• The National Partnership & Identification of Late Adopters – Since 2011, the Centers for Medicare & Medicaid Services (CMS) has seen a reduction of 38.9 percent in long-stay nursing home residents who were receiving an antipsychotic medication. Despite the success of the National Partnership, CMS identified approximately 1,500 facilities that had not improved their antipsychotic medication utilization rates for long-stay nursing home residents, referred to as late adopters. In December 2017, CMS notified these facilities of this identification.

• Enforcement for A Segment of Non-Improving Late Adopters with Multiple Citations - As of January 2019, there are 235 late adopter nursing homes that have been cited for noncompliance with federal regulations related to unnecessary medications or psychotropic medications two or more times since January 1, 2016, and who have not shown improvement in their long-stay antipsychotic medication rates. If these facilities are determined not to be in substantial compliance with requirements for Chemical Restraints, Dementia Care, or Psychotropic Medications during a survey, they will be subject to enforcement remedies for such noncompliance.

• Corporate Engagement - CMS is also looking for opportunities to engage with corporate chains that have significant numbers of nursing homes identified as late adopters.

The new Skilled Nursing Facility (SNF) Provider Threshold Report (PTR) is now available. This PTR is a user-requested, on demand report which enables users to obtain the status of their data submission completeness related to the compliance threshold required for the SNF Quality Reporting Program (QRP).

Currently, Fiscal Year (FY) 2020 and FY2021 are available for user selection for this report to assist providers in reviewing Calendar Year (CY) 2018 and CY2019 data submission. The SNF PTR will display an asterisk (*) for future dates (monthly and quarterly) when a measure is active, but data are not available yet. 

This report is available in the ‘SNF Quality Reporting Program’ category in the CASPER Reporting application. Please refer to Section 13-SNF Quality Reporting Program in the CASPER Reporting MDS Provider User’s Guide for additional information about this report.

MS is updating the Quality Improvement and Evaluation System

Starting in March, the Quality Improvement and Evaluation System (QIES), Certification and Survey Provider Enhanced Reports (CASPER) and Automated Survey Processing Environment (ASPEN) will undergo a series of modernizing enhancements. Once updated, the system will be called the Internet Quality Improvement and Evaluation System (iQIES). The iQIES system will not change how providers currently submit data to CMS.

The new enhancements in iQIES are based on user research and testing and feature a human-centered design and agile development practices. CMS is phasing in the iQIES system beginning with Long Term Care Hospitals (LTCH). Several updates to the QIES- Assessment Submission and Processing (ASAP) system are also planned. The Cloud-based solutions will also make it easier for users to receive support and use the system.

TEP on Maintenance of Four Nursing Home Quality Measures Publicly Reported on Nursing Home Compare and Used in the Five-Star Quality Rating System: Nominations due March 28, 2019

Nominations are due March 28, 2019 for a Technical Expert Panel (TEP) to comment on the implementation, application, utility, and value of four nursing home quality measures currently reported on Nursing Home Compare and used in the Five-Star Quality Rating System:

• Percent of Residents Who Self-Report Moderate to Severe Pain (Short Stay) (NQF #0676)
• Percent of Residents Who Self-Report Moderate to Severe Pain (Long Stay) (NQF #0677)
• Percent of Residents with a Urinary Tract Infection (Long Stay) (NQF #0685)
• Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder (Long Stay) (NQF #0686

The State Operations Manual (SOM) defines an anticipated discharge as “a discharge that is planned and not due to the resident’s death or an emergency (e.g., hospitalization for an acute condition or emergency evacuation).” For every discharge that meets this definition of anticipated, whether it be to another healthcare facility or to the resident’s home, the discharging facility is required to provide a discharge summary. With its primary purpose being to ensure that care is safely coordinated from one setting to another, the discharge summary must inform the continuing care providers of the course of treatment provided by the discharging facility. This document should be detailed and include an accurate description of the resident’s current status along with current individualized care instructions.

In order to avoid a citation for §483.21(c)(2) F661 (Discharge Summary), the discharging facility must include at least the following in the discharge summary:

In September 2018, Wendy DeCarvalho, RN, DNS-CT, QCP, and her team watched as Hurricane Florence approached their facility, which is located just two hours from the Carolina coast, nestled in a rural area in the flood zone. They banded together to keep their residents, staff, and families safe.

Here’s her advice, based on that firsthand experience, for how to handle emergencies before, during, and after they happen.

As recently as the February 14 Skilled Nursing Facility/Long-term Care Open Door Forum, officials with the Centers for Medicare & Medicaid Services (CMS) indicated that providers could have to wait several months for the release of version 12 (v12) of the MDS 3.0 Quality Measures User’s Manual. However, in a surprise move on February 21, CMS released the updated manual, as well as the Quality Measure Identification Number by CMS Reporting Module Table V1.7, on its Quality Measures (QM) page. 

The most significant revisions focused on these key areas:

• The short-stay and long-stay pressure ulcer QMs;

• The long-stay weight loss QM;

• The short-stay improvements in function QM;

• The long-stay and short-stay influenza vaccination QMs.

Here are the highlights:

Skilled Nursing Facility Quality Reporting Program Data Collection & Final Submission Deadlines for the FY 2021 SNF QRP

This table provides the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2021 Skilled Nursing Facility Quality Reporting Program (SNF QRP). The first column displays the measure name, the second column displays the data collection time frame, and the third column displays the final data submission deadlines.

CMS Improperly Paid Millions of Dollars for Skilled Nursing Facility Services When the Medicare 3-Day Inpatient Hospital Stay Requirement Was Not Met (A-05-16-00043)

According to Federal law, to be eligible for coverage of posthospital extended care services, a Medicare beneficiary must be an inpatient in a hospital for not less than 3 consecutive calendar days (3-day rule) before being discharged from the hospital. CMS improperly paid 65 of the 99 skilled nursing facility (SNF) claims we sampled when the 3-day rule was not met. Improper payments associated with these 65 claims totaled $481,034. On the basis of our sample results, we estimated that CMS improperly paid $84 million for SNF services that did not meet the 3-day rule during 2013 through 2015.

We attribute the improper payments to the absence of a coordinated notification mechanism among the hospitals, beneficiaries, and SNFs to ensure compliance with the 3-day rule. We noted that hospitals did not always provide correct inpatient stay information to SNFs, and SNFs knowingly or unknowingly reported erroneous hospital stay information on their Medicare claims to meet the 3-day rule. We determined that the SNFs used a combination of inpatient and non-inpatient hospital days to determine whether the 3-day rule was met. In addition, because CMS allowed SNF claims to bypass the Common Working File (CWF) qualifying stay edit during our audit period, these SNF claims were not matched with the associated hospital claims that reported inpatient stays of less than 3 days.

On Feb. 1, the QIES Technical Support Office (QTSO) announced changes to the MDS 3.0 Quality Measure Reports in the CASPER Reporting application, including calculation updates/changes to the short-stay pressure ulcer measure, the long-stay pressure ulcer measure, and the long-stay weight loss measure. As a result, providers have been expecting the Centers for Medicare & Medicaid Services (CMS) to quickly release version 12 of the MDS 3.0 Quality Measures (QM) User’s Manual. Although CMS mentioned that there would be a delay of the release of the MDS 3.0 QM User's Manual during the SNF LTC Open Door Forum on Feb. 14, the new version was posted on Feb. 21, 2019 and is now available. 

In other manual news, providers also won’t get the draft version of the next update to the RAI User’s Manual for the MDS 3.0 quite as early as most hoped to help them prepare for the Oct. 1, 2019, implementation of the Patient-Driven Payment Model (PDPM) under the Skilled Nursing Facility Prospective Payment System (SNF PPS).

“We historically publish that manual more toward August,” said officials. “We do understand the need to be able to review [it for] the PDPM, so our goal is to have that published in May sometime this year.”

The employee satisfaction survey can help your nursing home to recruit, motivate and retain staff. After all, nursing home employees are critical to better resident health and quality of life.

This free, anonymous survey offers facility employees an opportunity to share their perceptions about the nursing home workplace. Survey topics include:

• Employee engagement and team building
• Job satisfaction
• Management and leadership
• Scheduling and staffing
• Training