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ODM Quality Point system

FY 2016

Presented by

Maureen Wern, CNAC,CEAL President

Wernltcc.com

2016 QM’s

• PELI

• Staff retention

• Antipsychotic medication, uses both short and long stay measures

• Pressure ulcers, uses both short and long stay measures

• Potentially preventable Admissions

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QM Points: Financial Impact

• Using these thresholds and applying them to 2014 data, ODM

estimated that each quality point will be worth $0.82.

• Estimated points if these thresholds were applied to the 931 total

SNFs in Ohio for 2014

• 216 facilities would have earned one point

• 408 facilities would have earned 2 points

• 240 facilities would have earned 3 points

• 62 facilities would have earned 4 points

• 5 facilities would have earned 5 points

PELI

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Preferences for Everyday Living Inventory

• PELI – ODM states they expect all SNFs to check the box on the cost report for PELI

use “some way or another,” to quote one of the ODM staff people.

PELI

• The measure is captured by checking a box on the cost report indicating the SNF

utilizes PELI for all residents

• The form, in some variety, must be completed for residents by 12-31-2015

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PELI

• There are no guidelines for completion of the PELI tool

• There is no mandated format

• There is no frequency requirement

• Currently, there is no requirement for the PELI tool to be audited during the ODH survey

process or otherwise

PELI

• A Conservative approach: complete either the short or long stay tool for each resident

by 12-31-15

• Some more liberal approaches:

• Complete an initial PELI in compliance with the Quick start process

• Develop a P/P which identifies the PELI questions the facility will use and how often they will be

completed (ie: admission, or annually)

• Pair PELI and MDS section F items

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PELI

• Quick Start Process

• Select a team

• Select interview questions (10-15)

• Select and train interviewers

• Use assessments to complete the care plan preferences

• MDS 3.0 section F has 17 questions that mirror PELI questions

Staff Retention

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Staff Retention

•The 75th percentile will be based on the

last six months of 2015.

•For the 2015 cost report they are

changing the way the data are collected on

the cost report from FTEs to actual people

on staff.

• They have not yet shared the cost report

schedule changes

CMS QM’s

Pressure Ulcers short and long stay

Antipsychotic use short and long stay

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Definition of a Short Stay measure

• An episode with CDIF* less then or equal to 100 days at the end of the target period

• Let’s review the parameters of the short stay record selection process.

• * Cumulative Days in Facility

Definition of A Long Stay Measure

• An episode with CDIF greater then or equal to 101 days at the end of the target

period

• Let’s review the parameters of the long stay record selection process.

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Target date

• For an entry record A0310 = 1, the target date is equal to the entry date A1600

• For a discharge record A0310 F= 10, 11 or death in facility A0310F=12, the target

date is equal to the discharge date in A2000.

• For all other records, the target date is equal to the ARD in A2300.

• The assessment used to identify the measure for each resident is determined by

selecting the assessment whose target date is closest to the end of the calendar

quarter.

Look Back Scans

• The purpose of the look-back scan is to determine if events or conditions occurred

during a one year period from the ARD of the current target assessment

• For SS events within the episode are included

• For LS events within the time interval are included

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Risk Adjustment

• There are risk adjustments for some measures:

• EXCLUSIONS: ADL scores can be an exclusions if, for example, a resident who is

assessed as score of 4,7,or 8 in the four late loss ADL’s cannot show decline

• COVARIATES: certain clinical or functional conditions within the nursing home that

impacts the triggering of a quality measure(s). Covariates do not eliminate or

exclude the measure, they adjust the points applied to the measure.

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Quick Review Antipsychotics QM

• Long Stay Antipsychotic Use: Identical to QM currently

on Nursing Home Compare: % of residents with at least 101

days in the SNF who receive an antipsychotic (excluding those

with Schizophrenia, Tourette's or Huntington's)

• Short Stay Antipsychotic Use: Identical to QM currently

on Nursing Home Compare: % of residents not on an

antipsychotic at admission that have added one within the first

100 days in the SNF (excluding those with Schizophrenia,

Tourette's or Huntington's)

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Thresholds for CMS QM’s

• Pressure ulcers – 25th percentile on both long and short stay, based on the third and

fourth quarters of 2015.

• Antipsychotics – 25th percentile on both long and short stay, based on the third and

fourth quarters of 2015.

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Potentially Preventable Admissions

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Potentially Preventable Admissions

•Potentially preventable admissions –

actual/expected ratio of 1.0 or lower.

•This measure is supposed to be based on

data from the last half of 2015, process is still

unclear.

• Fifty-eight percent of SNFs met the standard

using 2014 data.

PPA Actual to expected Rate

• Actual/Expected Rate

• A ratio below 1.0 means the NF did better then expected

• A ratio equal to 1.0 means the NF did as expected

• A ratio above 1.0 means the NF did worse then expected

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Ratio PPA Example

What is included

• Both Medicaid primary and Dual eligible Medicare / Medicaid inpatient stays are

considered in the study

• Only Medicaid NF days are included in the calculation

• Only inpatient stays within 2 days of the NF days are tied back to the NF

• Individuals with 3M Risk Hierarchical status 8 or 9 are removed

• Residents with inpatient stays who have resided in the NF less then 14 days (Paid by

ODM) do not have their inpatient stays included

• Only DRG’s within the 5 related groupings are being considered in the PPA test

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DRG’s considered for PPA

RISK Status 8 or 9 Resident Stay Exclusions

•CRG Status 8 is Dominant, Metastatic

and complicated Malignancies

•CRG Status 9 is Catastrophic

Conditions

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ODM

Quality

Measure

5 Star

Dept of

Health

Survey

Quality Measures

X X Self-Reported (SR) Moderate/Severe Pain (S)

X X Self-Reported (SR) Moderate/Severe Pain (L)

X X X High-Risk Residents with Pressure Ulcers (L)

X X X New/Worsened Pressure Ulcers (S)

X X Physical Restraints (L)

X Falls (L)

X X Falls with Major Injury (L)

XPsychoactive Medication Use in Absence of Psychotic or

Related Condition (L)

X Antianxiety/Hypnotic Medication Use (L)

X Behavior Symptoms Affecting Others (L)

X Depressive Symptoms (L)

X X Urinary Tract Infection (L)

X X Catheter Inserted and Left in Bladder (L)

X Low-Risk Residents Who Lose Bowel/Bladder Control (L)

X Excessive Weight Loss (L)

X X Need for Help with ADLs Has Increased (L)

X X XResidents Who Receive an Antipsychotic Medication (S) and

(L)

QUESTIONS?

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bibliograpy

• QM Manual October 2015 Version 9.0

• AHCA Five Star Updates

• OHCA PELI White Paper

• Various OHCA communications

Housekeeping Announcements

• Problems during the call?

Press *0 to be connected to the Operator.

• Handouts

The handouts were attached to the

confirmation email.

If you were unable to access the handouts to

print, please contact the Association at

614/436-4154 after the call and we can

provide those for you.

• Evaluation

Each person listening to the call must complete the evaluation form.

FAX or mail to the Association (FAX: 614-436-0939).

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Quiz

• Due to new BELTSS regulations, each attendee

must complete a quiz following the webinar to

obtain CEUs.

• The quiz was attached to the email sent with the

call in instructions.

• Fax your completed quiz to 614-436-0939

immediately following the webinar.

• You must achieve a 80% to receive continuing

education credits for the webinar.

Continuing Education Credit

• FAX the quiz to OHCA immediately

following the webinar. 614-436-0939

• After your quiz is graded, you will receive

an email indicating that your certificates

are available.

• The email will include instructions for

downloading your certificates.

• Please note: this course is considered

a self study course by Ohio BELTSS.

Administrators are reminded that

BELTSS limits teleconference

(home/self study) credits to a total of five (5.0) per renewal period.

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Recording

This live program (as well as all previous webinars) are also available via CD

recording. Please note that there are no CEUs available for listening to the

recording. Please contact the Association if you would like to purchase a

recorded copy of a previous webinar.

Also for those listening to the recording, please note the there may have been

changes since the live broadcast of this program. Please contact OHCA or the

speaker for clarification.

Today’s Format

• 90 minutes available for presentation & questions

• Questions?

During the presentation:

you can type your questions

– There will also be time for live questions & answers

at the end of the presentation and the operator will

explain that procedure

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Today’s Speaker

• Kenneth Daily, LNHA, President, Elder Care Systems Group has more than 25 years

proven experience and working directly with long term health care providers

nationwide. Kenn provides organizational guidance, technical assistance, and

quality improvement and compliance management. Kenn is a member of the Ohio

Health Care Association Board of Directors and Chair of the Association’s Life Safety

- Disaster Management Committee. Kenn is also a member of AHCA’s Life Safety

Committee, National Fire Protection Association’s Health Care Section and formally

served nearly 6 years on AHCA’s Disaster Preparation Committee. Kenn is a

recognized author and recently completed editing the NFPA’s “2000-2012 Life Safety

Code Guidance” as well as authoring, Life Safety Essentials for Skilled Nursing

Facilities in 2013.