As many of you are aware, the already bloated QI/QM component of the 5 Star Rating on Nursing Home Compare will receive 6 more friends effective 4/1/2016. Of the 6 new measures, only 5 will contribute to your star rating at implementation, as the Sedative/Hypnotic measure will not be included until concerns about “specificity and appropriate thresholds” are resolved.
For those of you that missed the “big reveal” on March 3rd, the new quality measures are as follows:
1. Percentage of short-stay residents who were successfully discharged to the community (Claims-based)
2. Percentage of short-stay residents who have had an outpatient emergency department visit (Claims-based)
3. Percentage of short-stay residents who were re-hospitalized after a nursing home admission (Claims-based)
4. Percentage of short-stay residents who made improvements in function (MDS-based)
5. Percentage of long-stay residents whose ability to move independently worsened (MDS-based) 6. Percentage of long-stay residents who received an antianxiety or hypnotic medication (MDS-based)
Many of these measures should come as no surprise to those of us Federal Register and LTC Open Door junkies, who have been closely watching the blossoming of value-based purchasing in the skilled nursing channel for the last 5 years. The shift from quantity to quality should not be shocking to anyone, but I am somewhat surprised at the seemingly lightening-speed, especially for our government, to get these measures out in front of the public. Like 28 days from general announcement to deployment fast.
For those of you in heavy Medicare Advantage markets, I have great news – no, your Medicare Advantage reimbursement will not have parity with FFS Medicare, not now, not ever – the contributory data to these metrics will be mined exclusively from FFS data sets, so your Medicare Advantage beneficiaries will not contribute, or detract, from your measures, at least for now. I would assume the RFPs for next year’s Medicare Advantage plans will include a requirement to provide these data elements in a somewhat timely fashion. This is only good news if you are hitting it out the park with your traditional Medicare beneficiaries, which I assume you are, as your reimbursement actually covers the cost of the little things, like incredible care and a reasonable amount of physical therapy.
Over the next few weeks, I will autopsy all 6 new metrics for your reading delight and highlight ways that we, as your friendly neighborhood drug dealer, are going to keep the “shine on that star”.