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Senior Living Health Care Connection: New CMS quality measures

Learn about six new quality measures being posted by CMS.

SENIOR LIVING HEALTH CARE CONNECTION  | 

In April 2016, the federal Centers for Medicare & Medicaid Services (CMS) began posting data for six new quality measures (QMs) on Nursing Home Compare. Beginning in July 2016, five of these QMs will be used in the calculation of the Five-Star Quality Rating. The information used for the new measures will include a year of data retroactive to the beginning of July 2015. Providers should have received a preview of their data for the measures in April 2016.

There are three claims-based measures and three Minimum Data Set (MDS)-based measures as follows:

  • Percentage of short-stay* residents who were rehospitalized after a nursing home admission (claims-based)
  • Percentage of short-stay* residents who have had an outpatient emergency department (ED) visit (claims-based)
  • Percentage of short-stay* residents who were successfully discharged to the community (claims-based)
  • Percentage of short-stay* residents who made improvements in function (MDS-based)
  • Percentage of long-stay** residents whose ability to move independently worsened (MDS-based)
  • Percentage of long-stay** residents who received an antianxiety or hypnotic medication (MDS-based)
                    i.     Antianxiety and hypnotic medication measures will not be used in the Five-Star at this time
                    ii.    Per CMS, because it has been difficult to determine appropriate nursing home benchmarks for the acceptable use of these medications 

* Short stays are stays of less than or equal to 100 days
** Long stays are stays of greater than or equal to 101 days

The new claims-based measures are based on Medicare (fee-for-service) claims data submitted by hospitals and measure the rate of rehospitalization, emergency room use and community discharge among nursing home residents.

Percentage of short-stay residents who were rehospitalized after a nursing home admission (claims-based)

  • Purpose: If a nursing home sends many residents back to the hospital, it may indicate that the nursing home is not properly assessing or taking care of its residents who are admitted to the nursing home from a hospital.
  • This measure includes Medicare fee-for-service enrollees who entered or reentered the nursing home from a hospital and includes those who entered within one day of the hospital stay, not on hospice or not comatose.
  • The measure includes the percentage of short-stay residents who entered or reentered the nursing home from a hospital and were readmitted to a hospital for an unplanned inpatient stay or observation stay within 30 days of the start of the nursing home stay.
  • Planned discharges are not counted.
     

Percentage of short-stay residents who have had an outpatient emergency department visit (claims-based)

  • Purpose: If a nursing home often sends many of its residents to the ED, it may indicate that the nursing home is not properly assessing or taking care of its residents who are admitted to the nursing home from a hospital. Better preventive care and access to physicians and nurse practitioners in an emergency may reduce rates of ED visits.
  • This measure includes all new admissions or readmissions to a nursing home from a hospital where the resident had an outpatient ED visit (an ED visit not resulting in an inpatient hospital admission) within 30 days of entry or reentry.
  • This includes outpatient ED visits occurring after discharge from the nursing home, but within the 30-day time frame. Note that outpatient ED visits are included in the measure, regardless of their diagnosis.
  • The measure includes Medicare fee-for-service enrollees who entered or reentered the nursing home from a hospital, were not enrolled in hospice during their nursing home stay and who were not identified as comatose based on the MDS admission assessment.
     

Percentage of short-stay residents  who were successfully discharged to the community (claims-based)

  • Purpose: Many nursing home residents enter skilled nursing facilities for rehabilitation services. For many short-stay patients, return to the community is the most important outcome associated with nursing home care. If a nursing home discharges few residents back to the community successfully, it may indicate that the nursing home is not properly assessing its residents who are admitted to the nursing home from a hospital or not adequately preparing them for transition back to the community.
  • This measure includes short-stay residents admitted to the nursing home from a hospital who were discharged to the community with 100 calendar days of the start of the episode and who remained in the community for 30 consecutive days following discharge to the community.
  • This measure includes the residents who were discharged to the community within 100 calendar days of entry and:
                    i.      The resident did not die
                    ii.     Did not have a claim for an unplanned inpatient admission
                    iii.    Did not enter or re-enter a nursing home within 30 days of discharge to the community.
  • Outpatient emergency department visits, outpatient observation stays and planned inpatient admission are not counted as failed community discharges.
  • The measure includes Medicare fee-for-service enrollees who entered the nursing home from a hospital, were not a resident of the nursing home in the previous 30 days, were not enrolled in hospice during their nursing home stay and were not identified as comatose based on the MDS admission assessment.
  • Inpatient rehabilitation facility and long-term care hospitalizations are not included.
     

Percentage of short-stay residents who made improvements in function (MDS-based)

  • Purpose: The purpose is to determine, among short-stay nursing home residents who are discharged from the nursing home, the percentage of residents who gain more independence in transfer, locomotion and walking during their episodes of care. The measure assesses the percentage of short-stay nursing home residents of all ages with improved independence in these mobility functions (e.g., transfer: self-performance; locomotion on unit: self-performance; walk in corridor: self-performance) from the earliest initial assessment (admission or five-day assessment) to the discharge assessment (specifically, the discharge assessment when return to the nursing home is not anticipated).
  • Measures the percentage of short-stay residents who made functional improvements during their complete episode of care.
  • Based on activities of daily living (ADLs) of transfers, locomotion on unit and walk in corridor.
  • Measures function from five-day assessment to the discharge return not anticipated assessment.
  • Excludes residents on hospice or who have a life expectancy of less than six months or comatose.
 

Percentage of long-stay residents whose ability to move independently worsened (MDS-based)

  • Purpose: The long-stay locomotion measure evaluates the quality of nursing home care with regard to the loss of independence in locomotion among individuals who have been residents of the nursing home for more than 100 days. Loss of independence in locomotion is itself an undesirable outcome. Additionally, it increases risks of hospitalization, pressure ulcers, musculoskeletal disorders, pneumonia, circulatory problems, constipation and reduced quality of life.
  • Measures the percentage of long-stay nursing residents who experienced a decline in their ability to move around their room and in adjacent corridors over time.
  • Have a qualifying MDS 3.0 assessment during the target period. Qualifying MDS 3.0 assessments include: annual, quarterly, significant change or significant correction, PPS 14-, 30-, 60- or 90-day assessment or discharge assessment with or without return anticipated.
  • Uses MDS ADL “locomotion on unit” self-performance (either of the following):
                    i.     Movement by wheelchair
                    ii.    Movement by walking
  • Decline is measured by an increase of one or more points from prior assessments.
 

Percentage of long-stay residents who received an antianxiety or hypnotic medication (MDS-based) (Not used to determine the Five-Star Quality Rating).

  • Purpose: The measure is intended to prompt nursing homes to reexamine their prescribing patterns in order to encourage practices consistent with clinical recommendations and guidelines (e.g., preventing and stopping long-term use of benzodiazepine).
  • The long-stay antianxiety or hypnotic medication use measure assesses the percentage of long-stay residents in a nursing home who receive antianxiety or hypnotic medications. This quality measure excludes residents who are receiving hospice care or have a life expectancy of less than six months at the time of target assessment.
  • Long-stay measures include all residents who have resided in the nursing home for an episode of at least 101 days at the end of the target period (e.g., a calendar quarter). An episode is a period of time spanning one or more stays, beginning with an admission and ending with either a discharge or the end of the target period, whichever comes first.

For more information, contact Joan McCarthy at 1.312.634.3479 .

Decline is measured by an increase of one or more points from prior assessments.
Decline is measured by an increase of one or more points from prior assessments.

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