The Future and Direction of Quality in Post Acute Care “Everyone’s talking….” Cheryl Phillips, M.D. SVP Public Policy and Advocacy LeadingAge – CMS – Legislation – Consumers – State Medicaid Offices – NQF – NCQA – Joint Commission Who Drives Quality Measures in PA/LTC? MULTIPLE FORCES ARE DRIVING CHANGE in Long Term Care • New payers, new players, new rules • Payment for quality – AKA Value-based purchasing • Restricted networks • New “partners” – ACOs, bundled payments, “non-traditional” health care providers • Proposed payment changes • Big shifts in consumer expectations High Level Look at Some of These Forces “Better, Smarter, Healthier Care” Value-based Payment for PA/LTC Current Measures • CMS NH/HH Compare QMs • Survey Findings • Managed Care, ACOs and Bundled models – including measures of utilization and service • Length of stay • 24/7 admission availability • Utilization of Interact tool to reduce hospital admissions • WIDE variety of state-level VBP measures • Potential……NQF PA/LTC measure set • Soon to be…….IMPACT measures MEASURES OUT FOR PUBLIC COMMENT NOW… A Step by Step Guide to Building a Quality Assurance and Performance Improvement (QAPI) Program in Your Nursing Home Quality Measurement: Our New Currency CMS 5-Star Quality Rating What Will Change? NH Five-Star Quality Measures • Long-stay residents – – – – – – – – % whose need for help with ADLs has increased % of high risk residents with pressure ulcers % of residents who have/had a catheter placed and left in their bladder %of residents who were physically restrained % of residents with a UTI % of residents who self-report mod to severe pain % of residents experiencing one or more falls with major injury % of residents who received an antipsychotic medication • Short-stay residents – % of residents with pressure ulcers that are new or worsened – % of residents who self-report mod to severe pain – % of residents who newly received an antipsychotic med Longer-Term Potential Further Improvements to NH Compare (per CMS) • Dynamic consumer testing • Interactiveness: Make the website more interactive to refine search • Staffing Data: Collect staffing data based on payroll sources, submitted quarterly • Quality Measures: Add new quality measures (hospitalization measure…others?) Longer-Term Potential Further Improvements to NH Compare • NH Characteristics + Capabilities: Add additional information about nursing homes – Private rooms – Languages spoken – Availability of specialty units (rehab, ventilator support…) • Satisfaction Surveys: Study potential reporting of satisfaction survey results – residents, families, staff HR 4303: Protecting Access to Medicare Act of 2014 (PAMA) • All-cause, all-condition hospital readmission SNF measure by 10/1/15 • Risk-adjusted potentially preventable hospital readmissions for SNF by 10/1/16 • Quarterly feedback to SNFs • Public reporting on NH Compare • Establish a SNF VBP program with incentive/penalty payments to SNF IMPACT Act • Improving Medicare Post-Acute Care Transformation – “IMPACT” • Legislation introduced in June, H.R. 4994/S. 2553 • Bipartisan, bicameral interest and support • Passed House and Senate week of Sept. 15… now Law • In addition to new reporting requirements – sets the path for new models of post-acute payment Stated Goals of IMPACT • Compare quality across post-acute settings (hospitals originally included, but were exempted in final bill) • Improve hospital and PAC discharge planning • Use information to reform PAC payments (???site neutral) • Public reporting A Side Word on Site-Neutral (the point where true site-neutral occurs) Home Health Skilled Nursing Home Inpatient Rehab IMPACT Required Standardization • PAC providers must report: – Standardized resident assessment data – Data on quality measures – Data on resource use and other measures • PAC assessment instruments must be modified to: – Enable the submission of standardized data – Compare data across all applicable providers – ??? How this will align with current assessment requirements IMPACT Quality Measures • • • • • • • • • Functional status and changes Cognitive function and changes Skin Integrity Special services, treatments, etc (resource use) Medical conditions and co-morbidities Other impairments Medication reconciliation* Major falls* Patient preferences* * CMS is currently behind in development of standardized reporting measure IMPACT Resource Use Measure • May include standardized assessment data in addition to claims data • Total est. Medicare spending per beneficiary (will involve contractor to collect and report) • Discharge to community • All-condition, risk-adjusted potentially preventable hospital readmission rates Resources for PAMA and IMPACT • Protecting Access to Medicare Act of 2014 (PAMA) signed 4/1/14: – https://www.govtrack.us/congress/bills/113/hr4302/text/ enr#link+11_215&nearest=H80C0CE9753E241C2B84F9141 D931FA6F • Improving Medicare Post-acute Care Transitions (IMPACT) Act of 2014, signed 10/6/14 – https://www.govtrack.us/congress/bills/113/hr4994 Aligning what CMS and Payors Will be Looking For • • • • • • • Resource utilization (cost of care) Adverse Events (falls, pressure wounds, etc) Readmissions Length of Stay Return to home/community Timeliness of service Patient experience of care What do we do?? https://interact2.net/ Working Together to Improve Care, Communication, and Continuity for our Residents http://go.cms.gov/Nhqapi. 3,805 3,673 53 Consumers Nursing Home Staff Members State-based LANEs Assisted Living, Residential Care and Home Care/Personal Care Services • Regional quality problems in Residential Care/AL • No federal quality regulatory system now or likely in the future • MULTIPLE states are looking at a variety of quality measures and oversight strategies • Quality strategies for nursing homes and home health can be applied to assisted living What does it mean to create a culture of safety? How can I use these quality tools and measures to make that happen? Shift in thinking… • Goal is to create an environment of efficient, high quality, person-centered care across PA/LTC • Need to move to a “culture of safety” • Need to understand “systems” within PA/LTC and how to transform care BEFORE we penalize • Need to make the investment in workforce (training and resources) Questions, Discussion and Case Studies…..