From Data Elements to Quality Measures – Cross-Setting QRP Web-Based Training

The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides a high-level overview of how data elements within CMS patient/resident assessment instruments are used to construct quality measures (QMs) across post-acute care (PAC) settings. The PAC settings included are those covered under the Centers for Medicare & Medicaid Services (CMS) Quality Reporting Programs (QRPs) for Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs) and Skilled Nursing Facilities (SNFs). Information covered will include a short review of the QRPs’ cross-setting quality measures (QM), how data elements feed into these cross-setting QMs, how QMs are calculated and appear on QM reports and how to access and use this data for quality improvement. 

CMS has issued its 2020 measures under consideration (MUC) list. It includes two proposed SNF QRP QMs. The list includes more detailed info about proposed numerators, denominators, and rationales for each measure:

 MUC20- 0002: Skilled Nursing Facility Healthcare Associated Infections Requiring Hospitalization (outcome measure)

This measure will estimate the risk-adjusted rate of healthcare-associated infections (HAIs) that are acquired during skilled nursing facility (SNF) care and result in hospitalizations. The measure is risk adjusted to “level the playing field” and to allow comparison of measure performance based on residents with similar characteristics between SNFs. It is important to recognize that HAIs in SNFs are not considered “never-events.” The goal of this risk-adjusted measure is to identify SNFs that have notably higher rates of HAIs that are acquired during SNF care and result in hospitalization, when compared to their peers

 

More information:

Draft Measure Specifications: Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations For The Skilled Nursing Facility Quality Reporting Program

MUC20- 0044: SARS-CoV-2 Vaccination Coverage among Healthcare Personnel (process measure)

This measure tracks SARS-CoV-2 vaccination coverage among healthcare personnel (HCP) in IPPS hospitals, inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), inpatient psychiatric facilities, ESRD facilities, ambulatory surgical centers, hospital outpatient departments, skilled nursing facilities, and PPS-exempt cancer hospitals.

CMS press release:

New Measures Under Consideration Mark a Milestone for CMS’s Reimagined Quality Strategy to Increase Digital Innovation and Reduce Burden

Measures advance better quality care

The Centers for Medicare & Medicaid Services (CMS) today unveiled its 2020 list of quality and efficiency measures under consideration. Quality measures are tools the agency uses to collect data from providers on the effectiveness, safety, efficiency, and timeliness of care beneficiaries receive. Every year, CMS evaluates all measures in its programs, proposing to remove those that have become less relevant and proposing new measures that may be more meaningful based on review by external health care experts. This year, almost all of the measures proposed would be collected digitally, meaning information comes from claims and other electronic sources, and would not require doctors to retrieve data manually. As a signal for CMS’s broader direction as the agency puts patients over paperwork in the push for quality and innovation, the 2020 list of measures under consideration represents “a first” on several important fronts, particularly where digital innovation and reducing administrative burden are concerned.

Releasing the list is the first step in the “pre-rulemaking process,” when measures under consideration go to the National Quality Forum’s Measure Applications Partnership (MAP). Funded by CMS, the MAP is an independent, voluntary collaborative of organizations representing a broad group of stakeholders interested in or affected by the use of quality and efficiency measures and convened per statute to provide input on their selection. In a broader “CMS first,” a majority of measures under consideration in 2020 also rely on digital reporting of existing information, which can help providers spend more time with patients and less time collecting data. Coupled with a limited number of non-digital measures emphasizing patient-reported health outcomes, another priority for CMS, this digital innovation continues the reimagined quality strategy announced by CMS Administrator Seema Verma in 2017 as part of the Meaningful Measures initiative.

“We launched Meaningful Measures because too many providers were wasting precious time and resources reporting on quality metrics, many of which were barely relevant to their specialty,” said CMS Administrator Verma. “Over the last four years, this initiative has delivered better, less onerous metrics that are actually useful to those who use them. The measures we are announcing today represent more of the same. They prioritize health outcomes, reduce burden, and give providers more time to do the work they entered medicine to do: treat patients.”

Quality measures form the backbone of CMS’s ongoing effort to promote health for millions of Americans. The previously adopted measure for controlling high blood pressure, for example, helps CMS evaluate the quality of care by collecting data on the percentage of beneficiaries 18-85 years old whose high blood pressure has been adequately controlled during the measurement period, meaning their blood pressure readings were less than 140/90 mmHg. Additionally, reporting on these measures holds clinicians accountable for ensuring the best possible outcomes for beneficiaries.

However, many quality measures have required intensive manual data collection and individual chart reviews, robbing doctors and other health professionals of valuable time spent caring for Americans. Over the last several years, CMS has been working to reduce provider burden by shifting toward measures that can be collected digitally using existing data. That strategy has the next iteration of the Meaningful Measures framework – or Meaningful Measures 2.0, the comprehensive initiative launched in 2017 to identify high-priority areas for quality measurement and improvement – at its heart.

Though including a measure on the consideration list does not guarantee its adoption, the list represents a key first step and one built on collaboration between CMS and providers. Annually, the agency invites health care specialty societies and other stakeholder groups to submit candidate measures, due this year by June 30, narrowed down to identify promising candidates that warrant expert review as “measures under consideration.” The 2020 list – which includes a number of new measures, as well as several updates to modernize or replace existing measures – features:

·  Five outcome measures (measures that focus on the results of health care provided through Medicare), such as the rate of health care-associated infections requiring hospitalization for residents of skilled nursing facilities;

·  Five process measures (measures that emphasize efforts to promote standardized best practices), such as conducting kidney health evaluations or implementing interventions for patients with pre-diabetes (the medical term for blood glucose levels that are high but not yet high enough for a type-2 diabetes diagnosis). Importantly, the 2020 list includes three process measures for the coronavirus disease 2019 (COVID-19) vaccine. The measures under consideration list proposes looking at:

·  Vaccination coverage among health care personnel,

·  Vaccination by clinicians, and

·  Vaccination coverage for patients in End-Stage Renal Disease (ESRD) facilities;

·  Five cost/resource use measures (measures that evaluate how frequently health care items or services may be used, as well as how much they might cost) – including, for example, episode-based costs associated with addressing diabetes or asthma/chronic obstructive pulmonary disease;

·  Three composite measures (which summarize overall quality of care across multiple measures through the use of one value or piece of information); and

·  Two patient reported outcomes measures (measures where the information comes directly from the patient).

All but three measures under consideration rely on digital rather than traditional “pen-and-paper” data collection. Of the non-digital measures, two are measures aimed at assessing COVID-19 vaccinations among health care personnel and patients in ESRD facilities, and the other reflects key patient-reported health outcomes, which help prioritize patient voices and empower patients to take an active role in their health.

CMS expects to receive the MAP’s input on the 2020 measures under consideration by February 1, 2021. Experts at CMS and the Department of Health and Human Services will work collaboratively based on this assessment to select final measures available for further public comment through a notice of proposed rulemaking in the Federal Register.

On 12/7/20, the federal government, through the Health Resources and Services Administration (HRSA) operating under the U.S. Department of Health and Human Services (HHS), announced it will distribute $523 million in second round performance payments to over 9,000 nursing homes. These nursing homes are being rewarded for successfully reducing COVID-19 related infections and deaths between September and October.

In August, HHS announced plans to distribute $5 billion in additional Provider Relief Fund (PRF) payments to nursing homes from which $2 billion would be dedicated to establishing an incentive-based program that rewards nursing homes that create and maintain safe environments for their residents. In October, HHS announced the first round of awardees receiving $331 million in payments for keeping new COVID-19 infection and mortality rates among residents lower than the communities they serve – as analyzed against CDC data between August and September. This announcement is the second of five evaluation cycles rewarding nursing homes for their performance reducing nursing home infection and mortality rates. Nursing homes will begin receiving payments December 9.

Nursing Home Infection and Mortality Outcomes

HHS found that between September and October, of the 13,251 eligible nursing homes, 9,248, or 69 percent, met the incentive program's infection control criteria. While less than the first cycle, the collective efforts of these nursing homes resulted in over 3,900 fewer infections relative to the rates seen in the communities where they exist. Against the mortality criteria, 9,128, or 68 percent of eligible nursing homes, achieved outcomes that met or exceeded the expected COVID-19 mortality rate for their facility.

This announcement rewards nursing homes for a period in time. HHS recognizes COVID-19 is a fluid challenge and it continues to take a devastating toll on nursing homes stretched thin and disproportionately impacted due in part to factors such as their congregate setting and the existing vulnerabilities of older residents with comorbidities. This new round of incentive payments will bolster the $15 billion already distributed to nursing homes in both Targeted and General Distribution PRF funding. Recipients may use this funding to acquire additional personal protective equipment or other efforts to help slow the spread of COVID-19.

Continued Support for Nursing Homes

Two COVID-19 vaccine candidates have been submitted to the FDA for Emergency Use Authorization approval. In recognition of this administration's focus on protecting older Americans and as driven by data, the CDC, accepted the recommendation of the Advisory Committee on Immunization Practices (ACIP), that states prioritize nursing home residents for tier one COVID-19 vaccine distribution, once available. Placing nursing home residents and health care personnel at the top of the list for the COVID-19 vaccine will be a game-changer in what has been a difficult fight against the pandemic. Paired with continued funding directly tied to COVID-19 infection and mortality rate reductions, HHS is exhausting all measures to ensure nursing homes nationwide are safe. Residents and their families can be assured help is on the way.

Finally, HHS is reminding all certified nursing homes that free interactive training and mentoring is available through the Agency for Healthcare Research and Quality to advance COVID-19 preparedness, safety, and infection control. To date, only half of all U.S. nursing homes have enrolled but registration remains open. The Centers for Medicare and Medicaid Services also has a free training program for nursing homes. These are vital resources nursing homes should employ to combat this pandemic.

The Department of Health and Human Services (HHS) published two final rules that aim to reduce regulatory barriers to care coordination and accelerate the transformation of the healthcare system into one that pays for value and promotes the delivery of coordinated care.

The October 2020 refresh of SNF QRP data is now available on Nursing Home Compare (NHC), as well as the Nursing homes including rehab services web pages within Care Compare (CCXP) and Provider Data Catalog (PDC).

The data are based on quality assessment data submitted by SNFs to CMS from Quarter 1 2019 through Quarter 4 2019 (01/01/2019 –12/31/2019); and the annual update of the claims-based measures data from Quarter 4 2017 – Quarter 3 2019 (10/01/2017 – 9/30/2019).

Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.

 

The SNF QRP Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum and associated risk adjustment appendix and Hierarchical Condition Category (HCC) crosswalks are now available.

This ZIP file includes:

1. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum provides measure-related changes specified in a change table format in lieu of a complete update to the overall manual. Use this addendum to update the v3.0 manual.
2. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 Risk Adjustment Appendix File contains current and historical intercept values, coefficient values, and the risk-adjustment schedule for each risk-adjusted quality measure reported under the SNF QRP. 

SNF Quality Reporting Program (QRP) quality data on Nursing Home Compare are updated on a quarterly basis. All data displayed on NH Compare (Skilled Nursing Facility and Nursing Home) include demographic information, such as address, telephone number, and ownership. This demographic data is generated from the information stored in the Automated Survey Processing Environment (ASPEN) system.

Below are the steps to guide providers on how to verify and update Skilled Nursing Facility demographic data. 

Step 1: Verify Demographic Data is Accurate

It is important for providers to review their SNF QRP Preview Reports to verify that the demographic data is accurate. SNF QRP Preview Reports reflect the quality measure data and facility/provider demographic information that will be posted to NH Compare in the following quarter. SNF QRP Preview Reports are available in providers’ shared folder in the Centers for Medicare & Medicaid Services (CMS) designated data submission system, Certification and Survey Provider Enhanced Reporting (CASPER) during the 30-day preview windows prior to the quarterly NH Compare refreshes.

Step 2: If Demographic Data is Inaccurate, Contact your Medicare Administrative Contractor

If inaccurate or outdated demographic data is included on the SNF QRP Preview Report or on NH Compare, SNFs need to contact their Medicare Administrative Contractor (MAC) for assistance. When requesting updates to your demographic data, it is important to ask that the MAC send the updated 855A (provider enrollment form) to the CMS Regional Offices in order to update the ASPEN data. Changes to demographic data must be updated and uploaded to the national database via ASPEN in order for the Compare site to be updated.

When requesting updates to demographic data, it is important to ask for updates to the data within the ASPEN system, and not the data on the Compare site.

Please note - updates to demographic information do not happen in real-time and can take up to 6-months to appear on NH Compare. If you encounter difficulty reaching your MAC, or for assistance accessing SNF QRP provider preview reports, please contact the QTSO Help Desk at 1-800-339-9313 or iqies@cms.hhs.gov.

The FY 2021 SNF PPS Proposed Rule was a shadow of what the Centers for Medicare & Medicaid Services (CMS) had planned due to the ongoing coronavirus 2019 (COVID-19) public health emergency. So it's no surprise that the final rule, Medicare Program: Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNFs); Updates to the Value-Based Purchasing Program for Federal Fiscal Year (FY) 2021 (CMS-1737-F), finalizes most, if not quite all, of the proposals without modification. And while COVID-19 caused some changes to the payment rate calculations, CMS cited commenters' requests for additional relief from COVID-19 as beyond the scope of this rulemaking. 

Here are some of the key updates that directors of nursing services (DNSs) should pay attention to:

 

Reminder: 

·         Quality Reporting Programs are expected to report their quality data to meet requirements starting Quarter 3, which begins July 1, 2020. 

The March 27, 2020 Medicare Learning Network Newsletter (MLN) Exceptions and Extensions for Quality Reporting Program (QRP) Requirements that includes Skilled Nursing Facilities, Home Health Agencies, Hospices, Inpatient Rehabilitation Facilities, and Long-Term Care Hospitals (hereafter referred to as post-acute care (PAC) programs) applies only to Quarter 4 of 2019 (October 1-December 31, 2019) and Quarters 1 and 2 of 2020 (January 1-June 30, 2020).  Providers are expected to report data and meet the QRP requirements beginning with Quarter 3, 2020 that starts July 1, 2020.

 As stated in that March 27, 2020 MLN Newsletter, “In some instances, these exceptions and extensions are granted because the data collected may be greatly impacted by the response to COVID-19 and therefore should not be considered in the quality reporting program. CMS is closely monitoring the situation for potential adjustments and will update exception lists, exempted reporting periods, and submission deadlines accordingly as events occur.”

Starting with Quarter 3 that begins July 1, 2020, CMS expects providers to report their quality data.  CMS will analyze the data for each program recognizing that the COVID-19 public health emergency (PHE) remains in effect and could impact the quality data submitted.  CMS will closely monitor the situation for public reporting of the data and provide any updates.

CMS is delaying the release of the updated versions of the Minimum Data Set (MDS) needed to support the Transfer of Health (TOH) Information Quality Measures and new or revised Standardized Patient Assessment Data Elements (SPADEs) in order to provide maximum flexibilities for providers of Skilled Nursing Facilities (SNFs) to respond to the COVID-19 Pubic Health Emergency (PHE).

The release of updated versions of the MDS will be delayed until October 1st of the year that is at least 2 full fiscal years after the end of the COVID-19 PHE. For example, if the COVID-19 PHE ends on September, 20, 2020, SNFs will be required to begin collecting data using the updated versions of the item sets beginning with patients discharged on October 1, 2022.

Following the PHE, CMS will announce training opportunities for providers via this webpage and announcements sent out via email distribution lists and posted on the Medicare Learning Network.

Note that the COVID-19 reporting and SNF QRP reporting changes both will go into effect on May 8 since the effective date is the publication date.

Medicare and Medicaid Programs, Basic Health Program, and Exchanges: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program

ACTION: Interim final rule with comment period.

Requirement for Facilities to Report Nursing Home Residents and Staff Infections, Potential Infections, and Deaths Related to COVID-19

We are revising § 483.80 to establish explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this IFC.

SNF QRP

We are revising the compliance date for the SNF QRP to October 1st of the year that is at least two full fiscal years after the end of the PHE. This change is applicable on the effective date of this IFC.