By Guest Blogger, Christine Kroll, MS, OTR, FAOTA
Keeping your Five Star rating high on the nursing Home Compare website has become a focus for all skilled nursing home providers. Initially, there was the incentive that the consumer would look there first when attempting to find a SNF for a loved one or themselves. Now the incentive has deepened due the increasing prevalence of CMS’ Centers for Medicare and Medicaid Innovation (CMMI) alternative payment (APM) models and other incentive payment programs. APM’s means that SNFs need to be an attractive partner in providing cost effective and quality care across the patient’s post-acute care (PAC) continuum. Part of being an attractive partner is having at least a 3-star rating on the Nursing Home Compare website.
Six new quality measures will be added to the nursing home compare web-site. They will not impact the five star rating immediately; however, they will be posted and presence is everything. What are these new QMs to be reported and how can your therapy department help?
1. Percentage of short-stay residents who were successfully discharged to the community (claims-based). Most facilities have a program called “Rehab to Home”, your therapy department can engage with the patient on expectations for discharge and the safest way to discharge successfully. Care transitions are becoming very important, as a result a home visit needs to be completed to determine proper access to the home and bathrooms, etc…. Home visits are not all that is needed to create a successful discharge to the community. Therapy may address cognitive support issues, supervision for specific task, and identify abilities for medication self-management.
2. Percentage of short-stay residents who have had an outpatient ER visit (claims-based). Therapy may not have a create deal to do with the nursing staff identifying a potential need for the patient to go to the ER; however, therapy is involved with chronic care management and does notice when they patient is not doing well. Good therapy and nursing communication regarding patient status during therapy and overnight issue may help to identify medical issues before they become a crisis.
3. Percentage of short-stay residents who were re-hospitalized after a nursing home admission (claims-based). Care transitions are very important! The patient can decide when and where they want to go; however, a good interdisciplinary team that is communicating and working in concert can help both the patient and/or their caregivers to make a good decision regarding discharge plans. Therapy can provide a great deal of information regarding physical and cognitive abilities that will create barriers to a successful discharge to home if not addressed. Therapy, nursing, pharmacy, social workers, and the patient all need to work together. Patient engagement is necessary to create an optimal outcome and therapy spends more one on one time with the patient that any other department in most cases.
4. Percentage of short-stay residents who made improvements in function (MDS-based). This measure is reflecting the new MDS Section GG that will be required on all PPS Admission and Discharge assessments starting in October. Therapy is very involved with these items as they relate directly to the initial and last three-day period that they patient in in the SNF. Most of these items are on the therapy evaluations. Your therapy department should be providing you with data and a goal for at least one functional item per patient. Caution: the MDS is IDT so just therapy documentation is not all that needs to be considered by the MDS coordinator when scoring this item. CMS is providing training in June 2016 that should provide more information on Section GG.
5. Percentage of long-stay residents whose ability to move independently worsened (MDS-based). Nursing and Therapy communication regarding residents at risk for decreases mobility is critical. Therapy can intervene and provide treatment under the need to progress a condition or through maintenance therapy. Your therapy department may use your MDS quality measures report to screen for those residents that have triggered for this QM; however, it would be better to catch these issues before it is caught on the MDS so the patient did not trigger as all. Consider discussing your non-Med A population during your weekly Medicare meeting for any residents that are displaying increased difficulty moving around independently.
6. Percentage of long-stay residents who received an anti-anxiety or hypnotic medication (MDS-based)—on hold. This measure is on hold; however, occupational therapy can really help with this measure through cognitive programming. Frequently residents that have dementia will have “behaviors”, these behaviors may lead to medications being prescribed to reduce the anxiety or agitation. However, residents with dementia of varying types may be agitated because of the environment or because they are being challenged to perform tasks or communication above their abilities. Therapy can help to identify the functional cognitive abilities and work with the team to develop a plan of care that would be patient-centered and decrease agitation or anxiety.
While we have all talked about the IDT for years, the reality is we have worked in our own silos for years. Now is the time to therapy, nursing, social work, physicians/NPP, and pharmacy to all work together in an interprofessional collaboration to improve patient care.
About the blogger – Christine Kroll, MS, OTR, FAOTA is the Chief Compliance and Clinical Officer for Healthcare Therapy Services (HTS), Greenwood, IN. She has extensive experience in treatment of adult physical dysfunction in a variety of settings. She has specialized in the adult population related to treatment, management and program development for 27 years. She is the consultant for HTS regarding Medicare rules and regulations as well as directing operations. Through her state and national involvements, she has gained valuable expertise and knowledge regarding the issues related to administration, management, and regulatory compliance.