Introducing the Discharge to Community Quality Measure · 10/20/2015 · Objectives Define the...
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Introducing the Discharge to Community Quality Measure Rachel Delavan, Director of Research Dawn Murr-Davidson, RN BSN, Director of Quality Initiatives October 20, 2015 1
Transcript of Introducing the Discharge to Community Quality Measure · 10/20/2015 · Objectives Define the...
Introducing the Discharge
to Community Quality
Measure
Rachel Delavan, Director of Research
Dawn Murr-Davidson, RN BSN, Director of
Quality Initiatives
October 20, 2015 1
Objectives
Define the discharge to community quality measure an the importance of incorporating the measure into performance scorecards and dashboards
Indicate how the discharge to community measure will tie into the implementation of managed long-term care support and services.
Discuss the relationship between the discharge to community quality measure and other performance metrics such as length of stay.
Explain the value of including the discharge to community measure in conversations with referral sources and payers
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Discharge to Community
• The discharge to community quality measure focuses on
the transition of residents back into the community
• Currently this quality measure is not a Nursing Home
Compare Measure, but this measure is included as part of
the Impact Act.
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The IMPACT Act Charge
• IMPACT Act of 2014 focuses on Improving Medicare Post-Acute Care
Transformation and requires the implementation of specified clinical assessment
domains using standardized data elements within the assessment instruments
currently required for submission by LTCH, IRF, SNF, and HHA providers.
• The IMPACT ACT aligns with the CMS Quality Strategy’s goals which are:
• Making care safer by reducing harm caused in the delivery of care
• Ensuring that each person and family is engaged as partners in their care
• Promoting effective communication and coordination of care
• Promoting the most effective prevention and treatment practices for the
leading causes of mortality, starting with cardiovascular disease
• Work with communities to promote wide use of best practices to enable
healthy living
• Making quality care more affordable for individuals, families, employers and
governments by developing and spreading new healthcare delivery model 4
Quality Measure Domains to
be Standardized
• Skin integrity and changes in skin integrity
• Functional status, cognitive function, and changes in function and cognitive function;
• Medication reconciliation
• Incidence of major falls
• Transfer of health information and care preferences when an individual transitions
• Resource use measures, including total estimated Medicare spending per beneficiary
• All-condition risk-adjusted potentially preventable hospital readmissions rates
• Discharge to community
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The IMPACT Act and Discharge
to Community Timeline
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Alignment with National Initiatives
& Recommendations
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Managed Long-Term Services
and Support in Pennsylvania
Community HealthChoices (CHC) is the name of the MLTSS
program to be rolled out in Pennsylvania in three phases over
three years beginning in January 2017.
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CHC Goals
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Preliminary Procurement and
Implementation Schedule
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Milestone Description Date
Deadline for submission of comments on this document October 16, 2015
Release of RFP for CHC-MCOs November 16, 2015
Pre-proposal conference December 2, 2015
Deadline for submission of proposals January-February 2016
CHC-MCOs notified of selection (all regions) March 2016
Agreement negotiations for Phase 1 CHC-MCOs March-June 2016
Readiness reviews for phase 1 CHC-MCOs March-December 2016
Phase 1 CHC participants receive enrollment notices October 2016
Implementation of Phase 1 (Southwest Region) January 2017
Implementation of Phase 2 (Southeast Region) January 2018
Implementation of Phase 3 (Northwest, Lehigh-Capital and Northeast Regions) January 2019
Using Data to Drive
Results
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Data and Reports in Trend
Tracker
Clinical/Resident Information- CASPER Resident
Characteristics, NH QM Report
AHCA Metrics—Rehospitalization, Discharge to
Community and Length of Stay
Regulatory Compliance–Standard Health Survey,
Complaint, Combined, and Life Safety Code
Financial and Marketplace results– Cost Report, Five
Star, CASPER Staffing Report and Medicare Utilization
Report
Discharge To Community-
AHCA Measure Defined
Notes about the Measure- Numerator and Denominator,
exclusions and risk adjustment
AHCA Measure Exclusions and
Risk Adjustment
Under age 55
Missing MDS items A1800 or A2100 (“entered from” or “Discharge Status”)
Anyone with a stay in a nursing center during the 100 days prior to this
admission
Anyone with no risk adjustment data available from any MDS assessment
within 18 days of this SNF admission
The measure is risk adjusted using 59 variables in six domains:
demographic, functional status, prognosis, clinical conditions, clinical
treatments, and clinical diagnoses. Only data available from the MDS are
used in this model.
Interpreting Risk Adjusted Measure
Actual Rate- divide the total number of Discharges to Community from your center by the total number of Post-Acute Admissions to
your center.
Expected Rate- A model uses all the clinical and demographic characteristics to calculate the average likelihood of each person
being discharged back to the community. A center average is then calculated.
IF Actual = Expected, Center is performing as Expected given resident mix
IF Actual < Expected, Center had fewer discharges than expected, so risk adjusted rate will be lower than the national average
IF Actual > Expected, Center had more discharges than expected, so risk adjusted rate will be higher than the national average
Why Risk Adjust?
Use the risk adjusted rates to compare yourself to other centers in order to gauge your performance against your peers. This
rate adjusts for differences in patient population.
CMS will report a risk adjusted rate and referral sources and your partners in managed care and other payment models will
require it.
PA US
PA US
PA US
PA US
Interpreting Multiple Measures
PA US
PA US
PA US
Interpreting Multiple
Measures Example 1
Example 2
Center 2 PA
Center 2 PA
Center 2 PA
Center 1 PA
Center 1 PA
Center 1 PA
Additional LOS Report Information
Additional LOS Report Information
Long Term Care Trend Tracker
Resources
Login Page: https://ltctt.ahcancal.org/login
Resource Page: http://www.ahcancal.org/research_data/trendtracker/Pages/Resources.aspx
Contact for Help:
Rachel Delavan, PHCA Director of Research, [email protected]
PHCA Quality Initiative
Plan
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Quarterly Data
% Meeting 2014 Targets 30-Day Risk-Adjusted Readmission LS Antipsychotic Medication SS Worsening Pressure Ulcer LS Pain*
Three
Measures
Two
Measure
s
One
Measure 2013-Q3
2014-Q3
(P)
% Meet
2014
Target
%
Improve
10%+ 2013-Q3 2014-Q3
% Meet
2014
Target
%
Improve
10%+ 2013-Q3 2014-Q3
% Meet
2014
Target
%
Improve
10%+ 2013-Q3 2014-Q3
US N/A N/A N/A 17.3 15.6 N/A N/A 21.3 19.5 N/A N/A 1.3 1.0 N/A N/A 8.5 7.6
PA 17 58 90 17.4 15.4 53 54 19.8 18.1 62 48 1.3 1.0 54 54 8.2 7.5
PA Rank N/A N/A N/A N/A N/A N/A N/A 22 N/A N/A 27 N/A N/A 17
PA To 25% N/A N/A N/A 10.9 9.4 N/A N/A 10.8 9.3 N/A N/A 0.0 0.0 N/A N/A 2.2 1.8
PA For Profit 13 56 87 18.4 16.6 44 52 21.0 19.2 55 48 1.10 0.85 60 53 8.1 7.4
PA Not For Profit 22 63 94 16.2 14.0 64 57 17.6 15.9 76 48 1.59 1.17 46 54 8.3 7.6
PA Government 8 42 82 16.5 14.4 54 55 25.5 23.4 30 42 1.58 0.74 58 61 8.8 8.8
PHCA Members 14 58 90 18.4 16.5 43 52 20.6 18.9 57 50 1.05 0.82 64 54 8.1 7.4
PHCA 2015 Target N/A N/A N/A 14.75 14.75 N/A N/A 18.0 18.0 N/A N/A 0.75 0.75 N/A N/A N/A N/A
PHCA 2014 Target N/A N/A N/A 15.8 15.8 N/A N/A 19.0 19.0 N/A N/A 0.75 0.75 N/A N/A N/A N/A
New Quality Measure for 2015
Discharge to Community
2013-Q2 2013-Q3 2013-Q4 2014-Q1
2014-Q2
(P)
% Meet
2015
Target
%
Improve
10%+
US 58.1 59.9 60.3 61.4 62.5 N/A N/A
PA 56.6 58.1 58.8 59.5 60.4 47 30
PA Rank N/A N/A N/A N/A N/A N/A N/A
PA To 25% 68.3 70.4 70.6 71.3 71.9 N/A N/A
PA For Profit 56.0 57.6 58.1 58.6 59.5 41 32
PA Not For Profit 58.5 59.8 60.8 61.8 62.5 58 25
PA Government 43.5 45.0 46.2 48.8 51.1 11 38
PHCA Members 56.1 57.4 58.1 58.4 59.5 42 30
PHCA 2015 Target 62.0 62.0 62.0 62.0 62.0 N/A N/A
PHCA 2014 Target N/A N/A N/A N/A N/A N/A N/A
PHCA Quality Implementation
Strategies
Member Engagement
Strive for a quality contact at each and every member company or
independent center
Data sent to all board members, quality committee members and quality
contacts quarterly
At risk members sent an email sent for focus area(s) with educational
opportunities and tools on a recurring basis
Educational Opportunities and Resources
Webinars (quality topics at least monthly; archived webinars available)
PHCA Reporter articles devoted to quality topics and recognition
Featured Quality Topics at CALM Summit and Convention
AHCA/NCAL Quality Award—Bronze Workshop (Coming December 8, 2015)
Quality Seminar—Coming in May 2016
Recognition
Quarterly recognition of centers meeting all three goals are recognized in
PHCA Reporter and Board Meeting posters
End of 2014 Quality Initiative Plan Recognition
Please contact:
Dawn Murr-Davidson, Director of Quality Initiatives
Rachel Delavan, PHCA Director of Research,
