New Mary Dalrymple Managing Director, LTRAX LTRAX... · 2019. 3. 19. · Patients assessed for...

New Outcome Measures

Mary Dalrymple

Managing Director, LTRAX

Objectives

Review and discuss newly added outcome measures

Pressure Ulcers

• New or Worsened Unstageable (all types)

• Percent of Patients with Pressure Ulcers that are New or Worsened (Stages 2, 3 or 4) (NQF #0678)

• Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury

Drug Regimen Review

Spontaneous Breathing Trial

• Invasive Ventilator Weaning Admissions

• Assessed for Readiness for SBT by Day 2

• Deemed Ready for SBT by Day 2

• Ready and Received SBT by Day 2

New or Worsened Pressure Ulcers: Unstageable

Purpose

Visibility into Medicare’s roll-up for public reporting

Measures

How many assessments reported new or worsened pressure ulcer(s) of the itemized type?

• Unstageable: Nonremovable Dressing

• Unstageable: Slough/Eschar

• Unstageable: Deep Tissue Injury

Details

Measure has an assessment basis

• Each new Admission Assessment is counted as a new admission

Weighted for case-mix comparisons

Not a sum of new or worsened pressure ulcers at each stage

New or Worsened Pressure Ulcers:Unstageable

Numerator

Count of assessments where reported New or Worsened Pressure Ulcers at the selected stage is ≥ 1

• Until 7/1/18, “new or worsened” defined by data reported in M0800

• Beginning 7/1/18, “new or worsened” defined as pressure ulcers present on discharge but not present on admission

Calculated in the New or Worsened column on SKIN tab

Denominator

Planned and Unplanned Discharge transmissions

• Expired Assessments excluded

• Assessments missing Section M. Skin Conditions data excluded

NQF #0678 – New or Worsened (Stages 2, 3 or 4)

Purpose

Replicate Medicare’s measure for public reporting of Percent of Patients with Pressure Ulcers that are New or Worsened (Stages 2, 3 or 4) (NQF #0678)

Measures

Observed Score: How many assessments reported at least one new or worsened pressure ulcer of the selected stages at discharge?

Details



In use until LTCH CARE v. 4 on 7/1/18



Numerator

Patients discharged before 7/1/18

Any of M0800 A, B or C on the discharge assessment ≥ 1

• Assessment only counted once even if new or worsened pressure ulcers are reported in more than one stage

Denominator




Important

Only Stages 2, 3 or 4

This measure ends on 7/1/18

• Replaced by Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/ Injury


Percent of Patients with Pressure Ulcers that are New or Worsened (Stages 2, 3 or 4) (NQF #0678)

1.2% - national average

0% to 12% - range among hospitals

New or Worsened by Stage

1. Stage 2 – 0.6% average



Time Period: 7/1/17 – 6/30/18 (last 12-month reporting period)

Changes in Skin Integrity

Purpose

Replicate Medicare’s measure for public reporting of Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury

Measures

Observed Score: How many assessments reported at least one new or worsened pressure ulcer of any type at discharge?

Details



In use beginning with LTCH CARE v. 4 (7/1/18)



Numerator

Patients discharged 7/1/18 and later

≥ 1 pressure ulcer of any type reported on the discharge assessment that was not reported on the admission assessment

• Assessment only counted once even if new or worsened pressure ulcers are reported in more than one stage

Denominator




Important

All stages

Beginning 7/1/18


Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury


• Double the national average when only reporting Stages 2, 3 or 4


New or Worsened by Stage

1. DTI – 0.79% average

2. Unstageable: Slough/Eschar – 0.75% average


Time Period: 7/1/18 – 2/26/19 (all available data)

Pressure Ulcers

Change in Pressure Ulcer Measures

Increased rates under new measure

Increase driven by DTIs & Slough/Eschar

Both measures risk-adjusted

• In LTRAX, gap between your hospital and weighted national or regional average could indicate opportunity for improvement

2018 transitional year

• In LTRAX, new or worsened breakdowns span calendar 2018

• On LTCH Compare, the two pressure ulcer measures will not be publicly reported on the website at the same time

NQF measure will be publicly reported until new quarterly data is no longer available to report

Changes in Skin Integrity will be publicly reported by Oct. 2020

Drug Regimen Review

Purpose

Reflect Medicare’s calculations of publicly reported measure

Measures

Observed Score: How many patients meet all requirements for a complete drug regimen review and appropriate follow-up for potentially significant issues?

Details

7/1/16 and later



Not risk-adjusted

Higher is better

Drug Regimen Review

Numerator

A drug regimen review conducted at admission

• N2001. Drug Regimen Review not skipped

If potentially significant clinical issues were found, a physician or designee was contacted and recommended actions were taken by midnight of the next calendar day

• If N2001 = Yes, then N2003 must = Yes

Throughout the visit, a physician or designee was contacted and recommended actions were taken by midnight the next calendar day every time a potentially significant medication issue was identified; or, no issues occurred during the patient’s visit

• N2005 = Yes or NA

Denominator

Discharge transmissions

Important

Looks back to admission, so no recovery possible at discharge

Drug Regimen Review

Drug Regimen Review Conducted with Follow-Up for Identified Issues


• Higher is better


• Bimodal pattern suggests some hospitals may be misinterpreting and/or facing implementation challenges



Purpose

Reflect Medicare’s calculations of publicly reported measures

Measures

Invasive Ventilator Weaning Admissions: How many patients did we admit as invasive vent weaning patients?

Assessed for Readiness by SBT for Day 2: How many vent weaning patients were assessed for readiness for SBT by day 2?

Deemed Ready for SBT by Day 2: How many vent weaning were deemed medically ready for SBT by day 2?

Ready and Received SBT by Day 2: How may patients ready for SBT received SBT by day 2?

Details

7/1/16 and later



Not risk-adjusted

SBT: Invasive Ventilator Weaning Admissions

Numerator

Patients admitted on invasive ventilator and identified as weaning candidates

• O0150A. Invasive Mechanical Ventilation Support at Admission = Yes, weaning

Denominator

All discharge transmissions

Important

Identical to the measure used to identify pool of admissions used in Ventilator Liberation Rate measure

This measure identifies denominator for first of two Medicare publicly reported SBT measures

SBT: Assessed for Readiness for SBTby Day 2

Numerator

Patients assessed for readiness for SBT by day 2

• O0150B. Assessed for readiness for SBT by day 2 of the LTCH stay = Yes

and

• O0150C Deemed medically ready for SBT by day 2 of the LTCH say = Yes

or

• O0150D. Is there documentation of reason(s) in the patient’s medical record that the patient was deemed medically unready for SBT by day 2 of the LTCH stay? = Yes

Denominator

Invasive Ventilator Weaning Admissions

Important

Patient cannot be counted as assessed if documentation of unreadiness is not in the medical record by day 2

Higher is better

SBT: Deemed Ready for SBT by Day 2

Numerator

Patients deemed ready for SBT by day 2

• O0150C. Deemed medically ready for SBT by day 2 of the LTCH stay = Yes

Denominator

Assessed for Readiness for SBT by Day 2

Important

Denominator for second of two Medicare publicly reported SBT outcome measures

SBT: Ready and Received SBT by Day 2

Numerator

Patients who received SBT by day 2

• O0150E. SBT performed by day 2 of the LTCH stay = Yes

Denominator

Deemed Ready for SBT by Day 2

Important

Higher is better (within clinical appropriateness)


Assessed for Readiness for SBT by Day 2




• Many hospitals in 90’s or at 100%

Ready and Received SBT by Day 2




• Virtually all hospitals > 50%

• More than 80% of hospitals in the 90’s or at 100%


LTCH QRP Measures

Expectations and comparisons

LTRAX outcomes will show you raw and/or weighted national comparisons so you know how you compare to other LTCHs.

LTRAX offers similar regional comparisons (see HELP screen for details about your region).

If in an organization, LTRAX can compare your performance to your organization as a whole.

LTRAX will reflect the raw or unadjusted calculations of publicly reported measures.

• Medicare will risk-adjust based on their published methodology.

• LTRAX weighting gives you an apples-to-apples comparison but does not match Medicare’s risk adjustment.

Resources

LTRAX Outcomes Help Documentation

https://www.ltrax.com/help/OutcomesHelpLTRAX.htm

LTCH QRP Measure Calculations and Reporting User’s Manual v.3

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/Downloads/LTCH-Measure-Calculations-and-Reporting-Users-Manual-V30.pdf

https://www.ltrax.com/help/OutcomesHelpLTRAX.htm

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/Downloads/LTCH-Measure-Calculations-and-Reporting-Users-Manual-V30.pdf

Questions?

[email protected]

New Mary Dalrymple Managing Director, LTRAX LTRAX... · 2019. 3. 19. · Patients assessed for...

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