32 88 points (1/6 score) The Math:

36 points x .50 = 18 24 points x .33 = 7.9 88 points x .167 = 14.7 Grand Total 40.6 Check Cut Point Table 1 for your state

https://www.cms.gov/Medicare/ Provider-Enrollment-and- Certification/CertificationandCo mplianc/Downloads/cutpointsta ble.pdf

slide-9
SLIDE 9

5/22/2019 9

17

Cut Point Table Example

Grand Total = 40.6

https://www.cms.gov/medicare/provider-enrollment-and- certification/certificationandcomplianc/fsqrs.html 18

  • 17 QMs
  • Physical Restraints Removed from 5 star
  • QM Domain Split; Long Stay (LS) and Short Stay (SS)
  • Pressure Ulcer QMs include unstageable
  • Recalculated Cut points

– Two weight categories: Deciles and Quintiles

  • Two New LS Claims-based Measures (5 Total Claims Based Measures)
  • Replacement of 2 (SS) QMs with 2 similar measures from SNF

Quality Reporting Program

– Pressure Ulcers and Successful discharge to community

Quality Measures (QMs) Changes April 2019

slide-10
SLIDE 10

5/22/2019 10

19

  • MDS Measures

– Reported if they can be calculated for at 20 > resident assessments summed across 4 quarters (denominator)

  • LS and SS Claims-based Measure
  • Reported if the measure can be calculated for 20 NH stays over the course
  • f a year (denominator)
  • Facilities with missing data or not meeting the above

criteria

  • See Technical Users Guide to identify imputation strategy
  • Imputation strategy is based on pattern of missing data- page 14

Quality Measure Imputation

20

Risk Adjusted QMs

MDS Based Long Stay:

– Mobility decline – Catheter – Pain

Short Stay

– Functional improvement – Pressure Ulcers

Claims Based All Claims Based Measures

– Number of Hospitalization per 1000 LS resident days – Number of ED visits per 1000 LS resident days – % of SS residents hospitalized after admission – % of SS residents who had an ED visit – Rate of successful return to home/community from SNF

slide-11
SLIDE 11

5/22/2019 11

21

Quality Measures and Points

Note: the short-stay QM rating thresholds are based on the adjusted scores (after applying the factor of 1250/900 to the unadjusted scores)

22

Example QM Ranges for Point Values for QMs

Technical Users Guide

slide-12
SLIDE 12

5/22/2019 12

23

Quality Measure Domain Star Calculation

  • Points are assigned based on

QM performance value

  • 4 quarter average is used for

most MDS based QMs

  • Claims-based measures- use

4 quarters of data-anticipate quarterly update

– Watch for future updates!

  • 5 Star Goal > 1606 points

https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/CertificationandComplianc/downloads/usersguide.pdf

24

QM Scoring Thresholds

Please Note: Table 6 thresholds are accurate as of 5/8/2019. CMS updates the Technical User’s Guide often and we recommend you always check the website:

https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/CertificationandComplianc/downloads/usersguide.pdf

slide-13
SLIDE 13

5/22/2019 13

25

Example Preview Report Score with Thresholds

Preview Report

26

  • PBJ data that is submitted quarterly

– Specific Job Codes for RN,LPN,CNA

  • MDS Census Data
  • Both the PBJ and MDS Census summed across a quarterly

reporting period Critical Steps

  • Follow Technical Users Guide Instructions- page 9

– Extracting Census data – Identifying Discharged Residents

Staffing Domain Where Does Data Come From Now?

slide-14
SLIDE 14

5/22/2019 14

27

Expected Staffing Weights

Case-Mix Adjusted based on Resource Utilization Groups (RUG)-IV

  • Case Mix Hours: CMS Strive Study measured the

average number of RN,LPN and CNA minutes associated with each RUG Group

28

Using the Provider Rating Preview Report

https://data.medicare.gov/data/nursing-home-compare

slide-15
SLIDE 15

5/22/2019 15

29

Staffing Cut Point and Weighting Technical User’s Guide (TUG)

30

Calculate Staffing Stars

Provider Rating Preview Report

  • Nursing= 1.159
  • Total Nursing

Staff = 4.283

slide-16
SLIDE 16

5/22/2019 16

31

  • 4> Days in the quarter without RN staffing hours on

days when there are residents in the building

  • Failing to meet deadlines for staffing data submission
  • Failing to respond to CMS PBJ Audits or audits that

identify significant discrepancies between hours reports and verified

Caution: Staffing Scoring Exceptions Resulting in ONE Star Staffing

32

What Can Change Your Overall Five Star Rating

  • A New Health Inspection
  • A New Complaint resulting in > deficiency citation
  • 2nd, 3rd or 4th revisit
  • Resolution of Informal Dispute Resolutions, changing

scope and or severity of deficiencies

  • “Aging” of complaint deficiency
slide-17
SLIDE 17

5/22/2019 17

33

Telligen Tool

https://www.telligenqinqio.com/resource/our-work/nursing-home-care/nursing- home-care-resources/how-to-access-the-nursing-home-compare-five-star- rating-preview-report/ 34

Telligen Tool

Calculates 5 Star QM Score

  • Interactive
  • Teams see how each QM

score impacts overall score

  • Use to prioritize

improvement

slide-18
SLIDE 18

5/22/2019 18

35

Telligen Nursing Home Compare Five Star Rating Calculation Tool

36

Resources to Learn How QMs are Triggered

  • MDS 3.0 Quality

Measure Manual

  • Skilled Nursing Facility

Quality Reporting…. User’s Manual (Claims)

  • RAI Manual
slide-19
SLIDE 19

5/22/2019 19

37

Questions ?

38

  • Nursing Home Compare: www.medicare.gov
  • Design for Nursing Home Compare Five-Star Quality Rating

Technical User’s Guide:

  • https://www.cms.gov/Medicare/Provider-Enrollment-and-

Certification/CertificationandComplianc/downloads/usersguide.pdf

  • CMS User Manuals: https://www.cms.gov/medicare/quality-

initiatives-patient-assessment- instruments/nursinghomequalityinits/nhqiqualitymeasures.html

  • MDS 3.0 RAI Manual v1. 16:

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/NursingHomeQualityInits/MDS30RAIManual.html

Resources

slide-20
SLIDE 20

5/22/2019 20

39

Resources QIES/CASPER

  • CMS QIES Systems for Providers:

https://web.qiesnet.org/qiesmds/mds_home.html

  • MDS 3.0 Quality Measures User’s Manual

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/NursingHomeQualityInits/Downloads/MDS-30-QM-USERS-MANUAL- v120.pdf

  • How to Access the NHC Five Star Rating Preview Report:

https://www.telligenqinqio.com/resource/our-work/nursing-home-care/nursing-home- care-resources/how-to-access-the-nursing-home-compare-five-star-rating-preview- report/

  • QIES Technical Support Office: https://qtso.cms.gov/
  • CASPER Reporting User’s Guide for MDS Providers:

https://qtso.cms.gov/providers/nursing-home-mdsswing-bed-providers/reference-manuals

40

Connect with Us!

  • www.TelligenQINQIO.com
  • Learn more about the Telligen

QIN Nursing Home team

  • View nearly 170 helpful nursing

home resources

  • You follow us, we’ll follow you:

– Facebook – Twitter – LinkedIn

slide-21
SLIDE 21

5/22/2019 21

41

Receive the Weekly Digest!

  • Emailed every Monday
  • Latest events, news and resources

from Telligen and our partners

  • Visit www.TelligenQINQIO.com to

sign up!

42

Contact a QIN-QIO Nursing Home Team Member to Learn More

Gina Anderson gina.anderson@area-d.hcqis.org 515-223-2127 Lisa Bridwell Lisa.Bridwell@area-d.hcqis.org 630-928-5831 Deanna Curry deanna.curry@area-d.hcqis.org 720-554-1479 Stacy Gordon stacy.gordon@area-d.hcqis.org 630-928-5812 Nell Griffin nell.griffin@area-d.hcqis.org 630-928-5813 Elizabeth Schulte Mullins elizabeth.schulte@area-d.hcqis.org 720-554-1395 Kristen Ives, NHSN Support kristen.ives@area-d.hcqis.org 720-554-1695