Transcript Open Door Forum:SNF Quality Reporting Program

Open Door Forum:
SNF Quality Reporting Program
Skilled Nursing Facilities (SNF)/Long
Term Care (LTC) Open Door Forum
FY 2016 SNF PPS NPRM
Tara McMullen, PhD
Division of Chronic and Post Acute Care
May 14, 2015
Introduction: SNF Quality Reporting Program
FY 2016 SNF PPS NPRM (CMS-1622-P)
• The IMPACT Act of 2014 sets forth the requirements for Skilled
Nursing Facilities (SNFs) to submit data to CMS.
• Beginning FY 2018, providers [SNFs] that do not submit required
quality reporting data to CMS will have their annual update reduced
by 2 percentage points.
• SNFs are providers that meet Medicare requirements for Part A
coverage.
• The 60-day public comment period for the FY 2016 SNF PPS NPRM
ends on June 19, 2016.
• Note: Details presented here are proposals and are subject to
change in the Final Rule. CMS welcomes public comments.
2
FY 2016 SNF PPS NPRM (CMS-1622-P)
on Display As of April 20, 2015
Please refer to the FY 2016 Medicare Program;
Prospective Payment System and Consolidated
Billing for Skilled Nursing Facilities (SNFs) for FY
2016, SNF Value-Based Purchasing Program, SNF
Quality Reporting Program, and Staffing Data
Collection; Proposed Rule for complete information
available at:
https://www.federalregister.gov/articles/2015/04/2
0/2015-08944/medicare-program-prospectivepayment-system-and-consolidated-billing-forskilled-nursing-facilities
3
SNF Quality Reporting Program
FY 2016 SNF PPS NPRM (CMS-1622-P)
Policy Proposals
• Three proposed post-acute care (PAC) cross-setting measures
addressing the following domains:
– Skin integrity and changes in skin integrity
– Incidence of major falls
– Functional status, cognitive function, and changes in function and
cognitive function
• Proposed data submission compliance deadlines and
thresholds:
– Failure to submit required quality reporting data to CMS will result
in a 2% reduction to the FY 2018 market basket percentage
• Proposed SNF QRP Submission Exception and Extension
Requirements:
– Written request required within 90 days of the date extraordinary
circumstances occurred
4
FY 2016 SNF QRP NPRM (CMS-1622-P)
Quality Measures
NQF
Measure ID
Measure Title
Data Collection
Timeframe
Data Submission
Deadline
NQF #0674
Application of Percent of Residents
Experiencing One or More Falls with
Major Injury (Long Stay)
10/01/1612/31/16
May 15, 2017
NQF #0678
Percent of Patients or Residents with
Pressure Ulcers that are New or
Worsened
10/01/1612/31/16
May 15, 2017
10/01/1612/31/16
May 15, 2017
NQF #2631* Application of Percent of Long-Term
Care Hospital Patients with an
Admission and Discharge Functional
Assessment and a Care Plan that
Addresses Function
*Status: Under NQF Review
5
Possible Quality Measures for Future Years
• NQF #2510 Skilled Nursing Facility 30-Day AllCause Readmission Measure
• Application of the Payment Standardized
Medicare Spending Per Beneficiary (MSPB)
• Percentage residents/patients at discharge
assessment, who are discharged to a higher level
of care or to the community.
6
Measure Information
• Additional information on the proposed SNF
quality measures is available at the following
website:
http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/NursingHomeQualityInits/SNF-QualityReporting-Program-Measures-and-Technical-Information.html
7
Improving Medicare Post-Acute Care
Transformation (IMPACT) Act of 2014
Requires SNFs, HHAs, IRFs, and LTCHs to report standardized assessment data on:
 Specified Assessment Instrument Domains: functional status; cognitive function
and mental status; special services, treatments, and interventions; medical
conditions and co-morbidities; impairments; and other categories
 Quality Measure Domains: functional status; cognitive function and changes in
function and cognitive function; skin integrity and changes in skin integrity;
medication reconciliation; incidence of major falls; transfer of health information
when the individual transitions from the hospital/critical access hospital to postacute care (PAC) provider or home, or from PAC provider to another settings
Requires the submission of Data On:
 Resource Use, and Other Measures: Total estimated Medicare spending per
beneficiary discharged to the community, all condition risk-adjusted potentially
presentable hospital readmission rates
Pathway Toward Transformation:
The Implementation of Measures Will Evolve Over Time
To meet the October 2016 implementation date for the measure domains
specified under the Act for that time frame the following considerations were
given:
• Addresses a current area for improvement tied to a stated domain
• Consideration of measures previously support by the Measures Application
Partnership (MAP)
• Endorsed, implemented/finalized for use in the post-acute care quality
reporting programs (QRPs), e.g., NQF #0678 Percent of Residents or Patients
with Pressure Ulcers That Are New or Worsened; NQF # 0674 Percent of
Residents Experiencing One or More Falls with Major Injury
• Minimize added burden to the providers
• Where possible, avoid any impact on current assessment items already
collected
• Avoid duplication of existing assessment concepts
Important Dates & Resources
• Please submit public comments by 5pm on June 19,
2015 electronically at http://www.regulations.gov OR
• You may mail comments to the following address ONLY:
Centers for Medicare & Medicaid Services, Department
of Health and Human Services, Attention: PCMS–1622–P,
P.O. Box 8016, Baltimore, MD 21244–8016
• More information on the IMPACT Act is available at:
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014-andCross-Setting-Measures.html
10
Questions?
11